Actualizaciones en Anestesiologia y Reanimacion

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ISSN 1132-0095

Publications in this journal

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    ABSTRACT: Formación en anestesia regional guiada por ultrasonidos Training in regional anaesthesia M. Calvo, M. López Martínez, N. Brogly, A. Sancho, A. Abad, F. Gilsanz Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Hospital Universitario La Paz. Madrid Correspondencia: Fernando Gilsanz Rodríguez. Servicio de Anestesia, Reanimación y Tratamiento del Dolor. Hospital Universitario La Paz. Paseo de la Castellana, 261. 28046 Madrid e-mail: fernando.gilsanz@salud.madrid.org Resumen Programa de formación de médicos residentes en anestesia regional guiada por ecografía. Cronograma y objetivos. Palabras clave: Anestesia regional, Ecografía, Cronograma, Abstract Guidelines for the training of residents in the domain of regional anaesthesia with ecography. Objetives and development. Key words: Regional anaesthesia, Ecography, Development,
    No preview · Article · Apr 2014 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Pheochromocytomas are rare neuroendocrine tumors with a highly variable clinical presentation usually includes high blood pressure, headache and sweating. Patients with pheochromocytoma may develop potentially lethal cardiovascular complications without adequate perioperative management, including cardiomyopathy. These complications are due to the secretion of catecholamines. During the preoperative period the patient should be prepared pharmacologically to prevent a hypertensive crisis during surgery. Three intraoperative periods are the most critical for the patient: intubation, surgical manipulation of the tumor and ligation of venous drainage of the tumor. The first two are associated with catecholamine release, and the latter to a relative deficiency of these; this stage after tumor resection is characterized by a severe hypotension requiring anesthesiologic care as their consequences can become serious complications . Knowledge of the alterations caused by the secretion of catecholamines and therapeutic options for treatment are essential to reduce the risk in this surgery, which is a challenge for the anesthesiologist.
    No preview · Article · Jun 2013 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: ¿Puede el sugammadex salvar a un paciente en situación “no intubable no ventilable”? A propósito de un caso. Autores Gutiérrez García R. / Abad Gurumeta A. / Resumen Mujer de 43 años, programada para tiroidectomía total por bocio multinodular, a quien fue imposible intubar tras la inducción de la anestesia general mediante fentanilo, propofol y rocuronio. Tras tres intentos de intubación, el edema y el sangrado de la vía aérea por manipulación impidieron una adecuada ventilación. El sugammadex no solo permitió revertir la función neuromuscular sino también el restablecimiento de la ventilación espontánea antes de alcanzar una desaturación de hemoglobina crítica. Se analiza el impacto clínico que en la actualidad puede representar el sugammadex en una situación real de “no intubable no ventilable” y como puede influir en el algoritmo de vía aérea difícil de la American Society of Anesthesiologists (ASA). Palabras clave: Sugammadex. Vía aérea difícil. No intubable no ventilable. Bloqueo neuromuscular. Cirugía mayor ambulatoria. Curarización residual. Abstract ABSTRACT Woman, 43 years, scheduled for total thyroidectomy for multinodular goiter, who was unable to intubate after induction of general anesthesia with fentanyl, propofol and rocuronium. After three attempts at intubation, swelling and bleeding of the airway manipulation prevented adequate ventilation. Sugammadex not only allowed but reverse neuromuscular function also restoring spontaneous ventilation before reaching a critical hemoglobin desaturation. We analyze the clinical impact that today may represent the sugammadex in a real situation of "no intubable not breathable" and how it can influence the difficult airway algorithm of the American Society of Anesthesiologists (ASA). Key words: Sugammadex. Difficult airway. Not intubable not ventilable. Neuromuscular blockade. Ambulatory surgery. Residual curarization.
    No preview · Article · Oct 2012 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Nuevos horizontes en la anestesia actual con el Sugammadex / New horizons in current anesthesia with Sugammadex Gutiérrez García, R; Abad Gurumeta, A. Actual. anestesiol. reanim; 22(2): 9-12[2], abr.-jun. 2012. Artigo em Espanhol | IBECS (Espanha) | ID: ibc-101634 Resumo Desde la introducción del curare en la anestesia clínica en 1942, la utilidad de los bloqueantes neuromusculares se ha descrito ampliamente en la literatura. Pero a pesar de sus beneficios, siguen teniendo una serie de limitaciones importantes. La dosis del bloqueante neuromuscular durante la intubación orotraqueal continúa siendo un problema debido a la duración clínica de su efecto en cirugías de corta o mediana duración. También estamos muy limitados ante la necesidad urgente de una reversión inmediata en una situación ôno intubable no ventilableö. Además en cirugía mayor ambulatoria, se continúa pagando el precio de una duración larga del bloqueante neuromuscular al no tener una reversión rápida y predecible del mismo. Por otra parte, también estamos muy limitados para conseguir unas condiciones quirúrgicas óptimas con un bloqueo profundo hasta el final de cirugías exigentes que lo precisan, debido al problema de la curarización residual. Por todo esto, se analiza el impacto clínico del sugammadex desde su introducción hace cuatro años y cómo nos está ayudando a salvar todas estas limitaciones, abriéndonos puertas a nuevos escenarios en nuestra práctica clínica(AU) Since the introduction of curare in clinical anesthesia in 1942, the utility of neuromuscular blocking agents has been widely described in literature. But despite its benefits, are still a number of important limitations. The dose of neuromuscular blocker during tracheal intubation remains a problem due to the clinical duration of effect in surgery for short or medium term. We are also limited to the urgent need for an immediate reversal in a "cannot intubate cannot ventilateö situation. Also in ambulatory surgery, continue paying the price for a long duration of neuromuscular blocking by not having a predictable and rapid reversal of it. Moreover we are bound to get optimal surgical conditions with a profound block to the end of demanding surgeries that require it due to the problem of residual curarization. For all this, we analyze the clinical impact of sugammadex since its introduction four years ago and how is helping to save all these limitations, opening doors to new scenarios in our clinical practice(AU) Assuntos Humanos Masculino Feminino Anestesia/métodos Anestesia/tendências Bloqueadores Neuromusculares/administração & dosagem Bloqueadores Neuromusculares/uso terapêutico Intubação/instrumentação Intubação/métodos Estágio Clínico/métodos Estágio Clínico/tendências Anestesiologia/métodos Bloqueadores Neuromusculares/metabolismo Bloqueadores Neuromusculares/farmacologia Bloqueadores Neuromusculares/farmacocinética Estágio Clínico/organização & administração Estágio Clínico/normas Biblioteca responsável: ES1.
    No preview · Article · Apr 2012 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: NOVEDADES EN EL USO CLÍNICO DEL SUGAMMADEX A. Abad Gurumeta1, R. Gutierrez García1, T. López Quesada2, J. M. Calvo Vecino3 1Médico adjunto. Servicio de Anestesiología y Reanimación. Hospital Universitario Infanta Sofía. San Sebastián de los Reyes. Madrid. 2D.U.E. Enfermería del Bloque Quirúrgico. Hospital Universitario Infanta Sofía. San Sebastián de los Reyes. Madrid. 3Jefe del Servicio de Anestesiología y Reanimación. Complejo Hospitalario Universitario Infanta Leonor. Madrid. REALIZACIÓN Y DESARROLLO DEL TRABAJO Hospital Universitario Infanta Sofía. San Sebastián de los Reyes. Madrid DIRECCIÓN DE CONTACTO Alfredo Abad Gurumeta Servicio de Anestesiología y Reanimación Hospital Universitario Infanta Sofía Paseo de Europa, 34 28702 San Sebastián de los Reyes, Madrid. E-mail: alfredo.abadg@gmail.com CONFLICTO DE INTERESES La realización del artículo no ha sido financiada o subvencionada por ninguna Firma comercial o Entidad privada. Los autores han impartido ponencias financiadas por MSD. Resumen El uso del sugammadex en la práctica clínica ha producido una revolución en el campo de la reversión del bloqueo neuromuscular no despolarizante (BNMND) del grupo de los aminoesteroideos, especialmente rocuronio y vecuronio. Se exponen las últimas novedades en el uso clínico del sugammadex en las poblaciones y patologías especiales, junto con las últimas publicaciones de ensayos clínicos y nuestra experiencia como centro de referencia en la monitorización del bloqueo neuromuscular, así como las nuevas posibilidades terapéuticas del fármaco y las situaciones clínicas con las que el anestesiólogo puede encontrarse en su práctica clínica. Se precisan todavía estudios para poder conocer todas las posibilidades de los usos clínicos del sugammadex en la práctica anestésica. Igualmente, hay un amplio margen para la investigación y el desarrollo de nuevas publicaciones de un fármaco que podría reducir a cero los problemas de la curarización residual, siendo su principal inconveniente su elevado precio. Palabras clave: Sugammadex. Rocuronio. Curarización residual. Bloqueo neuromuscular Abstract The use of sugammadex in clinical practice has been a revolution in the field of neuromuscular blockade reversal of no depolarizing (BNMND) group of the aminosteroid, especially rocuronium and vecuronium. We describe the latest developments in clinical use of sugammadex in special populations and conditions, the latest publications of clinical trials and our experience as a reference center for monitoring of neuromuscular blockade, and moreover new therapeutic possibilities of the drug for different clinical situations that the anaesthesiologist can be found in their clinical practice. Studies are required to know all possibilities of clinical use of sugammadex in anaesthetic practice. Furthermore, there are great possibilities for research and development of new publications of a drug that could reduce to zero problems of residual curarization. However, the high price it is the main disadvantage. Key words: Sugammadex. Rocuronium. Residual neuromuscular blockade. Neuromuscular blockade
    No preview · Article · Apr 2012 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Indirect calorimetry could be an indicator of homeostatic changes during surgery. Stress increases oxygen consumption (VO2) and during anesthesia there is a decrease of VO2 arises from the absence of kinetic energy. The answer is cellular metabolism to the surgical trauma and anesthesia. More studies are necessary to know which of the VO2 measurement systems is the most appropriate in anesthesia, and what may be the limiting values of VO2 from which the anesthesiologist must consider immediate action or avoid making them.
    No preview · Article · Oct 2010 · Actualizaciones en Anestesiologia y Reanimacion

  • No preview · Article · Oct 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: In the last 30 years, some non invasive methods have developed to prevent and detect the occurrence of a stroke during carotid artery surgery. These methods, based mostly on monitoring blood flow (transcranial doppler, cerebral oximetry) and brain electrical activity (EEG, evoked potentials, bispectral index) give us information on the possible neuronal ischemic involvement. None of them has been able to build on the gold standard of monitoring, as they have a high percentage of false positives and negatives, even when mixed together. It remains to find and develop more reliable and reproducible method that is able to predict perioperative events that so far only the awake patient.
    No preview · Article · Oct 2010 · Actualizaciones en Anestesiologia y Reanimacion

  • No preview · Article · Oct 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Various forms of renal replacement therapies are available to treat acute kidney injury (AKI), like the intermittent haemodialysis, continuous haemofiltration, or hybrid forms which combine advantages of both are now available for application in cardiac surgery patiens. The severity of AKI, the aetiology, clinical and haemodynamic status of the patient may all influence the choice of the RRT strategy. AKI represents an independent risk factor for adverse outcomes in critically ill patients after cardiac surgery. Whether early initiation of RRT is associated with improved survival, is still unknown the duration they must have.
    No preview · Article · Oct 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Massive haemorrhage is an important cause of death, specially in trauma patients. Blood transfusion is a lifesaving procedure in this context. Associated coagulopathy in trauma patients is often seen. Its aggressive correction improves patients outcomes. Acidosis and hypothermia worsen politraumatism coagulopathy and must be prevented and rapidly treated. Massive transfusion is associated with poor outcomes, whatever is the cause of haemorrhage. Protocolized work looks the best way to manage this clinical challenge, based on hemodinamic and laboratory parameters. Recent protocols have purposed a 1:1 relation in red pack blood cells, fresh frozen plasma and platelets concentrates. The use of fibrinogen concentrates, prothrombin complex, activated VII factor or tranexamic acid should be under protocolized activity. We purpose a clinical protocol actually in use in our university hospital.
    No preview · Article · Jul 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Preeclampsia is a major cause of maternal mortality (15-20% in developed countries) and morbidities, perinatal deaths, preterm birth and intrauterine grow restriction. Refers to a syndrome characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is classified as mild or severe. Women with diagnosed preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status and severity of maternal condition at time of evaluation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. The aim of this article was to review literature and to make recommendations for diagnosis and treatment.
    No preview · Article · Jul 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: The development of surgical techniques increases complexity, particularly in cardiovascular and orthopedic surgery, cancer surgery, transplants and patients with multiple injuries has intensified the growing demands of transfusions. In recent years it has become necessary to minimize homologous blood transfusion by the possible adverse effects of immunological, and infection by viruses and prions. Recently, we have developed new therapeutic measures to minimize the use of homologous blood, mainly in elective surgery, among which the different modalities of postoperative autotransfusion.
    No preview · Article · Jul 2010 · Actualizaciones en Anestesiologia y Reanimacion

  • No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: In recent years there have been studies on the high incidence of residual block in clinical practice. The use of quantitative neuromuscular monitoring allows to tailor muscle paralysis and the proper recovery of the patient at the end of surgery, avoiding or reducing the incidence of residual paralysis, and serving as a guide for the use of reversers of the blockade. This review specifically describes the principles and practice of neuromuscular monitoring in clinical practice. It has conducted a review of medical literature up to December 2009 by searching the databases of evidence-based medicine, and bibliographic databases. Most of the references found were case series and review. The quantitative monitoring is an evidence-based practice to be consistently used whenever you use a neuromuscular blockade.
    No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    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.
    No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion

  • No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: To evaluate the nutritional state and total body water is fundamental for the evaluation and management of certain patients. Bioimpedanceometry is technology which measures the resistance of tissues and objects to an electric current and converts the data into nutritional and hydration states. In this way we can evaluate the state of a patient at a certain moment in time and monitor their evolution over time during certain pathological states. These measurements, which are collected in a non-invasive and rapid way, have become more precise and sophisticated with the development of better signal capturing systems and analytical algorithms. Thanks to bioelectrical impedance analysis it is possible to innocuously and precisely measure the body composition and state of hydration in both healthy and pathological patients. Data obtained using this system have a prognostic value for nutritional state, and, therefore constitute a validated, precise, non-invasive and simple method for measuring body composition. In this review we analyse the importance of knowing the body composition, the principles of bioimpedance, its applications in daily analysis as well as future fields of development.
    No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion
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    ABSTRACT: Latex allergy has increased in the last years up to turning into an important reason of morbidity and, nowadays, it is recognized as an international problem of health. It prevalence in the general population is concerning 1%, being able to increase up to 20% among the sanitary personnel. In the patients with latex allergy, when exist neither a specific definitive treatment nor an effective premedication, the only alternative is to avoid the exhibition. For it, the patients' identification is fundamental in addition with factors of risk of sensitization to the latex. The prevention has a fundamental role, but the ubiquity of the latex turns this prevention into a complex labour, which forces to consider changes in the sanitary assistance. In this review we will analyze the prevention of the allergy to the latex, doing emphasis in the importance of precocious diagnosis and education of the patients in order that they avoid the exhibition to the latex, as well as in the need of creation of multi-disciplinary and multiprofessional committees, which they could coordinate the medical attention that the patient allergic to the latex must receive from his revenue up to his discharge and develop rules of action to protect the workers of a hospital. We will insist on the significance of the decrease of the concentrations of latex on the environment.
    No preview · Article · Jan 2010 · Actualizaciones en Anestesiologia y Reanimacion