Revista espanola de anestesiologia y reanimacion

Publications in this journal

• Article: [Caudal epidural anesthesia in a case of Fournier's gangrene.]

  F Diez Burón, J M Marcos Vidal, M Merino García, R Pérez Blanco
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation.]

  G Monsalve-Mejía, W Palacio, C Rodríguez
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  ABSTRACT: The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome.
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Takotsubo cardiomyopathy in the context of Staphylococcus aureus sepsis.]

  D Núñez, R Bermejo, A Rodríguez-Velasco
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  ABSTRACT: Takotsubo cardiomyopathy consists of a transient dysfunction of the left ventricle. It is characterised by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually occurs after an episode of physical or emotional stress. We present the case of a 70 year-old woman, who, in the postoperative period of an ankle osteosynthesis, developed a Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed left ventricular medioapical akinesia. Coronary angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged from hospital to home with normal systolic function on echocardiography.
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft.]

  A Román Fernández, A López Álvarez, M C Corujeira Rivera, V Vilanova Váquez, A Carregal Rañó, M Á Pereira Loureiro
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  ABSTRACT: We present the case of a 77 year-old patient scheduled for coronary artery bypass. During the infusion of levosimendan as preconditioning for surgery, a rupture of right common iliac artery occurred. Surgery was delayed and an urgent aorto-bifemoral bypass was performed. We believe that the rupture of the artery was triggered by an increase in transmural pressure due to the inotropic effects of levosimendan in a dilated diseased vessel. To our knowledge, there are no cases of aneurysm rupture as a complication during levosimendan infusion, but the coincidence of events in time strongly suggests some kind of causal relationship.
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: Reversal of moderate and intense neuromuscular block induced by rocuronium with low doses of sugammadex for intraoperative facial nerve monitoring.

  J Fabregat López, G Porta Vila, M Martin-Flores
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  ABSTRACT: We report two cases in which moderate and intense rocuronium-induced neuromuscular block was reversed intraoperatively with low sugammadex doses in order to facilitate electromyographic evaluation of facial nerve function during surgery of the parotid gland and the middle ear. Acceleromyography was used to assess reversal of neuromuscular block before starting electromyography monitoring. Rocuronium-induced neuromuscular block was reversed with sugammadex 0.22mgkg(-1) when the TOF ratio was 0.14 in the first patient, and with sugammadex 2mgkg(-1) during intense block (PTC 0) in the second patient. In each case, appropriate neuromuscular function (TOF ratio≥0.9) was established soon after sugammadex administration, and electromyographic evaluation of facial nerve was successfully conducted. The use of rocuronium and sugammadex, coupled with objective neuromuscular monitoring with acceleromyography, assured complete restoration of neuromuscular function and created the optimal conditions for the surgical team.
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital.]

  A Bilbao Ares, A Sabaté, L Porteiro, B Ibáñez, M Koo, A Pi
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  ABSTRACT: OBJECTIVES: The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. MATERIAL AND METHODS: A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. RESULTS: A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. CONCLUSIONS: A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks.
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Clot in right atrium seen in transthoracic ultrasound in a patient with intraoperative cardiorespiratory arrest.]

  A Bilbao Ares, M Ansó Navarro, A Gutiérrez Martínez, P Tejedor Vargas
  Revista espanola de anestesiologia y reanimacion 05/2013;
• Article: [Fluid therapy in cardiac surgery. An update.]

  E Boix, R Vicente, J Pérez-Artacho
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  ABSTRACT: The anesthetist has 2 major tools for optimizing haemodynamics in cardiac surgery: Vasoactive drugs and the intravascular volume. It is necessary to identify which patients would benefit from one or the other therapies for a suitable response to treatment. Hemodynamic monitoring with the different existing parameters (pressure, volumetric static, volumetric functional and echocardiography) allows the management of these patients to be optimized. In this article a review is presented on the most recent and relevant publications, and the different tools available to control the management of the fluid therapy in this context, and to suggest a few guidelines for the haemodynamics monitoring of patients submitted to cardiac surgery. A systematic search has been made in PubMed, limiting the results to the publications over the last five years up to February 2012.
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Fulminant coagulopathy after bivalirudin use in a patient diagnosed with heparin-induced thrombocytopenia and subject to cardiac bypass surgery.]

  B de Prada Martín, J Gualis Cardona, I Pérez Blanco, J M Martínez Comendador
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  ABSTRACT: Patients with a previous history of heparin-induced thrombocytopenia are at a higher risk for thromboembolic events, and heparin administration is formally contraindicated. Bivalirudin has been reported as an alternative therapy whenever an intervention that requires systemic anticoagulation and cardiopulmonary by-pass pump is needed. We present the case of a patient diagnosed with heparin-induced thrombocytopenia and heparin-PF4 (+) antibodies requiring a triple cardiac valve replacement who developed fulminant coagulopathy after bivalirudin administration. A discussion on the serious difficulties that the management of these types of patients involves, as well as a review of prevention strategies are presented.
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Hemolysis, elevated liver enzymes and low platelet count in pregnancy: Differential diagnosis.]

  A Martínez-Blazquez, J de Capadocia-Rosell, P Cuesta-Montero, A Marín-Sánchez
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [The assessment of clinical skills as a problem.]

  A M González
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Bringing clinical simulation into an Anesthesia residency training program in a university hospital. Participants' acceptability assessment.]

  M A Corvetto, M P Bravo, R A Montaña, F R Altermatt, A E Delfino
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  ABSTRACT: INTRODUCTION: Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. METHODS: Activities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished. RESULTS: A total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness. CONCLUSIONS: The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: Postoperative nausea and vomiting: Incidence, characteristics and risk factors - A prospective cohort study.

  C Moreno, D Veiga, H Pereira, C Martinho, F Abelha
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  ABSTRACT: BACKGROUND: Postoperative nausea and vomiting are a common complication after surgery. The objective of the study was to identify risk factors, and to determine the incidence of postoperative nausea and vomiting in a cohort of patients in a tertiary university hospital. METHODS: Prospective cohort study was conducted in a Post Anesthetic Care Unit during a period of 3 weeks. One hundred and fifty-seven adult patients subjected to scheduled non-cardiac and non-intracranial surgery were eligible for the study. Patient perioperative characteristics data were analyzed. The postoperative nausea and vomiting intensity scale and nausea visual analog scale were applied to measure postoperative nausea and vomiting at 6h and 24h after surgery. Descriptive analysis was performed and the Mann-Whitney U, Fisher's exact, or Chi-square tests were applied. A univariate and multivariate logistic binary regressions with calculation of odds ratio (OR) and its 95% confidence interval (95% CI) were performed. RESULTS: Thirty-nine (25%) patients and 54 (34%) patients had postoperative nausea and vomiting at 6h and 24h, respectively. Of the patients who experienced postoperative nausea and vomiting, 6 (15%) had clinically significant postoperative nausea and vomiting (postoperative nausea and vomiting intensity scale>50) at 6h and 9 (23%) at 24h. The majority of patients classified nausea as mild at 6h (57%) and 24h (56%). At 6h, 3 (10%) patients classified nausea as severe, and at 24h 5 (9%) patients reported the same. The median and interquartile ranges for nausea visual analog scale were 40 (20-60) at 6h and 50 (20-60) at 24h. Six patients (14%) at 6h, and 7 (18%) at 24h had a nausea visual analog scale score>75. Patients with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale at 6h (75 versus 30, P<.05) and 24h (70 versus 40, P<.05). The univariate analysis identified risk factors for postoperative nausea and vomiting: Apfel score>2 (OR 3.2, 95% CI 1.6-6.4, P=.001), previous history of postoperative nausea and vomiting (OR 2.9 95% CI 1.3-6.5, P=.009) and female patients (OR 2.7, 95% CI 1.4-5.4, P=.005). In the multivariate analysis previous history of postoperative nausea and vomiting (adjusted OR 2.5, 95% CI 1.1-5.7, P=.030) and female gender (adjusted OR 2.4, 95% CI 1.2-4.9, P=.015) were considered as independent risk factors for postoperative nausea and vomiting. CONCLUSION: Most of the patients do not have clinically significant postoperative nausea and vomiting. The patients who presented with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale. Independent risk factors for postoperative nausea and vomiting were previous history of postoperative nausea and vomiting and being female.
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Albuminaemia, haematocrit, cardiac output and pharmacokinetic propofol infusion models.]

  M Gerónimo-Pardo, J A Monsalve-Naharro, M González-Moral
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Tracheal stenosis due to ectasia of the right brachiocephalic trunk.]

  J M Marcos-Vidal, J Gómez-Plana, B Prada, J Gualis
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Albuminaemia, haematocrit, cardiac output and pharmacokinetic propofol infusion models. Authors' reply.]

  P O Sepúlveda
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Non invasive mechanical ventilation in postoperative patients. Is positive pressure device selected relevant?]

  A M Esquinas, J L Jover Pinillos
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Reply to the letter «The assessment of clinical skills as a problem»]

  M Echevarría Moreno
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Reply to the article «Non invasive mechanical ventilation in postoperative patients. Is positive pressure device selected relevant?»]

  J A Monsalve-Naharro, P Cuesta-Montero, J de Capadocia-Rosell
  Revista espanola de anestesiologia y reanimacion 04/2013;
• Article: [Liability in Anaesthesiology: Theory of disproportionate damage.]

  J C Galán Gutiérrez, J C Galán Cortés
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  ABSTRACT: An analysis is made of the controversial application of the theory of disproportionate damage in the anaesthetic act, due to the high inherent risk, and regardless of the seriousness and importance of the surgery being performed. The existence of a disproportionate damage, that is, damage not foreseen nor accountable within the framework of the professional performance of the anaesthetist, does not by itself determine the existence of liability on the part of the anaesthetist, but the demand from the professionals themselves for a coherent explanation of the serious disagreement between the initial risk implied by their actions and the final consequence produced.
  Revista espanola de anestesiologia y reanimacion 03/2013;