Publications (5)0 Total impact
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Article: [Airway pressure monitoring by the continuous flow method in paediatric thoracoscopic surgery. A study in an animal model].
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ABSTRACT: To compare the airway pressures obtained before the endotracheal tube with the intratracheal ones in the continuous flow ventilation mode, in thoracoscopic surgery for one lung ventilation, in a paediatric model in animals. A simple prospective observational study was conducted. Ten Large White pigs weighing 4.6±0.8kg were used. The animals were ventilated in neonatal mode (continuous flow) with a Temel Supra ventilator. Using tracheotomy, we completely sealed the respiratory system in order to use tubes without special endotracheal cuffs, which would enable tracheal pressures to be registered without interfering with ventilation. Collapse of the right lung was performed by videothoracoscopy and was maintained for 120min. The variables were measured at 10 time periods: start and 5min with both lungs, after collapse at 5, 15, 30, 60, 90 and 120min, and 5 and 15min after lung re-expansion. We recorded the baseline, peak, plateau and positive end expiratory pressure in the mouth of the animal and intratracheal. The mean peak pressure in the mouth of the animal in one lung ventilation was 23.38mmHg and tracheal ventilation was 21.24mmHg, while the mean plateau pressure in the mouth of the animal in one lung ventilation it was 21.88mmHg and tracheal was 21.39mmHg, respectively, with significant differences in all of them (P<.05). We found statistically significant differences (P<.05) for peak and plateau pressure on comparing the record in the animal mouth with the tracheal record. The difference in absolute value was higher for the peak pressure record. The pressure parameters recorded in the animal mouth were acceptable for surgery, with a suitable respiratory and haemodynamic stability being maintained. We can state that the continuous flow mode according to the pressures study may be suitable for this type of surgery, and that the mouth of the animal (patient) record for the peak pressure does not reflect what really happens in the alveoli, but we can give a suitable clinical estimate for the plateau pressure.Revista espanola de anestesiologia y reanimacion 07/2012; 59(7):363-9. -
Article: [Patient with right ventricular arrhythmogenic dysplasia, ascites and ulcerative colitis: anesthetic management during major abdominal surgery].
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ABSTRACT: A 43-year-old man with ulcerative colitis was scheduled for pancolectomy owing to adenomatous transformation of polyps. The patient had right ventricular arrhythmogenic dysplasia, with deteriorating ventricular function, and carried an automatic implantable defibrillator. We discuss the general features of arrhythmogenic right ventricular dysplasia and its implications for management and monitoring during major abdominal surgery. Perioperative management of a patient with an implantable defibrillator is also discussed, with special attention to the influence of electromagnetic interference that can affect how the device functions during surgery. Finally, we list signs that should lead to suspicion of arrhythmogenic right ventricular dysplasia in an asymptomatic patient.Revista espanola de anestesiologia y reanimacion 01/2006; 52(10):631-3. -
Article: [Anesthetic management for thoracoscopic repair of type I esophageal atresia with continuous-flow single-lung ventilation].
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ABSTRACT: We describe a continuous flow mode of ventilation for repair of type I esophageal atresia in an infant. This type of atresia is defined by distal stenosis of the esophagus with a proximal blind pouch and no connection to the tracheobronchial tree. In traditional repair procedures the surgical approach is by thoracotomy, but newer videoassisted thoracoscopic techniques have introduced novel challenges to ventilatory mechanics in these low-weight infants. The literature contains little discussion of the anesthetic management or respiratory mechanics of these patients. Trying to maintain adequate tidal volume and oxygenation while thoracoscopic maneuvers take place increases the risk of barotrauma. Single-lung ventilation with a continuous flow respirator was effective in the case we report.Revista espanola de anestesiologia y reanimacion 11/2005; 52(8):499-502. -
Article: [Proposed experimental model to provide training in the management of anesthesia in liver transplantation].
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ABSTRACT: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting.Revista espanola de anestesiologia y reanimacion 58(6):345-52. -
Article: Manejo anestésico de un paciente con displasia arritmogénica de ventrículo derecho, ascitis y colitis ulcerosa para una cirugía abdominal mayor
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ABSTRACT: Summary A 43-year-old man with ulcerative colitis was sched- uled for pancolectomy owing to adenomatous transfor- mation of polyps. The patient had right ventricular arrhythmogenic dysplasia, with deteriorating ventricu- lar function, and carried an automatic implantable de- fibrillator. We discuss the general features of arrhyth- mogenic right ventricular dysplasia and its implications for management and monitoring during major abdomi- nal surgery. Perioperative management of a patient with an implantable defibrillator is also discussed, with spe- cial attention to the influence of electromagnetic interfe- rence that can affect how the device functions during surgery. Finally, we list signs that should lead to suspi- cion of arrhythmogenic right ventricular dysplasia in an asymptomatic patient.
