Research: University of ValenciaUniversity of ValenciaSpain · Valencia
Article: Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy.María J Estruch-Pérez, Angel Plaza-Martínez, Maria J Hernández-Cádiz, Juan Soliveres-Ripoll, Cristina Solaz-Roldán, María M Morales-Suarez-Varela[show abstract] [hide abstract]
ABSTRACT: To assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA). Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ(2) tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models. Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2. The findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.Archives of medical science : AMS. 05/2012; 8(2):236-43.
Article: Indirect laryngoscopy with rigid 70-degree laryngoscope as a predictor of difficult direct laryngoscopy.Jorge Sánchez-Morillo, María J Estruch-Pérez, Maria J Hernández-Cádiz, José M Tamarit-Conejeros, Lorena Gómez-Diago, Maite Richart-Aznar[show abstract] [hide abstract]
ABSTRACT: The commonly-used predictors for difficult airway management are not very accurate. We investigate the power of indirect laryngoscopy with the rigid 70-degree laryngoscope as a predictor of difficult visualisation of the larynx with direct laryngoscopy. We performed preoperative indirect laryngoscopy with the rigid laryngoscope on 300 patients. The vision obtained was classified into four grades: 1 (vocal cords visible), 2 (posterior commissure visible), 3 (epiglottis visible) and 4 (no glottic structure visible). Grades 3 and 4 were considered predictors of difficult larynx visualisation. Next, direct laryngoscopy with the Macintosh laryngoscope was carried out on the patients under general anaesthesia. Positive value was defined as a Cormack and Lehane III and IV. Other common clinical predictors were also analysed. A logistic regression model using the relevant variables was elaborated. We also investigated predictors of difficult visualisation of the larynx with indirect laryngoscopy. The model found and the coefficients for preparing it were: f(x)= -10.097+5.145 indirect laryngoscopy (3-4)+3.489 retrognathia+2.548 mouth opening <3.5 cm+1.911 thyromental distance <6.5 cm+.352 snorer+(0.151 cm neck thickness). This model provided a correct result in 94.3% of cases. In the case of indirect laryngoscopy, the model found was: f(x)=-2.641+0.920 snorer+0.875 cervical mobility. Indirect laryngoscopy was the independent variable with the greatest predictive power. Snoring is a common predictor in both laryngoscopy models.Acta Otorrinolaringológica Española 03/2012; 63(4):272-9.
María J Estruch-Pérez, Juan Soliveres-Ripoll, Josep Balaguer-Domenech, Lorena Gómez-Diago, Alicia Sanchez-Hernandez, Cristina Solaz-RoldánEuropean Journal of Anaesthesiology 01/2012; 29(5):247-9. · 2.23 Impact Factor
Chapter: Intraoperative Anesthetic Management for Vascular and Endovascular Abdominal Aortic Surgery11/2011; , ISBN: 978-953-51-0328-8
Article: Bispectral index variations in patients with neurological deficits during awake carotid endarterectomy.María J Estruch-Pérez, Manuel Barberá-Alacreu, Alicia Ausina-Aguilar, Juan Soliveres-Ripoll, Cristina Solaz-Roldán, María M Morales-Suárez-Varela[show abstract] [hide abstract]
ABSTRACT: The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia. Seventy consecutive carotid endarterectomies under regional anaesthesia were divided into two surgical groups: patients with and patients without neurological deficits. Patients' neurological status was evaluated and neurological deficits were compared with BIS values. Measurements were made at different surgical stages: baseline, after sedation, at the beginning of surgery, at preclamping, at the 3 min clamping test, during shunt insertion, at declamping, 15 min after declamping and at the end of surgery. We performed intergroup and intragroup comparisons of BIS values. A decrease in BIS of at least 10 associated with neurological deficits was taken as the cut-off point for the classification of patients with logistic regression models (crude and adjusted for potential confounders). Thirteen patients (18.6% of the total) developed clinical cerebral ischaemia, though BIS values decreased in 10 of these patients (76.9%). The mean BIS values were 92.5+/-5.6 and 84.7+/-12.3 for patients without and with neurological deficits, respectively (P value<0.05). The odds ratios of a BIS decrease associated with neurological deficits were 8.5 (95% confidence interval 2.1-35.1) and 5.4 (95% confidence interval 1.2-24.3) adjusted for contralateral stenosis. Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.European Journal of Anaesthesiology 04/2010; 27(4):359-63. · 2.23 Impact Factor