E. Alsina

Hospital Universitario La Paz, Madrid, Madrid, Spain

Are you E. Alsina?

Claim your profile

Publications (32)14.92 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Tissue injury secondary to surgical lesion produces profound changes in endocrine-metabolic function and defence mechanisms in the patient (inflammatory, immunological), leading to an increase in catabolism, immunosuppression and postoperative morbidity. The best anaesthetic and surgical technique should be capable of modulating this response, especially in major surgery, where it can be most harmful and increase patient morbidity. Many of the changes that maintain homeostasis are controlled by the hypothalamic-pituitary-adrenal axis. The autonomic-adrenal response is usually immediate, compared to the hypothalamus-pituitary gland, which is slower and longer lasting. Cytokine synthesis and release is one of the earliest stages in the response to tissue lesion. The most frequently studied cytokines in surgical stress response are IL-6 and TNF-α. Inflammatory mediator concentrations are direct indicators of perioperative stress, while haemodynamic changes are considered the indirect indicators of this response. Multiple anaesthetic techniques have been described to modify the stress response in patients undergoing elective surgery. The aim of this review is to present clinical evidence on perioperative stress modulation with different anesthetics. We also describe a different point of view in immunomodulation with the intraoperative management of haemodynamic responses with inhalational bolus of sevoflurane or with remifentanil intravenous bolus. The effects of sevoflurane used as an inhalational bolus to counteract patients' intraoperative haemodynamic responses modulates the immune response the same than opioid remifentanil.
    Current pharmaceutical design 03/2014; · 4.41 Impact Factor
  • Source
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: Small changes in the frequency of the electromyography could reflect an inadequate anesthetic or analgesic level, and it could be more specific than the hemodynamic monitors. The Datex-Ohmeda S/5 Entropy Module includes information about the electromyographic activity of the face muscles (response entropy--RE). The aim of our study is compare entropy and BIS ability to detect a nociceptive stimulus during a sevoflurane anesthesia. We designed an observational, prospective and descriptive study that included 20 patients. We performed sevoflurane anaesthesia induction, the end-tidal was kept at 3 and 4 %, during 15 min at each concentration, with no analgesic drug and no neuromuscular blocking agent, and we applied a nociceptive stimulus: tetanus 100 Hz, during 5 s. We set the standard monitorization, BIS, RE, and state entropy (SE) along the study. There was a significant difference between RE and SE post-noxious stimulus values at 3 and 4 % end-tidal sevoflurane (p < 0.05). Only RE changed significantly at the moment of the noxious stimulation at both sevoflurane concentrations studied (p < 0.05). In patients under general anesthesia only carried out with sevoflurane at concentrations that inhibit the movement to painful stimuli, the RE is a single parameter able to detect variations after the nociceptive stimulation.
    International Journal of Clinical Monitoring and Computing 03/2012; 26(3):171-5.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of levosimendan (Simdax(®)) was described in cases of acute cardiac failure in patients with peripartum cardiopmyopathy. We report the case of a 36 years old Philippine woman with an undiagnosed dilated myocardiopathy. She developed an acute severe left ventricular dysfunction in the early postpartum period after a cesarean section, possibly related to the recurrence of an unknown peripartum myocardiopathy. Due to failure of the conventional treatment with diuretics and inotropic support, an intra-aortic balloon with counter-pulsation was inserted. In rescue, treatment with levosimendan permitted to wean the patient from haemodynamic support, and a heart transplant was probably avoided. Three months later, a new echocardiography showed a persistent left ventricular dilation and a still marked alteration of left ventricular ejection fraction (28%).
    Annales francaises d'anesthesie et de reanimation 10/2010; 29(11):807-10. · 0.77 Impact Factor
  • E Guasch, F Gilsanz, J Díez, E Alsina
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND OBJETIVE: Epidural volume extension (EVE) with saline solution can contribute to greater cephalad spread of drugs injected into the subarachnoid space during cesarean section. We studied the incidence of material hypotension with spinal bupivacaine or levobupivacaine (L-bupivacaine) and the spread after epidural saline injection. After ethics committee approval, we randomized women scheduled for cesarean section to 4 groups to receive 5 mg of 0.25% bupivacaine with (n=51) or without (n=6) saline EVE; 5 mg of 025% L-bupivacaine (n=50); or 6 mg of 03% L-bupivacaine (n=50). All patients also received 25 microg of fentanyl per 2 mL of local hyperbaric spinal anesthetic. In all except the non-EVE group, 10 mL of saline was infused through an epidural catheter 5 minutes after anesthetic infusion. We recorded patient demographic data, procedural and anesthetic times, incision-clamping times, occurrence of hypotension, ephedrine dose required, motor and sensory blockade, requirement for rescue analgesics, and neonatal outcome. After 6 patients had been randomized to the non-EVE group, no further patients were assigned because all the women required rescue analgesics. Demographic data, duration of procedure, time between. incision and delivery, and Apgar scores were similar in all the groups. The incidence of hypotension was lower in the group receiving 5 mg of L-bupivacaine (26% vs. 52.9% in the bupivacaine 5-mg group, and 56% in the 6-mg L-bupivacaine group, P = .04). More women given 5 mg of L-bupivacaine required rescue analgesia (46%) than did those receiving 5 mg of bupivacaine (235%) or 6 mg of L-bupivacaine (28%) (P = .039). Hypotension was associated with a lower umbilical cord pH (P = .001). Ephedrine doses over 20 mg were also associated with a lower umbilical cord pH (P = .031). The incidence of hypotension was lowest in the group anesthetized with 5 mg of L-bupivacaine, but the need for rescue analgesia was greater in this group. Doses of 5 mg and 6 mg may be sufficient for cesarean section, as they provide a good level of sensory blockade.
    Revista espanola de anestesiologia y reanimacion 05/2010; 57(5):267-74.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of levosimendan (Simdax®) was described in cases of acute cardiac failure in patients with peripartum cardiopmyopathy. We report the case of a 36 years old Philippine woman with an undiagnosed dilated myocardiopathy. She developed an acute severe left ventricular dysfunction in the early postpartum period after a cesarean section, possibly related to the recurrence of an unknown peripartum myocardiopathy. Due to failure of the conventional treatment with diuretics and inotropic support, an intra-aortic balloon with counter-pulsation was inserted. In rescue, treatment with levosimendan permitted to wean the patient from haemodynamic support, and a heart transplant was probably avoided. Three months later, a new echocardiography showed a persistent left ventricular dilation and a still marked alteration of left ventricular ejection fraction (28%).
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2010; 29(11):807-810.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gas analysers are based on physical principles. They improve accuracy; they can provide continuous breath-to-breath measurement. We describe infrared absorption, ultraviolet absorption, thermal conductivity, electrode of CO 2, electrodes transcutaneous, intravascular probes and end tidal CO2 measurement. Copyright © 2010 Aran Ediciones, s. l.
    Actualizaciones en Anestesiologia y Reanimacion 01/2010; 20(1):4-10.
  • European Journal of Anaesthesiology 07/2009; 26(9):801-3. · 2.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the management of severe postpartum hemorrhage. Prospective observational study from July 2005 to November 2007 in women who were admitted to the recovery unit of a tertiary referral hospital due to postpartum hemorrhage. We analyzed incidence, prevalence, morbidity, mortality, and associated risk factors. The study included 21,726 deliveries (124 with severe bleeding). Postpartum hemorrhage was more common after an instrumental delivery (odds ratio [OR], 4.54) and after a cesarean delivery (OR, 2.86). The risk factors identified in the study population were multiple gestation pregnancy and fetal death. One patient died due to disseminated intravascular coagulation. The main causes of bleeding were uterine atony (45.2%) followed by vaginal tearing (26.6%). Treatment was provided using packed red blood cells in 96.8% of the patients, fibrinogen in 49.2%, prothrombin complex in 7.25% and activated factor VII in 3.2%. Selective arterial embolization was performed in 10.5% of the cases (success rate, 84.6%) and hysterectomy was required in 13.7%. The main complications were need for postoperative mechanical ventilation (11.3%), myocardial ischemia (4%), pulmonary edema (4.8%), acute renal failure (8.9%), ventricular fibrillation (0.8%), and death (0.8%). The incidence of severe postpartum hemorrhage in patients treated at our hospital is low, as is the mortality rate. Use of fibrinogen is common and provides good results. Angiographic embolization is very effective, though the percentage of hysterectomies is still high. Multiple gestation pregnancy and fetal death are associated risk factors.
    Revista espanola de anestesiologia y reanimacion 04/2009; 56(3):139-46.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have assessed the efficacy and safety of continuous spinal anesthesia in obstetrics, although placement of a catheter in the intrathecal space theoretically offers advantages in these patients. Ninety-two women scheduled for elective cesarean delivery using continuous spinal anesthesia with the catheter-over-needle technique (22- or 24-gauge Spinocath) were included in the study. The doses of local anesthetic used, hemodynamic variables, use of ephedrine and other drugs, and incidence of complications such as technical failure and postdural puncture headache (PDPH) were recorded. The mean (+/-SD) dose of hyperbaric bupivacaine used was 8.2+/-1.8 mg. The incidence of hypotension was 30% and the mean total dose of ephedrine was 4+/-7 mg. The continuous spinal anesthetic technique failed in 18 women (20%). The overall incidence of post-dural-puncture headache was 29%; 18% of patients with post-dural-puncture headache required a blood patch. Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice.
    International journal of obstetric anesthesia 03/2009; 18(2):137-41. · 1.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Monitoring of respiratory gases (oxygen, carbon dioxide, nitrous oxide, volatile agents), is considered highly important for the practice of anaesthesia and also a standard monitoring technique during anaesthesia. Paramagnetic oxygen analysers are the most common form of oxygen analyser used for monitoring inspired oxygen levels. Paramagnetic and mass spectrometer methods are suitable for analysis of respiratory gas mixtures. Fuel cell and polarographic methods are suitable for blood gas analysis. Mass spectrometry is a very accurate technique. Copyright © 2009 Aran Ediciones, S. L.
    Actualizaciones en Anestesiologia y Reanimacion 01/2009; 19(3):98-104.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Labour pain is individually felt by women and it can be the most painful experience that a woman can feel in all the life. That is the reason because the analgesic offer for labour pain should be wide and adapted to individual needs and adapted too to the environmental conditions (hospital and not hospital labour). The most effective technique for labour pain is epidural or neuraxial analgesia. This technique is sometimes unavailable for different reasons, such as: contraindication, not available in hospital, and woman's refusal. Non pharmacological techniques can be offered to laboring women, as example: acupuncture, massage, emotional support, etc. Its efficacy is variable and not completely studied. Systemic analgesia is another analgesic option and we remark the use of pethidine, as the most popular opioid for labour pain, and remifentanil, as a recently developed analgesic option. Self-administered inhalatory drugs have been commonly used in United Kingdom in the last century, although its use in Spain is nowadays unusual. Opioids and inhalatory drugs must be delivered in a hospital, with protocols and specialist medical care, what means the anesthesiologist guard duty. Copyright © 2009 Aran Ediciones, S. L.
    Actualizaciones en Anestesiologia y Reanimacion 01/2009; 19(3):105-112.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Massive obstetric haemorrhage is a very important cause of maternal morbidity and mortality in developed countries and in third world countries. Massive obsteric haemorrhage has a coagulopathic component and a vascular or surgical component that are often associated in the same patient. Nearly two thirds of patients cannot be identified with risk factors for obstetric haemorrhage, although a good knowledge and early identification of associated risk factors is helpful for its prevention in many cases. Obstetric haemorrhage is not always adequately identified or treated, because blood loss is underestimated by clinical observation. Postpartum haemorrhage is the cause of 95% of all obstetric haemorrhages. In this group, the main cause is uterine atony. Women's resuscitation objective is thr intravascular volume restoration, to reach and adequate tissue perfussion pressure. Once an obstetric haemorrhage is diagnosed, it is very important a coordinated, rapid and protocolized treatment. Rational use of blood components, team work with the blood bank, the use of pharmacological and surgical resources readily, are necessary actions in this context. It is highly recommended prompt implication of senior staff in severe obstetric haemorrhage resolution. It is recommended the use of local protocols for each maternity. This protocol must be known by all team members and it must be adapted to local hospital characteristics, and should be periodically revised. High risk patients for obstetric haemorrhage, must be transferred to a level III hospital where all resources can be used if necessary. Copyright © 2009 Aran Ediciones, S. L.
    Actualizaciones en Anestesiologia y Reanimacion 01/2009; 19(2):49-60.
  • Revista espanola de anestesiologia y reanimacion 03/2008; 55(2):127-8.
  • Revista espanola de anestesiologia y reanimacion 02/2008; 55(2):127–128.
  • International Journal of Obstetric Anesthesia 02/2007; 16(1):91-3. · 1.80 Impact Factor
  • European Journal of Anaesthesiology - EUR J ANAESTH. 01/2007; 24:143-144.
  • European Journal of Anaesthesiology - EUR J ANAESTH. 01/2006; 23:188-189.
  • European Journal of Anaesthesiology - EUR J ANAESTH. 01/2006; 23.