Alteración de signos vitales dentro de las 72 h previas a la activación de código azul en pacientes adultos hospitalizados de un hospital universitario / Deterioration of vital signs as predictors of major medical emergencies in hospitalized patients

Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.

¿Existe relación entre la concentración de inducción anestésica de sevofluorano y la incidencia de agitación postanestésica en niños? / Is there a relationship between the concentration of sevofluoran anesthetic induction and the incidence of post-anesthetic agitation in children?

Introducción. La inducción anestésica con sevofluorano se asocia con agitación postanestésica (APA) en niños. Concentraciones de sevofluorano mayores a 6% producen actividad cerebral epileptiforme, la que podría estar relacionada a APA. El propósito de este estudio fue comparar el efecto de dos diferentes concentraciones de inducción anestésica con sevofluorano sobre la incidencia de APA, en niños sometidos a cirugía infraumbilical. Método. Estudio prospectivo y doble ciego, en pacientes de 2 a 7 años, operados de fimosis o hernia inguinal con anestesia general y bloqueo epidural caudal. Los pacientes fueron aleatorizados para recibir sevofluorano 5 por ciento (grupo S5) o sevofluorano 8 por ciento (grupo S8). Se registraron variables demográficas, signos vitales, profundidad anestésica utilizando índice biespectral (BIS) y respuesta motora durante distintos momentos de la anestesia. Se evaluó la presencia de agitación en pabellón y recuperación utilizando la escala de APA pediátrica (PAED). Análisis estadístico: t-test o Mann-Whitney y test Chi-cuadrado o Fisher, p < 0,05 considerada significativa. Resultados. Se reclutaron 33 pacientes, 16 en el grupo S5 y 17 en el grupo S8. Ambos grupos fueron comparables en cuanto a variables demográficas, signos vitales, respuesta motora y valores de BIS. No hubo diferencias significativas en la incidencia de APA en pabellón (S5: 31,3 por ciento y S8: 35,3 por ciento) y en recuperación (S5: 43,8 por ciento y S8: 41,2 por ciento), entre los grupos. Conclusión. No habría relación entre la concentración de inducción anestésica de sevofluorano y la incidencia de APA en niños sometidos a cirugía infraumbilical con anestesia general y bloqueo caudal. (AU)

Introduction. Induction of anesthesia with sevoflurane is associated with post-anesthetic agitation (PAA) in children. Sevoflurane concentration greater than 6% produces epileptiform brain activity, which could be related to PAA. The aim of this study was to compare the effect of two different sevoflurane concentrations for anesthesia induction on the incidence of PAA in children undergoing infraumbilical surgery. Method. Prospective, double blind study, performed in patients 2 to 7 years of age, undergoing circumcision or inguinal hernia repair under general anesthesia and epidural caudal block. Patients were randomized to receive sevoflurane 5 percent (S5 group) or sevoflurane 8 percent (S8 group), during anesthesia induction. Demographic variables, vital parameters, anesthesia depth using bispectral index (BIS) and motor responses during different moments of anesthesia were recorded. The presence of agitation in the operating room and recovery room were determined using the pediatric PAA scale (PAED). Statistical analysis: t-test or Mann-Whitney, and Chi-square or Fisher test, p < 0.05 considered significant. Results. Thirty-three patients were enrolled, 16 in the S5 group and 17 in the S8 group. Demographic variables, vital parameters, motor responses and BIS values were comparable between both groups. There were no significant differences in the incidence of PAA in the operating room (S5: 31.3 percent percent and S8: 35.3 percent) or in the recovery room (S5: 43,8 percent and S8: 41.2 percent), between both groups. Conclusion. Sevoflurane concentration used for induction of anesthesia would not be related to the incidence of PAA in children undergoing infraumbilical surgery under general anesthesia and epidural caudal block. (AU)

Analgesia, sedación y anestesia para cateterismo diagnóstico y/o terapéutico en pacientes pediátricos con cardiopatías congénitas en el Hospital Clínico de la Pontificia Universidad Católica de Chile: algunas recomendaciones / Analgesia, sedation and anesthesia in diagnostic or therapeutic catheterization in pediatric patients with congenital heart disease

Las presentes recomendaciones han sido elaboradas en base a nuestra experiencia, con el propósito de entregar algunas pautas sobre analgesia, sedación y anestesia para cateterismos diagnósticos y/o terapéuticos en pacientes pediátricos con cardiopatías congénitas, de acuerdo a la clasificación de riesgo de los mismos. El propósito de ésta es contribuir a disminuir la incidencia de eventos adversos asociados a morbilidad y mortalidad.

Recommendations based con clinical experience with analgesia, sedation and anesthesia in diagnostic or therapeutic cardiac catheterization in pediatric patients with congenital heart disease are outlined. These recommendations, based on clinical experience at a single institution (Catholic University Hospital in Santiago, Chile) are intended to help reduce de incidence of adverse effects, morbidity and mortality in this patient population.

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios / Renal function during cardiac surgery with extracorporeal circulation

Background: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation. Aim: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery Material and Methods: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma now were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione s-transferase in urine were measured as markers of tubular damage in the pre and postoperative periods. Results: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively Conclusions: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups.

Anestesia y cirugía en revascularización coronaria en un paciente trasplantado cardiaco: reporte de un caso / Anesthesia and coronary revascularization surgery in a cardiac transplanted patient: a case report

Dado el aumento de la sobrevida de los pacientes trasplantados cardiacos es cada vez más frecuente que se sometan a otras cirugías, tanto cardíacas, como no cardíacas. En este artículo se presenta un caso clínico de un paciente trasplantado cardíaco sometido a una cirugía de revascularización coronaria, y posteriormente una revisión de la literatura y discusión del caso.