Francisco Reinoso-Barbero

Hospital Universitario La Paz · Servicio de Anestesia y Reanimación

Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional...

Los resultados del proyecto de Acompañamiento parental dentro del quirófano durante la inducción anestésica del Bloque Quirúrgico del Hospital Infantil La Paz demuestran que los niños cuando son acompañados por sus padres tienen mucho menor estrés y ansiedad al entrar en el quirófano, lo cual condiciona mayor cooperación en la inducción anestésica...

Resumen Introducción El dolor crónico afecta a un porcentaje significativo de la población pediátrica en los países desarrollados, y puede tener una causa médica bien definida en el dolor crónico secundario (DCS), o desconocida en el dolor crónico primario (DCP). En España, hasta el momento, no existe información acerca de las diferencias clínicas...

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective...

PurposeThe Sciatic Nerve Division (SND) into the Common Peroneal Nerve and Tibial Nerve presents a great anatomical variability in its location in the thigh, but the influence of age on it has not been fully addressed.Methods Anatomical distances from greater trochanter to SND and from SND to popliteal crease were obtained by ultrasound examination...

Atelectasis is one of the most common respiratory complications in pediatric patients after open-heart surgery, and may lead to weaning failure and increased morbidity. We report the use of an original, minimally invasive approach to refractory left lung atelectasis after repair of an aortic coarctation in a 2 month-old infant, in which a CPAP syst...

Family heart diseases related to sudden death are a group of cardiovascular diseases (cardiomyopathies, channelopathies, aortic diseases …) that require familiarity of the anesthesiologist with the perioperative treatment of complex hemodynamic disorders, as well as their surgical treatment.¹ We present the case of a 12-year-old man diagnosed with...

Resumen Las atelectasias postoperatorias en pacientes pediátricos sometidos a cirugía cardíaca son muy frecuentes y condicionan un fracaso en el destete con un notable aumento de la morbilidad y estancia en unidades de cuidados críticos. Presentamos un abordaje original y endoscópico para atelectasias refractarias a otras terapias a raíz de un caso...

Background. In the last two decades, pediatric patients have been identified as particularly vulnerable to the acute and chronic consequences of pain, and valid tools have been developed for the measurement and treatment of chronic pain in children. However, we do not know to what extent Spanish children receive the indicated multidisciplinary trea...

Objective To improve understanding of current practices in the treatment of children and adolescents with chronic pain in Spain. Methods A web-based survey was conducted with a representative sample of healthcare professionals (i.e. general practitioners [GP] and pediatricians [P]) in Spain. The survey included 23 questions on the pain education a...

Resumen Las cardiopatías familiares relacionadas con la muerte súbita son un grupo de enfermedades cardiovasculares (miocardiopatías, canalopatías, enfermedades aórticas…) que requieren familiaridad del anestesiólogo con el tratamiento perioperatorio de los trastornos hemodinámicos complejos, así como con el tratamiento quirúrgico de los mismos¹. P...

[This corrects the article DOI: 10.2196/16013.].

Background: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. Methods: Our cohort includ...

BACKGROUND Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the Madrid region. This article describes the first 2226 consecutive adult patients with COVID-19 admitted to the La Paz University Hospital in Madrid. METHODS Our cohort included all...

Background Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings. Objective The main objective of this study was to assess the association between the use of EVGs and the intensity of pai...

Introduction The digital version of the assessment scales recommended for the pediatric patient could contribute to its improvement and to implement the quality indicators described for the management of acute pain. Material and methods Psychometric validation (validity and reliability) of pain assessment and treatment side effects scales incorpor...

Infection is the leading cause of non-relapse-related mortality after allogeneic haematopoietic stem cell transplantation (HSCT). Altered functions of immune cells in nasal secretions may influence post HSCT susceptibility to viral respiratory infections. In this prospective study, we determined T and NK cell numbers together with NK activation sta...

Introduction: The digital version of the assessment scales recommended for the pediatric patient could contribute to its improvement and to implement the quality indicators described for the management of acute pain. Material and methods: Psychometric validation (validity and reliability) of pain assessment and treatment side effects scales inco...

Fundamentos: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o p...

Objective: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs...

Background: Pain management is a challenge and effective treatment requires professionals to collaborate if they are to address the needs of patients with pain. Comprehensive education and training is key to helping skilled professionals provide the best pain care possible. The objective of this work was to study the content of the pain education...

Williams-Beuren syndrome is the clinical manifestation of a congenital genetic disorder in the elastin gene, among others. There is a history of cardiac arrest refractory to resuscitation manoeuvres in anaesthesia. The incidence of myocardial ischaemia is high during anaesthetic induction, but there are patients who do not have this condition yet a...

Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tra...

Resumen El síndrome de Williams-Beuren es la manifestación clínica de una alteración genética congénita en el gen de la elastina, entre otros. Existen antecedentes de parada cardíaca refractaria a maniobras de resucitación en contexto anestésico. Es alta la incidencia de isquemia miocárdica durante la inducción anestésica, pero existen pacientes qu...

Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tra...

Background Parental report on a child's secondary chronic pain is commonly requested by anesthesiologists when the child cannot directly provide information. Daily pain intensity is reported as highest, average and lowest. However, it is unclear whether the parents’ score is a valid indicator of the child's pain experience. Methods Nineteen childr...

BACKGROUND: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. METHODS: The APRICOT study was a prospective observational m...

Se conoce el beneficio de la aplicación de estrategias para la prevención de la formación de atelectasias, pero falta evidencia del tratamiento de atelectasias en la población pediátrica, no existen algoritmos de manejo y hay pocos estudios de intervenciones de atelectasias refractarias, en donde una sola terapia no suele ser suficiente. Hay poca i...

Background Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. Material and methods A retrospective ana...

Background: Parental report on a child's secondary chronic pain is commonly requested by anesthesiologists when the child cannot directly provide information. Daily pain intensity is reported as highest, average and lowest. However, it is unclear whether the parents' score is a valid indicator of the child's pain experience. Methods: Nineteen ch...

Background: Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. Material and methods: A retrospective...

La oximetría cerebral analiza el balance entre aporte y demanda de O₂ cerebral. En cirugía cardiaca y el bypass cardiopulmonar es donde mayor desarrollo y aplicación ha encontrado. En una lesión cerebral tipo isquemia el CMRO₂ disminuye de forma proporcional a la gravedad de la lesión y se pueden alterar los mecanismos que regulan el FSC; de ahí qu...

Background and aims: Pain management constitutes an organisational challenge in all types of clinical establishments. The ISO 9001 Norms can be an effective way of integrating the different components of a comprehensive multidisciplinary programme. ISO 9001 International Standards ensure that products and services are safe, reliable and of good qua...

Background and aims: Pain management constitutes an organisational challenge in all types of clinical establishments. The ISO 9001 Norms can be an effective way of integrating the different components of a comprehensive multidisciplinary programme. ISO 9001 International Standards ensure that products and services are safe, reliable and of good qua...

The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal a...

El objetivo del presente estudio es analizar las paradas cardiacas relacionadas con la anestesia en un hospital infantil terciario, con el fin de identificar factores de riesgo que permitan establecer oportunidades de mejora.

OBJECTIVES: The aim of this study is to analyze the cardiac arrests related to anesthesia in a tertiary children's hospital, in order to identify risk factors that would lead to opportunities for improvement. METHODS: A 5-year retrospective study was conducted on anesthesia related cardiac arrest occurring in pediatric patients. All urgent and elec...

This randomized, single-dose, double-blind, Phase III study was designed to compare the level of procedural pain after use of premixed equimolar mixture of 50% oxygen and nitrous oxide (EMONO) or placebo (premixed 50% nitrogen and oxygen). Patients aged 1 to 18 years were randomly assigned to receive EMONO (n = 52) or placebo (n = 48) delivered by...

This study was designed to validate a new paediatric acute pain scale, LLANTO, comparing its scores with those obtained from the CHEOPS scale in 54 Spanish children aged 1 month-6 years. LLANTO is an acronym of five behavioural or physiological variables previously shown to be associated with pain in children (crying, attitude, respiratory pattern,...

This study was designed to validate a new paediatric acute pain scale, LLANTO, comparing its scores with those obtained from the CHEOPS scale in 54 Spanish children aged 1 month-6 years. LLANTO is an acronym of five behavioural or physiological variables previously shown to be associated with pain in children (crying, attitude, respiratory pattern,...

Background and Objective Thoracic epidural analgesia and patient-controlled analgesia (PCA) with intravenous fentanyl have both been shown to be effective in pediatric patients treated surgically for pectus excavatum using the Nuss procedure. We compare the efficacy and safety of these techniques. Methods Retrospective study of pediatric cases in...

Objetive The demand for sedation for pediatric diagnostic procedures performed outside operating rooms has increased considerably, but the ideal method to choose has been the subject of debate. The aim of this study was to assess the efficacy of using a device for continuous positive airway pressure, connected to a Mapleson D circuit and a nasophar...

The demand for sedation for pediatric diagnostic procedures performed outside operating rooms has increased considerably, but the ideal method to choose has been the subject of debate. The aim of this study was to assess the efficacy of using a device for continuous positive airway pressure, connected to a Mapleson D circuit and a nasopharyngeal tu...

Thoracic epidural analgesia and patient-controlled analgesia (PCA) with intravenous fentanyl have both been shown to be effective in pediatric patients treated surgically for pectus excavatum using the Nuss procedure. We compare the efficacy and safety of these techniques. Retrospective study of pediatric cases in which the Nuss procedure was used...

Lately, interest in studying quality of life as a possible target aim in clinical practice has been encouraged. Currently, increasing survival with a therapeutic treatment cannot be considered valid unless the quality of that survival is also improved. Several scales and different tools for measuring quality of life have been development for resear...

Postoperative pain is one of the most frequent causes of pain in the pediatric population. The majority of the surgical procedures in the pediatric population are performed in an ambulatory setting. The suitable control of postoperative pain is one of the bases of the success of this type of ambulatory surgery. This pain depends on three fundamenta...

Acute pediatric pain may last days or even weeks, and its most frequent causes are postoperative pain (after very aggressive interventions), polytraumatisms, extensive burns or mucositis after chemotherapy. Before starting therapy, it is necessary to identify the exact cause of the pain and also adjust the intensity of the treatment (light, moderat...

Most pediatric oncologic diseases are utterly different from those suffered by the adult population. The most frequent types of cancer in children are associated with hematologic, bone and neural neoplasms. The children with cancer frequently present pain associated with the diagnostic or therapeutic procedures, or acute pain secondary to postchemo...

Evaluation of children's pain was recently based on the measurement of the numerical scale of pain reported by the closest relatives, the so-called "NPS Parental" scale1. Acute pain is usually evaluated using several "tools" that consist in the combination of different vegetative and behavioral parameters to make up some clinical scales that are ap...

Ultrasound imaging is being used to guide pediatric nerve block procedures. Difficulties that arise because of the smaller anatomical structures in children can be compensated for by the greater aqueous consistency and reduced calcification. Given the shorter distance between the surface of the skin and nerves, it is advisable to use a linear array...

Ultrasound imaging is being used to guide pediatric nerve block procedures. Difficulties that arise because of the smaller anatomical structures in children can be compensated for by the greater aqueous consistency and reduced calcification. Given the shorter distance between the surface of the skin and nerves, it is advisable to use a linear array...

One of the best methods to manage and control intra- and postoperative pain is regional anesthesia. In pediatric patients, this type of analgesia is normally applied with general anesthesia or deep sedation, due to poor or absent patient cooperation. For shoulder and arm surgery, because of the frequency of related complications such as ipsilateral...

One of the best methods to manage and control intra- and postoperative pain is regional anesthesia. In pediatric patients, this type of analgesia is normally applied with general anesthesia or deep sedation, due to poor or absent patient cooperation. For shoulder and arm surgery, because of the frequency of related complications such as ipsilateral...

Combined (local and general) anaesthesia or Balanced (intravenous analgesics and inhalational hypnotics) anaesthesia are commonly used in paediatrics. The authors have investigated the influence of both types of anaesthesia on the requirements of sevoflurane to maintain an adequate level of hypnosis as measured by Bispectral index (at around 50) mo...

More than 2 million people receive medical treatment for thermal injury each year. Of the 100.000 patients hospitalized for thermal injuries, 30 to 40% are under the age of 15 years. Despite improvement in survival due to agressive fluid resuscitation, effective treatment of complications, and improved surgical techniques, burn and inhalational inj...

To determine the bispectral (BIS) index during induction of sedation with sevoflurane and awakening in children undergoing magnetic resonance imaging (MRI). We studied 50 pediatric patients sedated only with 2% sevoflurane in oxygen and air administered through a face mask. BIS was monitored during induction, before MRI, after MRI, during awakening...

The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a genuine...

Summary The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a...

There is critical care physicians agreement about the need of sedation and pain control for the adult and paediatric critically ill patient, even though only a few clinical practice guidelines have been developed to be used in adults, and even less in children. Substantial drug variability exists among Intensive Care Units, within each country and...

To document the effectiveness and safety of intrathecal baclofen administered through a tunneled catheter during a diagnostic procedure, prior to implantation of a subcutaneous pump, in children with chronic pain due to severe spasticity. This was a retrospective study of 6 children with intense chronic pain due to spasticity caused by cerebral pal...

The preoperative evaluation should clearly establish the child's present problem as well as the planned surgical, therapeutic, or diagnostic procedure. The presence and severity as well as the past and present treatments for known underlying medical problems must also be insvestigated. Because of the potential for drug interactions with anesthesia,...

There are several specific considerations regarding anesthesia in patients with mitochondrial disease. We describe the successful administration of a combined general and epidural anesthesia with sevoflurane maintenance in a patient with myoclonic epilepsy with ragged red fibers (MERRF syndrome) scheduled for surgical treatment of bilateral clubfoo...

Arteriovenous malformations usually cause subarachnoid hemorrhage. They may be present at any age but bleeding is most common between 7-25 years of age. Other common presentations include headache and seizures. The combination of high blood flow with low vascular resistance can ocasionally result in high output cardiac failure. When embolization an...