R Rodríguez

Hospital Clínico Universitario de Valladolid, Valladolid, Castille and León, Spain

Are you R Rodríguez?

Claim your profile

Publications (9)2.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the influence of early (first day) postoperative factors on postoperative course in patients who have undergone heart surgery. A cross-sectional study of consecutively enrolled heart surgery patients was designed. We recorded central venous pressure, time required for rewarming to a core temperature of 35.5degrees C, and total fluids administered in 24 hours. We then analyzed their influence on mortality and cardiac, pulmonary, and renal complications. Two hundred thirty-six patients were included. Central venous pressure over 18 mm Hg, time to rewarming over 6 hours, and administration of more than 5 L of fluids in the first 24 hours were factors associated with increased mortality and the development of cardiovascular, pulmonary, and renal complications. Central venous pressure, rewarming time, and fluid replacement volume required on the first day are predictors of postoperative course.
    Revista espanola de anestesiologia y reanimacion 01/2009; 55(10):605-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Systemic inflammatory response frequently occurs after coronary artery bypass surgery and is strongly correlated with the risk of postoperative morbidity and mortality. This study tests the hypothesis that the priming of the extracorporeal circuit with colloid solutions results in less inflammation in patients undergoing cardiac surgery than priming with crystalloid solutions. A prospective, randomized study was designed. Forty-four patients undergoing elective coronary artery bypass grafting were randomly allocated to one of two groups: 22 patients primed with Ringer's lactate (RL) solution and 22 patients primed with gelatin-containing solution during the surgery. Plasma levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP) and, complement 4 were measured during the surgical intervention and over the following 48 postoperative hours. Cytokine levels were measured by enzyme-linked assays from plasma samples obtained at specific time points pre- and post-operatively. In both groups the serum levels of the pro-inflammatory cytokines (IL-6, IL-8, TNF-alpha), CRP, complement 4, and leukocytes increased significantly over the baseline, although no significant differences were observed between the two groups. The operation time, blood loss, need for inotropic support, extubation time, and length of intensive care unit stay did not differ significantly between the two groups. Priming with gelatin vs. RL produces no significant differences in the inflammatory response in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
    Acta Anaesthesiologica Scandinavica 11/2008; 52(9):1204-12. DOI:10.1111/j.1399-6576.2008.01758.x · 2.31 Impact Factor
  • Revista espanola de anestesiologia y reanimacion 01/2008; 55(10). DOI:10.1016/S0034-9356(08)70671-6
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the effects of spinal and intravenous administration of morphine to supplement anesthesia with remifentanil in terms of analgesia during early postoperative recovery and considering time until extubation. This prospective, randomized, blinded trial enrolled 59 patients scheduled for cardiac surgery. The patients were assigned to receive either a spinal infusion of morphine (15 microg x Kg(-1)) or an intravenous infusion (0.3 mg x Kg(-1)). Anesthesia was maintained with 0.15 to 0.50 microg x Kg(-1) x min(-1) of remifentanil and 2 to 4 mg x Kg(-1) x h(-1) of propofol in perfusion. After the period of extracorporeal circulation, all patients were given an intravenous infusion of 30 mg of ketorolac. Later intravenous ketorolac was ministered at a dose of 30 mg per 8 hours; intravenous morphine (bolus dose of 3 mg) was also administered until pain was relieved. The same quality of postoperative analgesia and anesthetic recovery was achieved with both spinal and intravenous administration. The incidence of side effects was also similar. Likewise, the extubation times were similar in the 2 groups (spinal infusion group: 294.5 [SD, 150.5] minutes; intravenous group: 325.0 [139.9] minutes; P>0.05). Less postoperative intravenous morphine was administered in the first 24 hours to patients in the spinal morphine group (P<0.05) and fewer patients in that group required intravenous morphine boluses (P<0.05). Our study suggests that spinal morphine does not offer advantages over intravenous morphine with regard to postoperative analgesia, hemodynamic stability and respiratory parameters, time until extubation, or adverse effects.
    Revista espanola de anestesiologia y reanimacion 03/2006; 53(3):145-51.
  • [Show abstract] [Hide abstract]
    ABSTRACT: min -1 de remifentanilo y 2-4 mg Kg -1 h -1 de propofol en perfusión. Después del periodo de circulación extracorpórea, a todos se les administró 30 mg IV de ketorolaco. Poste- riormente se administró ketorolaco IV (30 mg/8 horas) y bolus de morfina IV de 3 mg hasta el alivio del dolor. RESULTADOS: Con las dos pautas analgésicas (morfina IT y morfina IV) se alcanzó el mismo nivel de analgesia postoperatoria, recuperación anestésica y efectos secun- darios. Los tiempos de extubación fueron similares en los dos grupos (Grupo MIT: 294,5 ± 150,5 minutos; grupo MIV: 325,0 ± 139,9 minutos, p < 0,05). La dosis de mor- fina IV administrada durante las primeras 24 horas fue menor (p
  • 01/1974;
  • N. G. Peterova, R. Rodriguez
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND. Analysing the influence of immediate (first-day) postoperative factors as possible indicators of postoperative evolution among patients having undergone heart surgery. METHODS. A retrospective study of 236 patients consecutively undergoing heart surgery. A study was carried out of both pre- and intraoperative demographic and clinical characteristics. Among postoperative factors, study was made of the times for re-warming and removal of tubes, first-day pulmonary capillary wedge pressure (PCWP), the quantity of colloid fluids and total fluids administered during the first day of the postoperative period, complications (cardiac, pulmonary, renal, infectious, etc.) and postoperative mortality. RESULTS. The authors found a higher and statistically significant incidence of postoperative complications related with the PCWP at more than 18 mm Hg., a rewarming time in excess of six hours, and the administering of over one litre of colloid liquids and five litres of total liquids, during the first day of the postoperative period. CONCLUSIONS. PCWP, the re-warming time and fluids administered during the first day are determiners of postoperative evolution. OBJETIVOS. Analizar la influencia de factores del pre, intra y postoperatorio inmediato (primer día), como posibles marcadores de la evolución postoperatoria en los enfermos operados de cirugía cardiaca. MATERIALES Y MÉTODOS. Estudio retrospectivo sobre 236 pacientes intervenidos consecutivamente de cirugía cardiaca. Se estudiaron las características demográficas y clínicas preoperatorias e intraoperatorias. Dentro de los factores postoperatorios se estudió: tiempo de recalentamiento, tiempo de extubación, presión capilar pulmonar enclavada (PCWP) del primer día, volumen de fluidos coloides y fluidos totales administrados el primer día del postoperatorio, complicaciones postoperatorias (cardiacas, pulmonares, renales, infecciosas, etc.) y mortalidad postoperatoria. RESULTADOS. Se encontró una incidencia más elevada y estadísticamente significativa de complicaciones postoperatorias relacionadas con la PCWP mayor de 18 mmHg, tiempo de recalentamiento mayor de 6 horas y administración de líquidos coloides mayores de 1 litro y líquidos totales mayores de 5 litros, durante el primer día del postoperatorio. CONCLUSIONES. La PCWP, el tiempo de recalentamiento y los líquidos administrados el primer día son determinantes de la evolución postoperatoria.
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJETIVE. Systemic inflammatory response frequently occurs after coronary artery bypass surgery and is strongly correlated with the risk of postoperative morbidity and mortality. This study tests the hypothesis that the priming of the extracorporeal circuit with colloid solutions results in less inflammation and reduces the protein plasma levels in the acute phase. METHODS. A prospective study was designed. Forty four patients undergoing elective coronary artery bypass grafting were allocated to one of two groups: 22 patients primed with Ringer�s lactate solution and 22 patients primed with gelatin-containing solution during coronary artery bypass surgery. Plasma levels of interleukin IL-6, C-reactive protein, complement 4, and SIRS score were measured during the surgical intervention and over the following 48 postoperative hours. Interleukine 6 levels were measured by enzyme-linked, total C4 and CRP were determined by nephelometry. RESULTS. No significant differences were noted between the two groups with respect to the perioperatory variables, the acute-phase protein levels, or the post-cardiopulmonary bypass complications. In both groups, compared with the initial levels, IL-6 levels peaked at 6 hrs after surgery and CRP at 48 hrs. Complement 4 levels decreased from the start of the cardiopulmonary bypass and returned progressively toward the baseline value at 48 hrs after surgery. CONCLUSIONS. Priming with gelatin versus Ringer�s lactate produces no significant differences in the inflammatory response in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. OBJETIVO. La respuesta inflamatoria que se produce después de las intervenciones de cirugía de bypass aorto-coronario se relaciona con la morbilidad y mortalidad. En este estudio planteamos la hipótesis que el purgado del circuito de circulación extracorpórea con colides produce un síndrome respuesta inflamatorio sistémico (SRIS) de menor intensidad y se acompaña de concentraciones sanguíneas más bajas de proteínas de fase aguda. MATERIAL Y MÉTODO. Se diseñó un estudio prospectivo en el que se incluyeron pacientes sometidos a intervenciones de cirugía electiva de pontaje aorto-coronario. Se incluyeron en el estudio 44 pacientes que fueron divididos en dos grupos: 22 pacientes con cebado de Ringer Lactato (RL; B. Braum, Melsungen, Alemania) (grupo RL) y 22 pacientes con cebado conteniendo gelatina (Gelafundina; B. Braun, Suiza) (grupo GEL) en la circulación extracorpórea (CEC). Se midieron las concentraciones plasmáticas de interleukina-6, protein C reactiva (PCR) y complement-4 (C-4) y la escala del SRIS, durante la intervención y las primeras 48 horas del postoperatorio. IL-6 se determinó por ELISA, C4 y PCR se determinaron por nefelometría. RESULTADOS. No se observaron diferencias significativas entre ambos grupos en las variables perioperatorias, en la concentración de IL- 6, C-4 y PCR, ni en las complicaciones después de la derivación cardiopulmonar. En ambos grupos, las concentraciones máximas de IL-6 se observaron a las 6 horas después de la cirugía (p < 0.0001) y las de PCR a las 48 horas (p < 0.0001). Las concentración de C4 descendieron (p < 0.0001) al inicio de la derivación cardiopulomnar volviendo a la normalidad a las 48 horas (p > 0.05). CONCLUSIONES. El purgado del bypass cardiopulmonary con gelatin versus ringer no produce diferencias significativas en la intensidad del SRIS y en las concentraciones sanguíneas de proteínas de fase aguda.