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Errando CL. No ventilator, no electric power, no oxygen, no drugs (hardly)… Anesthesia in low income countries. Heroes or thoughtless. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:257-258. [PMID: 35643757 DOI: 10.1016/j.redare.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 06/15/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología y Reanimación, Hospital Can Misses, Ibiza, Spain.
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2
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Errando CL, Romero-García CS, Hernández-Cádiz MJ, Pallardó-López MÁ, Puig J. SARS-CoV-2 infection. Descriptive analysis of a selected case series. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:34-42. [PMID: 35039243 PMCID: PMC8747947 DOI: 10.1016/j.redare.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
Objectives COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. Clinical cases The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. Results The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died. Conclusions It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
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Affiliation(s)
- C L Errando
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C S Romero-García
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - J Puig
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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3
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Errando CL, Romero-García CS, Hernández-Cádiz MJ, Pallardó-López MÁ, Puig J. SARS-CoV-2 infection. Descriptive analysis of a selected case series. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00136-5. [PMID: 34518043 PMCID: PMC8031254 DOI: 10.1016/j.redar.2021.03.009] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. CLINICAL CASES The clinical, radiological, analytical evolution of 6patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. RESULTS The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2patients showed middle symptoms, but the 2most severely affected died. CONCLUSIONS It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
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Affiliation(s)
- C L Errando
- Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C S Romero-García
- Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | | | - J Puig
- Consorcio Hospital General Universitario de Valencia, Valencia, España
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4
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Errando CL, Ferrando C. Publication in the Spanish Journal of Anesthesiology and Reanimation of study protocols. ACTA ACUST UNITED AC 2020; 67:361-363. [PMID: 32534725 DOI: 10.1016/j.redar.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - C Ferrando
- Departamento de Anestesiología y Cuidados Críticos, Institut d́investigació Pi i Sunyer (IDIBAPS), Hospital Clinic i Provincial, Barcelona, España; CIBER de Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid, España
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5
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Díaz-Cambronero O, Mazzinari G, Flor Lorente B, García Gregorio N, Robles-Hernandez D, Olmedilla Arnal LE, Martin de Pablos A, Schultz MJ, Errando CL, Argente Navarro MP. Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery. Br J Surg 2020; 107:1605-1614. [DOI: 10.1002/bjs.11736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/20/2020] [Accepted: 05/03/2020] [Indexed: 12/13/2022]
Abstract
Abstract
Background
It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery.
Methods
This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3.
Results
Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2·77, 95 per cent c.i. 1·19 to 6·40, P = 0·017; risk ratio (RR) 1·82, 1·79 to 1·87, P = 0·049). The IPP strategy was also associated with a higher probability of emotional (P = 0·013) and overall (P = 0·011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0·001) and the plasma neutrophil–lymphocyte ratio was lower (P = 0·029). Other endpoints were not affected.
Conclusion
In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O Díaz-Cambronero
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Castellón, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Castellón, Spain
- Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, PT17/0017/0035, Hospital Universitario y Politécnico la Fe, Castellón, Spain
| | - G Mazzinari
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Castellón, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Castellón, Spain
| | - B Flor Lorente
- Department of Colorectal Surgery, Hospital Universitario y Politécnico la Fe, Castellón, Spain
| | - N García Gregorio
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Castellón, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Castellón, Spain
| | | | | | | | - M J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C L Errando
- Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, and Departments of Anaesthesiology, Castellón, Spain
| | - M P Argente Navarro
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Castellón, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Castellón, Spain
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6
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Ferrando C, Colomina MJ, Errando CL, Llau JV. Anesthesiology and the Anesthesiologists at COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:289-291. [PMID: 32487319 PMCID: PMC7261101 DOI: 10.1016/j.redar.2020.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 01/16/2023]
Affiliation(s)
- C Ferrando
- Director de la Revista Española de Anestesiología y Reanimación (REDAR)
| | - M J Colomina
- Editor adjunto de la Revista Española de Anestesiología y Reanimación (REDAR).
| | - C L Errando
- Editor adjunto de la Revista Española de Anestesiología y Reanimación (REDAR)
| | - J V Llau
- Editor adjunto de la Revista Española de Anestesiología y Reanimación (REDAR)
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7
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Diaz-Cambronero O, Mazzinari G, Errando CL, Schultz MJ, Lorente BF, García-Gregorio N, Montañés MV, Robles-Hernández D, Arnal LEO, Martín-De-Pablos A, Marí AM, Navarro MPA. Correction to: An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study. Trials 2020; 21:70. [PMID: 31931888 PMCID: PMC6956552 DOI: 10.1186/s13063-020-4055-3] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
After publication of our article [1] the authors have notified us that there are changes in the primary outcome and the statistical analysis plan of the study.
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Affiliation(s)
- O Diaz-Cambronero
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain. .,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,SCReN-IIS La Fe, PT17/0017/0035, Spanish Clinical Research Network (SCReN), Valencia, Spain.
| | - G Mazzinari
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitari i Politecnic la Fe, Valencia, Spain
| | - C L Errando
- Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - B Flor Lorente
- Department of Colorectal Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - N García-Gregorio
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - M Vila Montañés
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, Hospital General Universitario de Castellón, Castellón, Spain
| | - L E Olmedilla Arnal
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Martín-De-Pablos
- Department of Anaesthesiology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A Marqués Marí
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - M P Argente Navarro
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
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8
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Errando CL, García-Villalobos I. Remarks on the difusse idiopatic skeletal hyperostosis (Forestier Rotes-Querol disease). Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:405-406. [PMID: 31031046 DOI: 10.1016/j.redar.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Affiliation(s)
- C L Errando
- Dirección médica de Servicios Quirúrgicos y Servicio de Anestesiología, Reanimación y Tratamiento del Dolor y Enfermería Quirúrgica, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - I García-Villalobos
- Dirección médica de Servicios Quirúrgicos y Servicio de Anestesiología, Reanimación y Tratamiento del Dolor y Enfermería Quirúrgica, Consorcio Hospital General Universitario de Valencia, Valencia, España
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9
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Diaz-Cambronero O, Mazzinari G, Errando CL, Schultz MJ, Flor Lorente B, García-Gregorio N, Vila Montañés M, Robles-Hernández D, Olmedilla Arnal LE, Martín-De-Pablos A, Marqués Marí A, Argente Navarro MP. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study. Trials 2019; 20:190. [PMID: 30944044 PMCID: PMC6446296 DOI: 10.1186/s13063-019-3255-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/27/2019] [Indexed: 02/04/2023] Open
Abstract
Background A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. Methods The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. Discussion The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. Trial registration ClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3255-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- O Diaz-Cambronero
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain. .,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain. .,SCReN-IIS La Fe, PT17/0017/0035, Spanish Clinical Research Network (SCReN), Valencia,, Spain.
| | - G Mazzinari
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitari i Politecnic la Fe , Valencia, Spain
| | - C L Errando
- Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - B Flor Lorente
- Department of Colorectal Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - N García-Gregorio
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - M Vila Montañés
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, Hospital General Universitario de Castellón, Castellón, Spain
| | - L E Olmedilla Arnal
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Martín-De-Pablos
- Department of Anaesthesiology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A Marqués Marí
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - M P Argente Navarro
- Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe (IIS laFe), Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
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10
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Errando 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. Respose to the letter to the editor: "Is there a real consensus among anaesthetists and surgeons about the neuromuscular block? Methodological considerations about the ACHILLES study". Revista Española de Anestesiología y Reanimación 2017; 64:603-604. [PMID: 28690006 DOI: 10.1016/j.redar.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C L Errando
- Servicios Quirúrgicos, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - C Moreno-Sanz
- Servicio de Cirugía General y Aparato Digestivo, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P Vila-Caral
- Servicio de Anestesiología y Reanimación, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - J C Ruiz de Adana-Belbel
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - E Vázquez-Alonso
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Granada, Granada, España
| | | | - G Veiga-Ruiz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario Santa Lucía, Cartagena, Murcia, España
| | - E Guasch-Arévalo
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J I Lora-Tamayo D'Ocón
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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11
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Errando CL, Mazzinari G, Díaz-Cambronero O, Garutti I. Residual neuromuscular blockade in the postanesthesia care unit. A secondary analysis of the ReCuSS. Observational cross-sectional study of a multicenter cohort. Rev Esp Anestesiol Reanim 2017; 64:419-422. [PMID: 28341080 DOI: 10.1016/j.redar.2017.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - G Mazzinari
- Servicio de Anestesiología, Hospital de Manises, Valencia, España
| | - O Díaz-Cambronero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Politécnico La Fe, Valencia, España
| | - I Garutti
- Servicio de Anestesiología y Reanimación. Hospital General Universitario Gregorio Marañón, Madrid, España
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12
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Errando CL, Blanco T, Díaz-Cambronero Ó. Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring. Rev Esp Anestesiol Reanim 2016; 63:533-538. [PMID: 27216713 DOI: 10.1016/j.redar.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/04/2016] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - T Blanco
- Servicio de Neurofisiología Clínica, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Ó Díaz-Cambronero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Politécnico La Fe, Valencia, Spain
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13
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Errando CL, Peiró CM, Gimeno A, Soriano JL. Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study. Rev Esp Anestesiol Reanim 2014; 61:481-488. [PMID: 25060950 DOI: 10.1016/j.redar.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 01/16/2014] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia. METHODS In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12. RESULTS After exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6mg vs. 8.7mg in the B0.5 group, p<0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6±23.6 (95% CI 51.7-110.2)min vs. 125.5±37.9 (95% CI 101.7-169.4)min in the B0.5 group, p=0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed. CONCLUSION Lowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C M Peiró
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Gimeno
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Soriano
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Errando CL. [Comments to the article "Spanish anesthesiologists approach on intraoperative awareness with explicit recall. Results of a national survey performed in 2011"]. Rev Esp Anestesiol Reanim 2014; 61:530-531. [PMID: 25053146 DOI: 10.1016/j.redar.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 03/29/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
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15
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Errando CL, Soriano-Bru JL, Peiró CM, Ubeda J. Single shot spinal anaesthesia with hypobaric bupivacaine for hip fracture repair surgery in the elderly. Randomized, double blinded comparison of 3.75 mg vs. 7.5 mg. ACTA ACUST UNITED AC 2014; 61:541-8. [PMID: 25236946 DOI: 10.1016/j.redar.2014.07.001] [Citation(s) in RCA: 3] [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: 02/24/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Arterial hypotension is the most frequent adverse effect of subarachnoid anaesthesia in the elderly sustaining a femoral proximal fracture. Decreasing the local anaesthetic dose reduces the incidence of hypotension but shortens sensory block duration that could be insufficient in some surgical procedures. Sensory block duration could be prolonged using hypobaric local anaesthetics. We evaluated whether low hypobaric bupivacaine doses were adequate for this type of surgery while maintaining the haemodynamic stability. METHODS A prospective, randomized, double blinded study was designed. Patients over 65 years old, sustaining traumatic hip fracture, were assigned to one of two groups: B0.5 group, hypobaric bupivacaine 7.5mg 5mg/ml (control group), and B0.25 group, hypobaric bupivacaine 3.75 mg 2.5mg/ml (study group). After subarachnoid injection, sensory level and motor blockade degree were registered, as were blood pressure, and heart rate at basal time and at 2, 5, 10, 15, 20 and 30 min after injection. The doses of vasopressor needed were registered as well. Surgical conditions and the duration of the surgical procedure-whether rescue analgesia or anaesthesia was needed-and sensory level regression to T12, were registered as well. RESULTS Sixty four patients was the calculated sample size. The study was stopped in an interim analysis because an elevated number of patients in the B0.25 group needed iv rescue anaesthesia. In the analyzed cases, blood pressure was significantly lower in the B0.5 group at the 15 and 30 min measurements. Vasopressor drugs needs were similar between groups [ephedrine accumulated mean (SD) doses 11.4 (5.2) mg vs. 9.1 (2.7) mg, p=0.045)]. Sensory block regression to T12 was faster in the B0.25 group, [(mean (SD) 68.2 (29.0) min vs. 112.8 (17.3) min in the B0.5 group, p<0.05]. Five out of 19 patients in the B0.25 group needed intravenous anaesthesia rescue before surgery started. CONCLUSION Lowering hypobaric bupivacaine dose to 3.75 mg in subarachnoid anaesthesia for hip fracture repair surgery in elderly patients decrease intraoperative blood pressure, but in an important number of patients intravenous anaesthesia rescue was needed and preclude recommendation.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - J L Soriano-Bru
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C M Peiró
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Ubeda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Carmona P, Mateo E, Montoro A, Alós L, Coret M, Errando CL, Llagunes J, De Andrés J. [Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery]. ACTA ACUST UNITED AC 2014; 62:3-9. [PMID: 24746360 DOI: 10.1016/j.redar.2014.02.011] [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: 01/21/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND GOAL OF STUDY Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. MATERIALS AND METHODS A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. RESULTS Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). CONCLUSION This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.
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Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Mateo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - A Montoro
- Servicio de Análisis Clínicos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Alós
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Coret
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Llagunes
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J De Andrés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Carmona P, Mateo E, Hornero F, Errando CL, Vázquez A, Llagunes J, De Andrés J. [Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?]. ACTA ACUST UNITED AC 2014; 61:311-8. [PMID: 24556510 DOI: 10.1016/j.redar.2014.01.003] [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: 11/25/2013] [Revised: 12/26/2013] [Accepted: 01/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality. MATERIAL AND METHODS A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay. RESULTS Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01). CONCLUSIONS The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined.
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Affiliation(s)
- P Carmona
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - E Mateo
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
| | - F Hornero
- Servicio de Cirugía cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario, Valencia, España
| | - C L Errando
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - A Vázquez
- Servicio de Cirugía cardiaca, Hospital Politécnico La Fe, Valencia, España
| | - J Llagunes
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - J De Andrés
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
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Errando CL, Del Moral A, Cobo I, García-Gregorio N, Pallardó-López MA. Spinal anaesthesia in a patient with post-spine surgery dural ectasia. ACTA ACUST UNITED AC 2013; 61:47-50. [PMID: 24135680 DOI: 10.1016/j.redar.2013.08.004] [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: 06/05/2013] [Revised: 08/09/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
Dural sac ectasia is a very infrequent anatomical abnormality, usually caused by connective tissue diseases, as Marfan syndrome. Very few cases have been described being a consequence of a previous spine surgical procedure. We describe the case of an elderly patient who should be operated on twice due to sub-occlusive colon disease. Surgery was performed under spinal anaesthesia. A dural sac ectasia was suspected after the first procedure and the abdominal X-ray was reviewed. The characteristics of the anatomical alteration and the course of both anaesthetic procedures were described. X-ray and CT images were provided.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Del Moral
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - I Cobo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - N García-Gregorio
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M A Pallardó-López
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
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19
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Errando CL, Pérez-Caballero P, Verdeguer-Ribes S, Vila-Montañés M. [Severe pre-eclampsia. An evidence-based practice proposal]. ACTA ACUST UNITED AC 2013; 60:371-83. [PMID: 23726726 DOI: 10.1016/j.redar.2013.03.007] [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: 12/21/2012] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. MATERIAL AND METHODS A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. RESULTS A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. CONCLUSIONS Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Unversitario, Valencia, España.
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Errando CL, Fernández-Mondéjar E, Piñeiro Corrales G. [The "2013 Seville Document" on allogeneic blood transfusion alternatives: a consensus document and an example of multidisciplinary medical cooperation]. Rev Esp Anestesiol Reanim 2013; 60:243-244. [PMID: 23623776 DOI: 10.1016/j.redar.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
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21
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Errando CL. [New aspects of the Spanish Journal of Anesthesiology and Critical Care for readers, authors and reviewers. Editor's Report]. ACTA ACUST UNITED AC 2012; 59:235-6. [PMID: 22703828 DOI: 10.1016/j.redar.2012.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 11/15/2022]
Affiliation(s)
- C L Errando
- Director de Revista Española de Anestesiología y Reanimación, Madrid, España
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22
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Errando CL, Navarro L, Vila M, Pallardó MA. Anesthetic management of a patient diagnosed with CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy). ACTA ACUST UNITED AC 2012; 59:102-6. [PMID: 22480557 DOI: 10.1016/j.redar.2012.02.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leu-koencephalopathy) is an infrequent inherited disease that could have anesthetic implica-tions. However these have rarely been reported. We present a male patient previously diagnosed with CADASIL, who had suffered an ischemic vascular cerebral accident with a MRI compatible with leukoencephalopathy, and who was dependent for daily activities, and sustained dementia, mood alterations, apathy, and urine incontinence. He had famil-ial antecedents of psychiatric symptoms and ischemic stroke events in several relatives including his father, two brothers and one sister. He was scheduled for arthrodesis of the left knee because of multiple infectious complications of prosthetic knee surgery. He was under clopidogrel treatment which was withdrawn seven days before surgery. The pro-cedure was performed under combined spinal-epidural anesthesia, intraoperative seda-tion with midazolam, and postoperative multimodal analgesia including epidural patient controlled analgesia. The perioperative management was uneventful and we outline the adequacy of managing these patients under regional anesthesia and analgesia, as these permit to maintain hemodynamic stability leading to adequate cerebral perfusion, key to avoid an increase in the effects of the chronic arteriopathy patients with CADASIL sustain.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Abstract
Respiratory stridor developed rapidly during an interscalene brachial plexus block for shoulder arthroscopy in an obese woman. Extensive cervicothoracic edema due to tissue diffusion of the arthroscopic fluid was suspected. The outcome of patient after conservative management was satisfactory. We give a brief review of how this complication develops, the ultrasound findings, and briefly discuss similar cases.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia.
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Gálvez Cañellas JL, Errando CL, Ordóñez Arana A, Falcó E, Mazzinari G, Robles D, Vila Sánchez M. [Sugammadex, efficacious in reversing a neuromuscular block in a woman with Becker muscular dystrophy]. Rev Esp Anestesiol Reanim 2011; 58:614-617. [PMID: 22263407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Becker muscular dystrophy affects mainly the musculoskeletal system, causing muscle wasting and progressive weakness. A 61-year-old woman with breast cancer, who had been diagnosed with Becker muscular dystrophy 45 years earlier, was scheduled for right mastectomy. We induced general anesthesia with propofol, fentanyl, and a nondepolarizing muscle blocker (rocuronium). Neuromuscular function was monitored continuously by acceleromyographic train-of-four ratio (TOFr) (Watch-SX monitor). The block was reversed with sugammadex. After preoxygenation with fentanyl and propofol, the device was calibrated and the baseline TOFr was recorded. We injected 1 mg/kg of rocuronium and assessed TOF responses every 15 seconds. The maximum decrease in TOF response (to 0 twitches) was at 52 seconds. Tracheal intubation was uneventful. Anesthesia was maintained by intravenous infusion. The operation lasted 74 minutes. The second TOF twitch (T2) reappeared 86 minutes after the initial dose. After we injected 2 mg/kg of sugammadex, a TOFr of 0.7 was reached at 79 seconds; a TOFr of 0.9 was reached at 108 seconds and a TOFr of 1.0 at 152 seconds. No electrocardiographic or hemodynamic abnormalities occurred during sugammadex administration and there were no signs of residual neuromuscular blockade on awakening or adverse events in the following 24 hours.
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Affiliation(s)
- J L Gálvez Cañellas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General de Castellón.
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Errando CL. [Neuromuscular blockers. Residual neuromuscular blockade. Monitoring. Pharmacologic reversion. Update]. Rev Esp Anestesiol Reanim 2011; 58 Suppl 2:1-3. [PMID: 21919228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Consorcio Hospital General Universitario de Valencia.
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Gómez-Arnau JI, Otero MJ, Bartolomé A, Errando CL, Amal D, Moreno AM, Puebla G, Marzal JM, Santa Ursula JA, González R, Pérez M, García del Valle S, González A, Domínguez-Gil A. [Labeling of injectable drugs used in anesthesia]. Rev Esp Anestesiol Reanim 2011; 58:375-383. [PMID: 21797088 DOI: 10.1016/s0034-9356(11)70087-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- J I Gómez-Arnau
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid.
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Errando CL, Muñoz-Devesa L, Soldado MA. [Ultrasound-guided interscalene block in a patient with supraclavicular anatomical abnormalities due to radiotherapy and surgery]. Rev Esp Anestesiol Reanim 2011; 58:312-314. [PMID: 21688510 DOI: 10.1016/s0034-9356(11)70067-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Regional blocks can be difficult in surgical patients with certain superficial anatomical abnormalities. Such blocks may be possible, however, under ultrasound guidance. We report a case in which a man with a fractured right humerus required an ultrasound-guided interscalene brachial plexus block. Secondary to radiotherapy, the patient had right cervical and facial abnormalities that had altered the location of external anatomical landmarks. We describe the approach used to insert the catheter and the exploration of the region by ultrasound. Nerve stimulation was not used to avoid painful contractions. Analgesia was excellent during surgery and over the following 24 hours.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia
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de Santiago J, Santos-Yglesias J, Girón J, Jiménez A, Errando CL. [Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl]. ACTA ACUST UNITED AC 2011; 57:565-70. [PMID: 21155337 DOI: 10.1016/s0034-9356(10)70283-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 microg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 microg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position.
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Affiliation(s)
- J de Santiago
- Departamento de Anestesiología, Hospital USP La Colina, S.C. de Tenerife, Tenerife.
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De Santiago J, Santos Yglesias J, Girón J, Errando CL. [Selected spinal anesthesia: diluted solutions and low dosages]. Rev Esp Anestesiol Reanim 2011; 58:201-202. [PMID: 21608274 DOI: 10.1016/s0034-9356(11)70040-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Osseyran Samper F, Errando CL, Plaza Lloret M, Díaz Cambronero O, García Gregorio N, de Andrés Ibáñez J. [Prophylaxis for hypotension during cesarean section under spinal anesthesia: a randomized trial comparing hydroxyethyl starch 130/0.4 to ephedrine]. Rev Esp Anestesiol Reanim 2011; 58:17-24. [PMID: 21348213 DOI: 10.1016/s0034-9356(11)70693-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Spinal anesthesia is the technique of choice for scheduled or emergency cesarean section, but the prevalence of hypotension is high in this setting. Our aim was to compare the efficacy of a colloid (6% hydroxyethyl starch [HES] 130/0.4) to ephedrine for preventing hypotension. PATIENTS AND METHODS Patients undergoing elective or emergency cesarean section (in non-life-threatening situations) were enrolled. Patients were randomized to 3 groups for prophylaxis. The first ephedrine group received 5 mg of ephedrine intravenously (EPHE-5); the second ephedrine group received 10 mg of the drug intravenously (EPHE-10); and the HES group received 500 mL of HES 130/0.4 in rapid infusion n 15 minutes. We recorded systolic and diastolic blood pressures and heart rate after 10 minutes in the operating room and 2, 5, 10, 15, 20, and 30 minutes after injection of the anesthetic. We also assessed the sensory and motor blockades on both sides 2, 5, 10, 15, 20, and 30 minutes after injection. Neonatal status was assessed by Apgar score and umbilical cord blood gas analysis. RESULTS Ninety-six patients, 33 in each ephedrine group and 30 in the HES group, were enrolled. Blood pressure decreased similarly in all 3 groups (36% EPHE-5 group, 36% EPHE-10 group and 40% HES group); no significant between-group differences were observed. Nor were there significant differences in the percentages of patients requiring bolus doses of ephedrine to treat hypotension (23% in the HES group vs 33% in the EPHE-5 group and 27% in the EPHE-10 group) or in the cumulative doses of ephedrine. Neonatal status was also similarly satisfactory in all 3 groups. CONCLUSIONS HES 130/0.4 is as useful for hypotension prophylaxis as 5-mg or 10-mg intravenous doses of ephedrine. HES 130/0.4 might be a substitute for sympathomimetic agents if adverse effects are predicted or contraindications to the use of such drugs are present.
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Affiliation(s)
- F Osseyran Samper
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario La Fe, Valencia.
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Del Rosario E, Errando CL, García del Valle S. [Fire in the operating room: fact or fiction and what can we learn?]. Rev Esp Anestesiol Reanim 2010; 57:133-135. [PMID: 20422844 DOI: 10.1016/s0034-9356(10)70186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Errando CL, Vila M, Armario P. [Hypertension and the surgical patient]. Rev Esp Anestesiol Reanim 2009; 56:465-466. [PMID: 19994613 DOI: 10.1016/s0034-9356(09)70435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Errando CL. [Comments on the editorial "Primum non nocere"]. Rev Esp Anestesiol Reanim 2009; 56:273. [PMID: 19580129 DOI: 10.1016/s0034-9356(09)70393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Errando CL. [Ultrasound-guided femoral nerve block: catheter insertion in a girl with skeletal abnormalities]. Rev Esp Anestesiol Reanim 2009; 56:197-198. [PMID: 19408792 DOI: 10.1016/s0034-9356(09)70368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Errando CL. Comments on a case of 'cerebral blood migration' after lumbar spinal anaesthesia. Acta Anaesthesiol Scand 2009; 53:405. [PMID: 19243331 DOI: 10.1111/j.1399-6576.2008.01810.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Errando CL. [Spatial relationships between the ultrasound transducer, the needle, and nerve structures in plexus and peripheral nerve blocks]. Rev Esp Anestesiol Reanim 2009; 56:57-59. [PMID: 19284135 DOI: 10.1016/s0034-9356(09)70327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Errando CL. [Ultrasound images for venous puncture and venous access]. Rev Esp Anestesiol Reanim 2008; 55:593-594. [PMID: 19177858 DOI: 10.1016/s0034-9356(08)70668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Errando CL. [On a case of idiopathic brachial neuritis following general anesthesia: idiopathic or iatrogenic?]. Rev Esp Anestesiol Reanim 2008; 55:513-514. [PMID: 18982790 DOI: 10.1016/s0034-9356(08)70636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Errando CL. Possible explanation of a bilateral thalamic infarct after general anaesthesia. Acta Anaesthesiol Scand 2008; 52:1174-5. [PMID: 18840127 DOI: 10.1111/j.1399-6576.2008.01726.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Errando CL, Sigl JC, Robles M, Calabuig E, García J, Arocas F, Higueras R, Del Rosario E, López D, Peiró CM, Soriano JL, Chaves S, Gil F, García-Aguado R. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth 2008; 101:178-85. [PMID: 18515816 DOI: 10.1093/bja/aen144] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We have prospectively evaluated the incidence and characteristics of awareness with recall (AWR) during general anaesthesia in a tertiary care hospital. METHODS This study involves a prospective observational investigation of AWR in patients undergoing general anaesthesia. Blinded structured interviews were conducted in the postanaesthesia care unit, on postoperative day 7 and day 30. Definition of AWR was 'when the patient stated or remembered that he or she had been awake at a time when consciousness was not intended'. Patient characteristics, perioperative, and drug-related factors were investigated. Patients were classified as not awake during surgery, AWR, AWR-possible, AWR-not evaluable. The perceived quality of the awareness episode, intraoperative dreaming, and sequelae were investigated. The anaesthetic records were reviewed to search for data that might explain the awareness episode. RESULTS The study included 4001 patients. Incidence of AWR was 1.0% (39/3921 patients). If high risk for AWR patients were excluded, the incidence was 0.8%. After the interview on the seventh day, six patients denied having been conscious during anaesthesia; hence, the incidence of AWR in elective surgery was 0.6%. Factors associated with AWR were: anaesthetic technique incidence of 1.1% TIVA-propofol vs 0.59% balanced anaesthesia vs 5.0% O2/N2O-based anaesthesia vs 0.9% other anaesthetic techniques (mainly propofol boluses for short procedures), P=0.008; age (AWR 42.3 yr old vs 50.6 yr old, P=0.041), absence of i.v. benzodiazepine premedication (P=0.001), Caesarean section (C-section) (P=0.019), and surgery performed at night (P=0.013). More than 50% of patients reported intraoperative dreaming in the early interview, mainly pleasant. Avoidable human factors were detected from the anaesthetic records of most patients. Subjective auditory perceptions prevailed, together with trying to move or communicate, and touch or pain perception. CONCLUSIONS A relatively high incidence of AWR and dreams during general anaesthesia was found. Techniques without halogenated drugs showed more patients. The use of benzodiazepine premedication was associated with a lower incidence of AWR. Age, C-section with general anaesthesia, and surgery performed at night are risk factors.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014 Valencia, Spain.
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Gimeno AM, Murcia M, Calabuig E, Errando CL, Salvador L, De Andrés JA. [Discrepancy between clinical and radiologic manifestations of an epidural hematoma after catheterization]. Rev Esp Anestesiol Reanim 2008; 55:245-248. [PMID: 18543508 DOI: 10.1016/s0034-9356(08)70556-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Neuraxial techniques are considered safe if certain guidelines are followed, but they are not risk free. We report the case of an 81-year-old woman with an invasive bladder tumor who underwent radical cystectomy with a Bricker-type procedure. General anesthesia was used and epidural analgesia was also provided for surgical and postoperative pain management. Late in the postoperative recovery period a large epidural hematoma was diagnosed based on radiologic signs of spinal cord compression, in the absence of symptoms other than mild and progressive back pain that developed after extubation. The surgeon decided against emergency surgery to reduce compression. Symptoms resolved gradually, and a magnetic resonance image 45 days after discharge confirmed that the hematoma was smaller. In addition to the usual safety recommendations for epidural anesthesia with regard to drugs that alter hemostasis, it is important to bear in mind circumstances that have pharmacokinetic repercussions and that increase risk. Lower back pain can be a warning sign. Some cases may resolve spontaneously.
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Affiliation(s)
- A M Gimeno
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia.
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Errando CL. Comments about thoracic spinal anesthesia for gastrostomy. Acta Anaesthesiol Scand 2008; 52:444. [PMID: 18269397 DOI: 10.1111/j.1399-6576.2007.01495.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Errando CL, Murcia M, Gimeno A, Herrera R. [Anesthesia in a patient with Angelman syndrome]. Rev Esp Anestesiol Reanim 2007; 54:566-569. [PMID: 18085111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We describe the perioperative treatment of a patient diagnosed with Angelman syndrome, which is usually caused by a deletion in chromosome 15. The patient showed the characteristic signs of psychomotor retardation, epilepsy, lack of speech, frequent laughter and happy demeanor, light skin, blue eyes, and blond hair, hyperactivity, and sleep disturbance. He was scheduled for multiple tooth extractions under general anesthesia. Intravenous anesthesia was induced using ketamine, propofol, and rocuronium, and was maintained with low concentrations of sevoflurane. There were no incidents during or after surgery. The chromosomal abnormality that causes Angelman syndrome is located on the same genes that control the production of gamma-aminobutyric acid-A receptors, which are activated by most intravenous and inhaled anesthetic agents. The effect of the condition on the response of these agents is unknown. The combined use of propofol, ketamine, and sevoflurane at low doses provided adequate anesthesia for this patient. Other characteristics of the syndrome that may affect the use of anesthesia in these patients are discussed.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia.
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Errando CL, Blasco P. [Drug administration errors in departments of anesthesiology, intensive care recovery, and emergency: improving safety and quality assurance]. Rev Esp Anestesiol Reanim 2006; 53:397-9. [PMID: 17066858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Errando CL, Pallardó MA, Herranz A, Peiró CM, de Andrés JA. [Bilateral axillary brachial plexus block guided by multiple nerve stimulation and ultrasound in a multiple trauma patient]. Rev Esp Anestesiol Reanim 2006; 53:383-6. [PMID: 16910147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We present the case of a woman with multiple wounds and injuries after attempted suicide by jumping from a high place. She had multiple craniofacial injuries and fractures of both forearms requiring emergency osteosynthesis. The neurosurgeons requested that a level of consciousness be maintained for frequent assessment; therefore it was decided to provide a bilateral axillary brachial plexus block. The procedure was carried out with the aid of a nerve stimulator to locate a triple response in the left arm (radial, medial and musculocutaneous nerves) and with both ultrasound and double nerve stimulation in the right arm (medial and radial nerves). Surgery proceeded without adverse events. The location of nerves or nerve roots with both ultrasound and stimulators was highly useful in this patient in need of bilateral brachial plexus blockade. This combination, and ultrasound in particular, might be the technique of choice because it offers an image in real time and assessment of the least amount of anesthetic that seems to be needed for achieving a block.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia.
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Errando CL, Tatay J, Serrano-Romero A, Gudín-Uriel M, Revert M, Peiró CM. Splenic rupture and haemoperitoneum in a patient with non-compaction of the left ventricular myocardium. Br J Anaesth 2005; 95:358-61. [PMID: 16040634 DOI: 10.1093/bja/aei207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The anaesthetic and critical care management of blunt abdominal trauma in a patient previously diagnosed with non-compaction of the left ventricular myocardium (a rare autosomal dominant inherited disease) is reported. The management was influenced by the presence of an implanted automated internal defibrillator and treatment with anticoagulants because of the high frequency of severe arrhythmias and systemic embolism. The pathophysiology of ventricular non-compaction is reviewed briefly.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Avenida Tres Cruces s/n, 46014-Valencia, Spain.
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Errando CL. [Severe injury in the obstetric patient: considerations for anesthesiologist and critical care specialist]. Rev Esp Anestesiol Reanim 2005; 52:336-48, 366. [PMID: 16038173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In spite of the high incidence of moderately severe or severe injury in obstetric patients, the anesthesiology literature contains few references to their diagnosis and treatment. We review the epidemiology, etiology, treatment, and prognosis of severe or moderately severe injuries in obstetric patients.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimaci6n y Tratamiento del Dolor. Consorcio Hospital General Universitario de Valencia.
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Errando CL, Peiró CM. [Diffuse idiopathic skeletal hyperostosis, Forestier and Rotés-Querol syndrome, and difficult spinal puncture]. Rev Esp Anestesiol Reanim 2005; 52:252. [PMID: 15901037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia.
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