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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Frances R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00022-2. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Teresa López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Frances
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC)
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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2
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Frances R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00021-0. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Frances
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Poliècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Presidente de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR)
| | | | | | - C Camacho Leis
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES)
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology - Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology - Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC)
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Poliècnic La Fe, Valencia, Spain
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Viderman D, Bilotta F, Badenes R, Abdildin Y. Anesthetic management of endovascular neurosurgical procedures in acute ischemic stroke patients: A systematic review of meta-analyses. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:580-592. [PMID: 37678462 DOI: 10.1016/j.redare.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/06/2023] [Indexed: 09/09/2023]
Abstract
Restoration of cerebral circulation in the ischemic area is the most critical treatment task for reducing irreversible neuronal injury in ischemic stroke patients. The recanalización of appropriately selected patients became indispensable for improving clinical outcomes and resulted in the widespread revascularization techniques. There is no clear answer as to which anesthetic modality to use in ischemic stroke patients undergoing neuro-endovascular procedures. The purpose of this systematic review is to conduct a qualitative analysis of systematic reviews and meta-analyses (RSs & MAs) comparing general anesthesia and non-general anesthesia methods for cerebral endovascular interventions in acute ischemic stroke patients. We developed a protocol with the inclusion and exclusion criteria for matched publications and conducted a literature search in PubMed and Google Scholar. The literature search yielded 52 potential publications. Ten relevant RSs & MAs were included and analysed in this review. The decision about which anesthesia method to use for endovascular procedures in managing acute ischemic stroke patients should be made based on the patient's personal characteristics, pathophysiological phenotypes, clinical characteristics, and institutional experience.
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Affiliation(s)
- D Viderman
- Department of Surgery (Section of Anesthesiology, Intensive Care, and Pain Medicine), Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan.
| | - F Bilotta
- Departamento de Anestesia y Cuidado Intensivo, Universidad de Roma La Sapienza, Roma, Italy
| | - R Badenes
- Departamento de Anestesiología y Cuidado Intensivo, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Y Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
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Madrid Díaz G, Pinilla A, Arango E, Amaya O, Raffan F, Ferrer L. Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:674-9. [PMID: 36241513 DOI: 10.1016/j.redare.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. METHODS A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4h between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. RESULTS 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients' demographics. During the first 24h post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27-56.2). Emergent surgery and age were also found to be risk factors. CONCLUSION 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.
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5
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Fayos T, Casañ M. Phelan-McDermid and general anesthesia with different hypnotics. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:587-591. [PMID: 36257878 DOI: 10.1016/j.redare.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/23/2021] [Indexed: 06/16/2023]
Abstract
Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disease, caused by an autosomal dominant mutation due to the terminal deletion of 22q13, leading to a defect in the SHANK3 protein. We present the clinical case of a 12-year-old patient with this syndrome, who underwent three interventions that required general anesthesia. In none of them did she present intraoperative or postoperative complications.
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Affiliation(s)
- T Fayos
- Servicio de Anestesia y Reanimación, Hospital General Universitario de Castellón, Castellón, Spain.
| | - M Casañ
- Servicio de Anestesia y Reanimación, Hospital General Universitario de Castellón, Castellón, Spain
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:355-359. [PMID: 35753930 DOI: 10.1016/j.redare.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/04/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, Spain.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, Spain
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7
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Gómez Tarradas JM, Calvo A, Belda I, Topczewski T, Tercero FJ, Valero R. Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:109-113. [PMID: 35168917 DOI: 10.1016/j.redare.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/09/2020] [Indexed: 06/14/2023]
Abstract
Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.
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Affiliation(s)
- J M Gómez Tarradas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - A Calvo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Belda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Topczewski
- Servicio de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, Spain
| | - F J Tercero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Valero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
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8
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Gómez Tarradas JM, Calvo A, Belda I, Topczewski T, Tercero FJ, Valero R. Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(20)30294-2. [PMID: 34565573 DOI: 10.1016/j.redar.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 10/20/2022]
Abstract
Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.
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Affiliation(s)
- J M Gómez Tarradas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Calvo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - I Belda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - T Topczewski
- Servicio de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, España
| | - F J Tercero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - R Valero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
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9
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3,132 cases. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00135-3. [PMID: 34565574 DOI: 10.1016/j.redar.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, España.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, España
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10
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Valente MF, Simões FJ, Mourão J. General anesthesia vs. sedation in transcatheter aortic valve implantation (TAVI): retrospective study of the incidence of acute kidney injury. ACTA ACUST UNITED AC 2021; 68:121-127. [PMID: 33487457 DOI: 10.1016/j.redar.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Anesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anesthetic approach and mortality was also assessed. MATERIALS AND METHODS A retrospective, single-center, observational study was conducted at the Centro Hospitalar Universitário de São João, a Portuguese reference center. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anesthesia (GA) and sedation. RESULTS One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p < 0.001). Regarding postoperative outcomes, there were no significant differences in AKI incidence (20.8 vs. 12.0%, p = 0.319) and mortality. A significant association was found between postoperative AKI and preexisting chronic kidney disease (CKD), preoperative heart failure functional class, intraoperative hypotension, longer length of stay in level II unit, longer hospital stay and worsening of previous CKD stage. CONCLUSIONS It was not possible to established association between the anesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs.
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Affiliation(s)
- M F Valente
- Servicio de Anestesiología, Centro Hospitalar Universitario Sao Joao, Porto, Portugal; MEDCIDS, Departamento de Medicina da Comunidad, Información y Decisión en Salud, Facultad de Medicina de Universidad de Porto, Porto, Portugal.
| | - F J Simões
- Facultad de Medicina de Universidad de Porto, Porto, Portugal
| | - J Mourão
- Servicio de Anestesiología, Centro Hospitalar Universitario Sao Joao, Porto, Portugal; Departamento de Cirugía y Fisiología, Facultad de Medicina de Universidad de Porto, Porto, Portugal
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Caro-Domínguez P, Sánchez-Garduño JJ, Martínez-Moya M, Fajardo-Cascos M, Galván-Banqueri F, Hernández-Herrera C, Pavón-Delgado A. Brain MRI without anesthesia in children less than 3 months old. Radiologia (Engl Ed) 2020; 64:S0033-8338(20)30120-X. [PMID: 33069365 DOI: 10.1016/j.rx.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.
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Affiliation(s)
- P Caro-Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J J Sánchez-Garduño
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Martínez-Moya
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Fajardo-Cascos
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Galván-Banqueri
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - C Hernández-Herrera
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Pavón-Delgado
- Unidad de Neonatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Sastre JA, López T, Gómez-Ríos MA, Garzón JC, Mariscal ML, Martínez-Hurtado E, Freire-Otero M, Redondo JM, Gómez G, Casalderrey-Rivas M. Current practice of rapid sequence induction in adults: A national survey among anesthesiologists in Spain. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:381-390. [PMID: 32564884 DOI: 10.1016/j.redar.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/03/2020] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.
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Affiliation(s)
- J A Sastre
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Grupo Español de Vía Aérea Difícil (GEVAD), España; Difficult Airway Society, UK.
| | - T López
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Grupo Español de Vía Aérea Difícil (GEVAD), España
| | - M A Gómez-Ríos
- Departamento de Anestesia y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Grupo Español de Vía Aérea Difícil (GEVAD), España
| | - J C Garzón
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Grupo Español de Vía Aérea Difícil (GEVAD), España
| | - M L Mariscal
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Getafe, Getafe, Madrid, España; Grupo Español de Vía Aérea Difícil (GEVAD), España
| | - E Martínez-Hurtado
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Grupo Español de Vía Aérea Difícil (GEVAD), España
| | - M Freire-Otero
- Departamento de Anestesia y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - J M Redondo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cáceres, Cáceres, España
| | - G Gómez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Son Espases, Palma, Mallorca, España
| | - M Casalderrey-Rivas
- Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España
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Jáuregui-Huerta F, Redolar-Ripoll D, Cupul-García JC, Trillo-Gómez JP, Ruvalcaba-Delgadillo Y. General anesthesia in infants: neurobiological and neuropsychological concerns. Bol Med Hosp Infant Mex 2020; 77:54-67. [PMID: 32226001 DOI: 10.24875/bmhim.19000165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
General anesthetics are crucial drugs for surgical interventions, which are indicated to induce analgesia, diminish pain, and reduce anxiety in order to facilitate invasive procedures. In pediatric patients, benefits of general anesthetics also include abolishment of motility. Besides their probed benefits on surgery, the recent warning of the Food and Drug Administration (FDA) on the use of general anesthetics in children yielded a controversy on their potential neurotoxic effects. In this review, the main facts of the cerebral development are studied, and the available evidence concerning the use of general anesthesia on the neuropsychological development of children is analyzed. Most of the studies found were uncontrolled retrospective cohorts for which conclusions are difficult to obtain. However, a few group of controlled studies, including the Mayo Anesthesia Safety in Kids study (MASK), have partially supported the FDA warning. Cumulated evidence appears to support the safety use of general anesthetics, but no conclusive data supporting that it may induce massive effects on the cognitive development of exposed children has been reported. Important evidence suggests that specific cognitive functions may result altered under long-term expositions. Such data must be considered for those involved in anesthetic procedures.
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Affiliation(s)
- Fernando Jáuregui-Huerta
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Diego Redolar-Ripoll
- Cognitive Neuro-lab, Facultad de Ciencias de la Salud, Universitat Oberta de Catalunya, Barcelona, España
| | - Juan C Cupul-García
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Juan P Trillo-Gómez
- Programa de Maestría en Neuropsicología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Yaveth Ruvalcaba-Delgadillo
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
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14
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Gómez Tarradas JM, Pujol Fontrodona G, López-Baamonde M, Sánchez D, Jiménez MJ, Navarro-Ripoll R. Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy. ACTA ACUST UNITED AC 2020; 67:15-9. [PMID: 31353039 DOI: 10.1016/j.redar.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging. PATIENTS AND METHODS A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed. RESULTS Between May 2015 and October 2018 7patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5of the 7patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6of the 7patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed. CONCLUSIONS HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.
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15
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Ferreira AL, Nunes C, Mendes JG, Amorim P. Do we have today a reliable method to detect the moment of loss of consciousness during induction of general anaesthesia? Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:93-103. [PMID: 30077394 DOI: 10.1016/j.redar.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
This review aims to give an overview of the current state of monitoring depth of anaesthesia and detecting the moment of loss of consciousness, from the first clinical signs involved in anaesthesia to the latest technologies used in this area. Such techniques are extremely important for the development of automatic systems for anaesthesia control, including preventing intraoperative awareness episodes and overdoses. A search in the databases Pubmed and IEEE Xplore was performed using terms such anaesthetic monitoring, depth of anaesthesia, loss of consciousness, as well as anaesthesia indexes, namely BIS. Despite the several methods capable of monitoring the hypnotic state of anaesthesia, there is still no methodology to accurate detect the moment of loss of consciousness during induction of general anaesthesia.
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Affiliation(s)
- A L Ferreira
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal; Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal.
| | - C Nunes
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal; Departamento de Ciências e Tecnologia, Universidade Aberta, Oporto, Portugal
| | - J G Mendes
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal
| | - P Amorim
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal
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Bermúdez-Triano M, Guerrero-Domínguez R, Martínez-Saniger A, Jiménez I. General anesthesia considerations in CADASIL disease. ACTA ACUST UNITED AC 2019; 66:226-229. [PMID: 30665799 DOI: 10.1016/j.redar.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy) disease is an inherited systemic arterial disease that affects the small and medium calibre cerebral vessels. Around 500 families are affected in the world, most of them in Europe. It is characterised by migraine attacks, subcortical dementia, neuropsychiatric disorders, and recurrent ischaemic strokes. The objective of this article is to describe, for the first time in the literature, the management by general anaesthesia of an intracranial neurosurgical procedure in a patient with CADASIL disease. Continuous monitoring of blood pressure is considered essential, as well as the maintenance of normocapnia and normothermia to avoid the development of new cerebrovascular accidents. This disease is relevant due to its anaesthetic implications and the few publications to date.
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Affiliation(s)
- M Bermúdez-Triano
- Servicio de Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Guerrero-Domínguez
- Servicio de Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - A Martínez-Saniger
- Servicio de Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Jiménez
- Servicio de Anestesiología y Reanimación, Hospital de Rehabilitación y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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17
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Lavado JS, Gonçalves D, Gonçalves L, Sendino C, Valente E. General or regional? Exploring patients' anaesthetic preferences and perception of regional anaesthesia. ACTA ACUST UNITED AC 2019; 66:199-205. [PMID: 30635114 DOI: 10.1016/j.redar.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/21/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Regional anaesthesia (RA) has gained popularity due to its numerous benefits and increasing safety. Yet, often patients refuse this procedure and prefer general anaesthesia (GA). This study aimed to investigate variables (demographic factors, safety perception of GA and RA, patients' fears, anxiety, and knowledge) related to patients' anaesthetic preference. MATERIAL AND METHODS Participants were patients aged 18 years or more proposed to an anaesthesia appointment for preoperative assessment. Patients completed a written questionnaire before meeting the anaesthesiologist. The questionnaire asked about their preferences, fears and perceptions about RA. RESULTS One hundred and 2patients agreed to participate. Mean age was 52.6±13.5 years, 57.8% were female and 44.5% had at least 12 years of education. Given the choice, 54.0% would prefer GA and 20.7% said they would refuse RA if proposed by the anaesthesiologist. Among patients who already experienced neuroaxial anaesthesia, 40.0% said they did not wish to repeat it. Patients who preferred GA over RA perceived GA to be safer than RA and expressed more anxiety towards being awake during surgery and more fear of feeling pain during surgery, of having back pain, and of needle puncture. Results also suggested that patients are unaware of RA's real risks and benefits. CONCLUSIONS Knowing patients' fears is essential for the anaesthesiologist address their patients' needs. Anaesthesiologists should work on improving general population perspective and knowledge about RA.
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Affiliation(s)
- J S Lavado
- Departamento de Anestesiología, Centro Hospitalar de Leiria, Leiria, Portugal.
| | - D Gonçalves
- Departamento de Anestesiología, Centro Hospitalar de Leiria, Leiria, Portugal
| | - L Gonçalves
- Departamento de Anestesiología, Centro Hospitalar de Leiria, Leiria, Portugal
| | - C Sendino
- Departamento de Anestesiología, Centro Hospitalar de Leiria, Leiria, Portugal
| | - E Valente
- Departamento de Anestesiología, Centro Hospitalar de Leiria, Leiria, Portugal
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18
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Quintero Salvago AV, Leal Del Ojo Del Ojo JD, Barrios Rodríguez L, Fedriani de Matos JJ, Morgado Muñoz I. Total thyroidectomys in patient with McArdle's syndrome: Anesthetic management. ACTA ACUST UNITED AC 2018; 66:163-166. [PMID: 30509783 DOI: 10.1016/j.redar.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 10/27/2022]
Abstract
McArdle disease or type V glycogenosis is a rare metabolic myopathy consisting of muscle loss and weakness. These patients have risks associated with anaesthesia. They can present with hypoglycaemia, rhabdomyolysis, acute renal failure, and electrolyte changes. It has also been associated with a higher incidence of malignant hyperthermia during the anaesthetic procedure. Intermittent compression due to the measurement of non-invasive pressure, postures on the operating table that may cause muscle contractures, or tremor caused by hypothermia or anaesthesia itself, may trigger rhabdomyolysis in these patients. In this article we present our experience in submitting a patient with McArdle's syndrome to general anaesthesia for total thyroidectomy due to multinodular euthyroid goitre.
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Affiliation(s)
- A V Quintero Salvago
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España.
| | - J D Leal Del Ojo Del Ojo
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España
| | - L Barrios Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España
| | - J J Fedriani de Matos
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España
| | - I Morgado Muñoz
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera (Cádiz), España
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Iglesias González JL, Gómez-Ríos MA, Poveda Marina JL, Calvo-Vecino JM. Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:552-557. [PMID: 30177221 DOI: 10.1016/j.redar.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. METHODS 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. RESULTS The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. CONCLUSIONS Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.
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Affiliation(s)
- J L Iglesias González
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - M A Gómez-Ríos
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Grupo Español de Vía Aérea Difícil (GEVAD); Grupo de Investigación Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | - J L Poveda Marina
- Departamento de Bioestadística, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J M Calvo-Vecino
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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20
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Esparza Isasa E, Palomero Rodríguez MA, Acebedo Bambaren I, Medrano Viñas C, Gil Mayo D, Domínguez Pérez F, Pestaña Lagunas D. Anesthesia in a pediatric patient with ROHADD syndrome. ACTA ACUST UNITED AC 2018; 65:525-529. [PMID: 29728260 DOI: 10.1016/j.redar.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare entity that is characterised by its onset in healthy children at 2-4 years of age. It is a complex syndrome that includes, among other symptoms, rapid weight gain with hyperphagia, hypothalamic dysfunction, central hypoventilation, and autonomic dysregulation. The case is presented of a 10-year-old boy with a diagnosis of ROHHAD syndrome undergoing insertion of a port-a-cath under general anaesthesia, who developed complications during the anaesthetic procedure related to his illness. The peri-operative management of these patients represents a challenge for the anaesthetist, given the involvement of multiple systems and the frequent respiratory comorbidities associated with them. A summary is presented of some of the implications and anaesthetic considerations that must be taken into account in the management of these patients.
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Affiliation(s)
- E Esparza Isasa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M A Palomero Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - I Acebedo Bambaren
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Medrano Viñas
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - D Gil Mayo
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Domínguez Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - D Pestaña Lagunas
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
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García-Fernández J, Romero A, Blanco A, Gonzalez P, Abad-Gurumeta A, Bergese SD. Recruitment manoeuvres in anaesthesia: How many more excuses are there not to use them? ACTA ACUST UNITED AC 2018; 65:209-217. [PMID: 29395110 DOI: 10.1016/j.redar.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 11/29/2022]
Abstract
Pulmonary recruitment manoeuvres (RM) are intended to reopen collapsed lung areas. RMs are present in nature as a physiological mechanism to get a newborn to open their lungs for the first time at birth, and we also use them, in our usual anaesthesiological clinical practice, after induction or during general anaesthesia when a patient is desaturated. However, there is much confusion in clinical practice regarding their safety, the best way to perform them, when to do them, in which patients they are indicated, and in those where they are totally contraindicated. There are important differences between RM in the patient with adult respiratory distress syndrome, and in a healthy patient during general anaesthesia. Our intention is to review, from a clinical and practical point of view, the use of RM, specifically in anaesthesia.
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Affiliation(s)
- J García-Fernández
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma , Madrid, España.
| | - A Romero
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - A Blanco
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - P Gonzalez
- Department of Anesthesia and Perioperative Medicine, Akademiska University Hospital, Uppsala, Suecia
| | - A Abad-Gurumeta
- Servicio de Anestesiología, Cuidados Críticos y Dolor, Hospital Universitario Infanta Leonor, , Madrid, España; La Revista Española de Anestesiología y Reanimación; Departamento de Farmacología, Facultad de Medicina. Universidad Complutense , Madrid, España
| | - S D Bergese
- Neurosurgical Anesthesia, Departments of Anesthesiology and Neurological Surgery, The Ohio State University, Columbus, Ohio, Estados Unidos
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22
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Vieira Marques F, Montenegro Sá F, Lapa T, Simões I. Postoperative myocardial infarction in an orthognatic jaw surgery. ACTA ACUST UNITED AC 2017. [PMID: 28625607 DOI: 10.1016/j.redar.2017.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular complications, in particular perioperative myocardial infarctions, are central contributors to morbidity and mortality after non-cardiac surgery. We present a case of a 41-year-old male, smoker and dyslipidemic, who underwent bimaxillary orthognathic jaw surgery with the development of an acute coronary syndrome in the immediate postoperative period. We managed to early diagnose the myocardial infarction and promptly performed a percutaneous transluminal coronary angioplasty, resulting in a positive outcome.
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Affiliation(s)
- F Vieira Marques
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal.
| | - F Montenegro Sá
- Departamento de Cardiología, Hospital de Santo André, Leiria, Portugal
| | - T Lapa
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal; Facultad de Ciencias de la Salud, Universidad da Beira Interior, Covilhã, Portugal
| | - I Simões
- Departamento de Anestesiología, Centro Hospitalar é Universitário de Coimbra, Coimbra, Portugal
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Ramos-Luengo A, Asensio-Merino F. Hypnosis closed loop TCI systems in outpatient surgery. ACTA ACUST UNITED AC 2017; 64:323-327. [PMID: 28057334 DOI: 10.1016/j.redar.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. PATIENTS AND METHODS Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9. RESULTS There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005. CONCLUSION The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units.
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Affiliation(s)
- A Ramos-Luengo
- Servicio de Anestesia y Reanimación, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - F Asensio-Merino
- Servicio de Anestesia y Reanimación, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
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24
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Pérez Herrero MA, López Álvarez S, Fadrique Fuentes A, Manzano Lorefice F, Bartolomé Bartolomé C, González de Zárate J. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim 2016; 63:564-571. [PMID: 27091641 DOI: 10.1016/j.redar.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The quality of postoperative recovery is one of the most important among all the quality indicators used in clinical situations. This is even more important after cancer surgery. Our aim was to evaluate this after non-reconstructive breast surgery under general anesthesia and paravertebral blockade or serratus-intercostal plane blockade, in the early and late post-operative period. MATERIAL AND METHODS A prospective observational study was conducted on 60 patients (25 paravertebral blockade group and 35 serratus-intercostal plane blockade group) scheduled for non-reconstructive breast surgery during a 6 month period. Every patient received general anaesthesia and were randomised to receive either paravertebral blockade or serratus-intercostal plane blockade. The quality of post-anaesthetic recovery was quantified by Postoperative Quality Recovery Scale, which is used to assess physiological, nociceptive, emotional, autonomy, cognitive and general state domains at different times: baseline (before surgery), 15min after the end of surgery, at discharge to home, and one month after surgery. RESULTS A total recovery of 95.93% was achieved in the early postoperative period (15min PACU), 99.07% at discharge to home, and 99.25% at one month after the intervention. No significant differences were found between groups in total score or in each evaluated area. CONCLUSIONS A progressive improvement was observed in the scores assessed with the Postoperative Quality Recovery Scale, reaching values that would allow the discharge to home and early return to usual active life from the immediate postoperative period, with no significant differences between the 2 analgesic techniques. Savings in opioid use and the excellent recovery were observed in all measured domains observed.
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Affiliation(s)
| | - S López Álvarez
- Complejo Hospitalario Universitario de A Coruña, A Coruña, España
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25
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Errando-Oyonarte CL, Moreno-Sanz C, Vila-Caral P, Ruiz de Adana-Belbel JC, Vázquez-Alonso E, Ramírez-Rodríguez JM, Veiga-Ruiz G, Guasch-Arévalo E, Lora-Tamayo D'Ocón JI. Recommendations on the use of deep neuromuscular blockade by anaesthesiologists and surgeons. AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad) Consensus. ACTA ACUST UNITED AC 2017; 64:95-104. [PMID: 27692692 DOI: 10.1016/j.redar.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures. METHODS Multidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n=65) and general surgeons (n=36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focussing on the level of neuromuscular blockade. RESULTS Five recommendations were agreed: 1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), 2) and in obese patients (76.2%); 3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as as immobility or better surgical access (86.1 to 72.3%); 4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally 5) anaesthesiologists/surgeons joint protocols are recommended. CONCLUSIONS Collaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.
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Alvarez Corredor FA. Comparison of the effectiveness of dexmedetomidine, meperidine and ketamine in the prevention of postoperative shivering. ACTA ACUST UNITED AC 2016; 63:505-12. [PMID: 27062174 DOI: 10.1016/j.redar.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/18/2016] [Accepted: 02/12/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the prophylactic effectiveness of dexmedetomidine, meperidine, and ketamine for postoperative shivering. MATERIALS AND METHODS A randomized, controlled, double-blind, clinical trial, including 160 patients (ASA I - II) undergoing surgical procedures under general anaesthesia for longer than one hour. They were randomly assigned to four groups to receive a single intravenous dose: Dexmedetomidine 1ug/kg (group A, n=33), meperidine 0.4mg/kg (group B, n=38), ketamine 0.5mg/kg (groupC, n=40), or 0.9% saline solution (group D, n=45), administered 20min before the skin suture. To avoid bias, the anaesthetic induction and maintenance technique, as well as postoperative follow-up was standardised. RESULTS For any level of shivering, the greatest incidence was observed in the placebo group (47%) (P<.01). The greatest effect on shivering level 3 and 4 occurred in the placebo group (22% and 18%, respectively). For levels 3 and 4 during follow-up, there was not a single case of shivering at any time in the meperidine group (P<.01). The placebo group (38%) had the highest proportion of patients requiring treatment for post-operative shivering (P<.01). CONCLUSION Meperidine given intravenously in a single dose of 0.4mg/kg is a useful means for preventing postoperative shivering.
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Galán Gutiérrez JC, Fernández Suárez FE, Miranda García P, Sopena Zubiria LA. Anaesthetic management of breast surgery in a patient with Eisenmenger syndrome. ACTA ACUST UNITED AC 2017; 64:41-5. [PMID: 27554331 DOI: 10.1016/j.redar.2016.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
Abstract
Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted.
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Vallés-Torres J, Garcia-Martin E, Fernández-Tirado FJ, Gil-Arribas LM, Pablo LE, Peña-Calvo P. Contact topical anesthesia versus general anaesthesia in strabismus surgery. ACTA ACUST UNITED AC 2015; 91:108-13. [PMID: 26743186 DOI: 10.1016/j.oftal.2015.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the anesthetic block provided by contact topical anesthesia (CTA) in strabismus surgery in adult patients. To analyze postoperative pain and surgical outcome obtained by CTA compared with general anesthesia (GA). METHODOLOGY Prospective longitudinal cohort study of adult patients undergoing strabismus surgery by CTA or GA. The intensity of pain perceived by patients during the course of surgery and in the postoperative period was measured using Numerical Pain Scale. The success of the surgical outcome, considered as a residual ocular deviation<10 prism diopters, was evaluated. RESULTS Twenty-three patients were operated using CTA and 26 using AG. During the course of surgery, pain intensity experienced by patients in ATC group was 3.17±2.44. There were no differences between CTA group and AG group in the intensity of pain in the immediate postoperative period (2.13±2.39 vs. 2.77±2.18, respectively; P=.510) and during the first postoperative day (3.22±2.84 vs. 3.17±2.73; P=.923). Surgical success was significantly higher in the CTA group than in the GA group (78.3 vs. 73.1%; P=.019). CONCLUSIONS CTA provides adequate sensory block to perform strabismus surgery. The control of postoperative pain is similar to that obtained with AG. Conservation of ocular motility providing CTA enables better surgical outcome.
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Affiliation(s)
- J Vallés-Torres
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - E Garcia-Martin
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Hospital Universitario Miguel Servet, Zaragoza, España
| | - F J Fernández-Tirado
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Hospital Universitario Miguel Servet, Zaragoza, España
| | - L M Gil-Arribas
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Hospital Universitario Miguel Servet, Zaragoza, España
| | - L E Pablo
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Peña-Calvo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Miguel Servet, Zaragoza, España
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Ariza F, Montilla-Coral D, Franco O, González LF, Lozano LC, Torres AM, Jordán J, Blanco LF, Suárez L, Cruz G, Cepeda M. Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study). ACTA ACUST UNITED AC 2014; 61:362-8. [PMID: 24661725 DOI: 10.1016/j.redar.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. METHODS We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. RESULTS GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05). CONCLUSIONS AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.
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Affiliation(s)
- F Ariza
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
| | - D Montilla-Coral
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - O Franco
- Department of Pediatric Surgery, Fundación Valle del Lili, Cali, Colombia
| | - L F González
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L C Lozano
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - A M Torres
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - J Jordán
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L F Blanco
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L Suárez
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - G Cruz
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - M Cepeda
- Clinical Research Unit, Fundación Valle del Lili, Cali, Colombia
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Fernández-Ordóñez M, Tenías JM, Picazo-Yeste J. [Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis]. ACTA ACUST UNITED AC 2014; 61:254-61. [PMID: 24529683 DOI: 10.1016/j.redar.2013.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. MATERIAL AND METHODS An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. RESULTS The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001). CONCLUSIONS Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery.
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Affiliation(s)
- M Fernández-Ordóñez
- Departamento de Investigación, Docencia y Formación, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - J M Tenías
- Departamento de Investigación, Docencia y Formación, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Picazo-Yeste
- Departamento de Cirugía, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Martín Jaramago J, Tamarit Conejeros M, Escudero Torrella M, Solaz Roldán C. [Monitoring of recurrent laryngeal nerve injury using an electromyographic endotracheal tube in thyroid and parathyroid surgery. Anesthetic aspects]. ACTA ACUST UNITED AC 2013; 60:576-83. [PMID: 23886448 DOI: 10.1016/j.redar.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/29/2013] [Accepted: 06/03/2013] [Indexed: 12/20/2022]
Abstract
Recurrent laryngeal nerve injury remains one of the main complications in thyroid and parathyroid surgery. When this injury is bilateral, an acute upper airway obstruction may occur, leading to a potentially life-threatening situation for the patient. The visual identification of the nerve during surgery is the best way to preserve its integrity. However identification of the nerves by means of electromyographic stimuli through electrodes attached to endotracheal tubes could help in decreasing nerve injury. In these cases the experience and role of the anesthetist is essential to correctly place the electromyographic endotracheal tube and ensure that the electrodes are in touch with the vocal cords during the surgery. Moreover, the results of the electromyography can be affected by the neuromuscular blocking agents. Therefore, the choice and dose must be adapted, in order to ensure a suitable anesthetic depth, and adequate response.
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Affiliation(s)
- J Martín Jaramago
- Departamento de Anestesiología y Reanimación, Hospital Universitario Doctor Peset, Valencia, España.
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32
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Fernández Suárez FE, del Valle Fernández R, González Alvarez A, Sánchez Lasheras J, Fernández Sánchez L, Argüelles Tamargo L. [Anesthetic management and experience in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve]. ACTA ACUST UNITED AC 2013; 60:440-7. [PMID: 23829945 DOI: 10.1016/j.redar.2013.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the experience and anesthetic management in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve, in a university tertiary hospital. MATERIAL AND METHODS Observational analytical review of data incorporated into a prospectively maintained database of 142 patients diagnosed with severe aortic stenosis who underwent implantation of a CoreValve(®) aortic self-expanding aortic valve between December 2007 and December 2012. RESULTS The mean age of patients was 82.5±6.1 years and the logistic EuroSCORE was 14.9±11.2. General anesthesia was used in 107 patients (75.3%), with local anesthesia with sedation in 35 (24.6%). Local anesthesia and sedation was associated with a lower requirement of vasoactive drugs (P=.003) during implantation. No statistically significant differences were found between the 2 anesthetic techniques in the duration of the procedure, hospital stay, or morbimortality. The success rate was 97.1%. The most common complication was conduction disorders that required implantation of a permanent pacemaker in 46 patients (32.3%). There was no intraoperative mortality, and all-cause mortality at 30 days was 6.3%, with a one-year survival estimated by the Kaplan-Meier of 83.1%. CONCLUSIONS This study confirms that in patients with severe aortic stenosis and high surgical risk, transcatheter implantation of aortic valve is a safe and effective alternative. Both, general anesthesia and local anesthesia with sedation are valid options, depending on the experience of the team.
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Affiliation(s)
- F E Fernández Suárez
- Servicio de Anestesiología y Reanimación, Hospital Central de Asturias, Oviedo, España.
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