Misericordia Basora

Hospital Clínic de Barcelona · Servicio de Anestesiología y Reanimación

Uso de técnicas de ahorro de sangre en la artroplastia primaria de cadera y rodilla en España. Estudio FILTRO Blood saving measures in patients undergoing primary elective hip or knee arthroplasty in Spain. The FILTRO study Resumen Objetivo: El estudio FILTRO pretende conocer las medidas profilácticas del sangrado quirúrgico excesivo que se aplican...

Background - Anemia is highly prevalent in end-stage chronic kidney disease patients, increasing their risk of receiving blood transfusions during and on the days after a kidney transplant (KTx) surgery. However, there is currently a lack of data that thoroughly describes this phenomenon in this population, the associated risk factors, and how they...

Background: Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. Methods: Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodyna...

Background Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut‐off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. Methods Planned secondary analysis of data collected during a multicentre cohort study of patients...

Objectives: To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates. Methodology: We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light...

Introduction: Fluid administration is the cornerstone in hypovolemic patient's reanimation. Clinical guidelines restrict colloid administration favouring crystalloids. Currently, we don't know exactly which is the daily clinical practice during the perioperative period. The objective of this study is to describe perioperative use of colloids analy...

Resumen El Patient Blood Management (PBM) es un enfoque centrado en el paciente, sistemático y basado en la evidencia, destinado a mejorar los resultados de las pacientes mediante el manejo y la preservación de la propia sangre. Consta de tres pilares clásicos que se llevan a cabo de forma multidisciplinar y multimodal: optimización de la masa erit...

Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local inf...

Purpose: To define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery. Methods: We conducted a prospective cohort study of adults undergoing surgery during the COVID-19 outbreak. The elective pathway...

Introduction Differential diagnosis between Parkinson's disease (PD) and atypical parkinsonisms (APs: multiple system atrophy[MSA], progressive supranuclear palsy[PSP], corticobasal degeneration[CBD]) remains challenging. Lately, cerebrospinal fluid (CSF) studies of neurofilament light-chain (NFL) and RT-QuIC of alpha-synuclein (α-SYN) have shown p...

Resumen Introducción La administración intravenosa de fluidos constituye un elemento fundamental en la reanimación de pacientes con hipovolemia. Las guías clínicas restringen el uso de coloides en favor de los cristaloides. Actualmente, no conocemos con exactitud cuál es la práctica clínica habitual al respecto durante el periodo perioperatorio. E...

Purpose: Among various methods for estimating blood loss, the gravimetric method is the most accurate; however, its use in routine practice is complicated. Although several equations have been proposed for this purpose, there is no consensus on the most suitable. Methods: A cross-sectional study was conducted in seven secondary and tertiary hosp...

Background Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods We designed the Fluid Day study as a cross-sectional,...

Background: Standard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis. Objective: To test the noninferiority of the analgesic effect of genicular nerves block in...

Purpose: High doses of local anesthetic administered intra-articularly and peri-articularly during local infiltration analgesia (LIA) for total knee arthroplasty (TKA) may have potential effects on patient hemodynamics. The aim of this study was to know if hemodynamic changes are associated with LIA in patients undergoing TKA. Methods: In a prospec...

Background Implementation of Patient Blood Management programmes remain variable in Europe, and even in centres with well-established PBM programmes variability exists in transfusion practices. Objectives and methods We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip...

Resumen Antecedentes La implementación de los programas Patient Blood Management (PBM) es variable en Europa, incluso en centros en los que estos programas están bien establecidos, donde existe variabilidad en cuanto a prácticas transfusionales. Objetivos y métodos Realizamos una encuesta para valorar la práctica actual sobre PBM perioperatoria e...

La evidencia en la efectividad y seguridad del tratamiento con ATX en cirugía ortopédica mayor debería conllevar que este tratamiento fuera incluido en todos los protocolos de los diferentes centros donde se realizan estas cirugías. Es recomendable consensuar con todo el equipo que participa en el período perioperatorio y llegar a un acuerdo para s...

Background-Patient blood management (PBM) is an evidence-based care bundle with proven ability to improve patients' outcomes by managing and preserving the patient's own blood. Since 2010, the World Health Organisation has urged member states to implement PBM. However, there has been limited progress in developing PBM programmes in hospitals due to...

Introduction Thoracic erector spinae plane block is now performed in many different surgical procedures, including lumbar spinal fusion. We evaluated the analgesic effect of lumbar ESP performed at L4 after lumbar spinal fusion surgery. Methods and case series Eight patients scheduled for lumbar spinal fusion were included in the case series. Erec...

Overnight total hip arthroplasty is becoming common in our center. Despite all the patients are under the same protocol, which includes a funcional discharge criteria, not all the patients leave the hospital the day after the surgical procedure. We conducted a study evaluating a group of patients who stayed one night, compared to a matched pair reg...

Resumen Introducción El bloqueo en el plano del erector espinal (erector spinae plane [ESP]) a nivel torácico se ha desarrollado en los últimos años en multitud de procedimientos quirúrgicos, incluido los pacientes tratados mediante artrodesis lumbar. Nos propusimos evaluar el efecto analgésico del ESP realizado a nivel lumbar L4 en el postoperato...

Original Estudio epidemiológico de la anemia preoperatoria en pacientes sometidos a cirugía oncológica en España. Estudio RECIRON

Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused. Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty be...

Fluid administration is not any more a trivial and irrrelevant act and acquires the degree of therapy. Restoration of intravascular volume in order to compensate perioperative losses and enhance organ perfusion are one of its main stablished objectives, while minimizing side effects of fluid overload like pulmonary, gastrointestinal complications a...

Background: Severe and morbid obesity (Class II -III) represents a challenge for successful knee surgery. There isn't consensus on what influence body mass index has on blood loss and on red blood cell (RBC) transfusion during total knee arthroplasty (TKA). The objective was to determine blood loss and transfusion needs in severe and morbid obese...

Background: An analytic-decision model was built to estimate the cost-effectiveness of using ferric carboxymaltose for pre-operative haemoglobin optimisation in patients with iron deficiency anaemia undergoing primary knee arthroplasty. Materials and methods: We simulated 20,000 patients who were randomly assigned to the haemoglobin optimisation...

Hospital Clínic de Barcelona, Dept of Surger y, Barcelona, Spain Background and Goal of Study: Red Blood Cell (RBC) transfusion is still highly prevalent in Or thotopic Liver Transplantation (OLT) and a coagulation disorder has been considered as a major cause. However the role of preop- erative anaemia and his optimization has not been consider...

Background: Perioperative tranexamic acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients...

In patients undergoing major orthopaedic surgery, pre-operative anaemia, peri-operative bleeding and a liberal transfusion policy are the main risk factors for requiring red blood cell transfusion (RBCT). The clinical and economic disadvantages of RBCT have led to the development and implementation of multidisciplinary, multimodal, individualised s...

Tau and amyloid-β (Aβ) aggregates have been suggested to play a role in the development of dementia in Parkinson's disease (PD). Positron emission tomography (PET) with [18F]FDDNP and the determination of cerebrospinal fluid (CSF) levels of these proteins constitute a means to visualize in vivo Aβ and tau brain accumulation. Information about longi...

The validity of α-synuclein (α-Syn) as a biomarker for Parkinson’s disease (PD) is still under investigation. Conventional methods for capture and quantitation of α-Syn protein in human samples are primarily based on anti-α-Syn antibodies. Specific and competent antibodies were raised against α-Syn. However, capture by anti-α-Syn antibodies may be...

Objectives Total knee arthroplasty (TKA) has a high transfusion rate. In our protocol, the use of postoperative cell salvage is indicated in patients with contraindications to tranexamic acid (TA). An analysis was performed on the effect of post-operative cell salvage (POCS) regarding transfusion rate and costs in patients undergoing TKA. Material...

Purpose: Transfusion of packed red blood cells (RBCs) stored for >14 days has been associated with a higher risk of infection but there is no data about the impact in revision hip arthroplasty. Methods: We retrospectively reviewed 280 patients who underwent revision hip arthroplasty from January 2002 to May 2012. Relevant risk factors and prosth...

Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to...

Objectives: Total knee arthroplasty (TKA) has a high transfusion rate. In our protocol, the use of postoperative cell salvage is indicated in patients with contraindications to tranexamic acid (TA). An analysis was performed on the effect of post-operative cell salvage (POCS) regarding transfusion rate and costs in patients undergoing TKA. Materi...

The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this...

Clinical Practice Guideline answers to clinical questions about security in the choice of fluid (crystalloid, colloid or Hydroxyethylstarch 130) in patients who require volemic restoration in the perioperative period of non-cardiac surgery patients. From the summary of evidence, the recommendations were developed following the GRADE methodology. F...

The risks and benefits of transfusing critically ill patients continue to evoke controversy. Specifically, the critically ill patients with active ischemic cardiac disease continue to represent a 'gray area' in the literature. Meta-analysis of the effects of lower versus higher hemoglobin thresholds on mortality in critically ill patients was carri...

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplin...

The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation...

To minimize allogeneic blood transfusions (ABTs) during complex surgery and surgery with considerable blood loss risk, various blood-sparing techniques are needed (multimodal approach). All surgical patients should be assessed with sufficient time to optimize hemoglobin levels and iron reserves so that the established perioperative transfusion stra...

Patient Blood Management (PBM) is the design of a personalized, multimodal multidisciplinary plan for minimizing transfusion and simultaneously achieving a positive impact on patient outcomes. The first pillar of PBM consists of optimizing the erythrocyte mass. The best chance for this step is offered by preoperative preparation. In most cases, a d...

Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The trea...

Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematini...

The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation...

To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed. Retrospective observational study carried out in two third-level hospitals between January 2005 and D...

The aim of this study was to compare the prosthetic joint infection (PJI) rate after total joint arthroplasty in two consecutive periods with different antibiotic prophylaxis: cefuroxime versus cefuroxime plus teicoplanin. We retrospectively reviewed 1897 patients who underwent THA or TKA between March 2010 and February 2013. From March 2010 to Aug...

Background Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the...

Certain aspects of total knee arthroplasty (TKA) in severely and morbidly obese (SMO) patients (BMI ≥ 35 kg/m(2)) remain controversial. This study aimed to assess the duration of TKA surgery and hospital stay in relation to patients' BMI. Three operative times during TKA surgery were recorded: tourniquet time, to determine surgical difficulty, tota...

Uso de técnicas de ahorro de sangre en la artroplastia primaria de cadera y rodilla en España. Estudio FILTRO Blood saving measures in patients undergoing primary elective hip or knee arthroplasty in Spain. The FILTRO study Resumen Objetivo: El estudio FILTRO pretende conocer las medidas profilácticas del sangrado quirúrgico excesivo que se aplican...

Background and Objective Optimization of the preoperative hemoglobin (Hb) level is an effective way to reduce allogeneic transfusion in total knee arthroplasty (TKA) though the procedure is expensive, requires close monitoring and is often inconvenient for patients with reduced mobility. Our aim was to investigate the value of preoperative Hb level...

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, trans...

Background and Objective Optimization of the preoperative hemoglobin (Hb) level is an effective way to reduce allogeneic transfusion in total knee arthro-plasty (TKA) though the procedure is expensive, requires close monitoring and is often inconvenient for patients with reduced mobility. Our aim was to investigate the value of preoperative Hb leve...

Patients undergoing cardiac surgery are at high risk of bleeding and transfusion. This risk has increased in recent years and is associated with increased morbidity and mortality. Moreover, despite being one of the most common complications associated with this surgery, there remains a large variability in its management between institutions. Imple...

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, trans...

Patients undergoing cardiac surgery are at high risk of bleeding and transfusion. This risk has increased in recent years and is associated with increased morbidity and mortality. Moreover, despite being one of the most common complications associated with this surgery, there remains a large variability in its management between institutions. Imple...

Background: Haemodilution during resuscitation after massive haemorrhage may worsen the coagulopathy and perpetuate bleeding. Materials and methods: Blood samples from healthy donors were diluted (30 and-60%) using crystalloids (saline, Ringer's lactate, Plasmalyte(TM)) or colloids (6% hydroxyethylstarch [HES130/0.4], 5% human albumin, and gelat...

4349 BACKGROUND Massive bleeding and subsequent coagulopathy are responsible for 35% of deaths in trauma patients. Hemodilution during resuscitation may worsen the coagulopathy and perpetuate bleeding. STUDY DESIGN AND METHODS Blood samples from healthy donors were diluted (30–60%) using crystalloids (saline, Ringer’s lactate, Plasmalyte™) or col...

Post-operative cognitive dysfunction (POCD) can affect 30% of orthopedic surgery patients. We hypothesized that perioperative temperature has an impact on POCD. We included 150 patients over 65 years of age scheduled for total knee replacement under spinal anesthesia. They were randomized to receive standard care (sheet cover) or active warming. Ne...

Objective To determine practices related to control of perioperative hemostasis and transfusion in patients undergoing cardiac surgery in Spain, including the extent to which protocols are being used. Methods A questionnaire was created to collect information from physicians in anesthesiology and postoperative recovery care between July 1 and Sept...

To determine practices related to control of perioperative hemostasis and transfusion in patients undergoing cardiac surgery in Spain, including the extent to which protocols are being used. A questionnaire was created to collect information from physicians in anesthesiology and postoperative recovery care between July 1 and September 20, 2007. The...