Analgesia perioperatoria mediante bloqueo del plano erector espinal en implante de asistencia ventricular izquierda / Perioperative analgesia by erector spinae plane block in left ventricular assist implant

Los dispositivos de asistencia ventricular izquierda se han convertido en los últimos años en un elemento importante para el manejo del fallo ventricular izquierdo refractario a tratamiento farmacológico. Su implantación (realizada mediante toracotomía izquierda o esternotomía) genera un importante dolor perioperatorio, que puede ser manejado con técnicas de anestesia locorregional. Sin embargo, existe gran controversia sobre su realización en cirugía cardíaca debido a la interferencia con la terapia anticoagulante necesaria en estos pacientes.El bloqueo del plano erector espinal constituye una alternativa a las técnicas locorregionales clásicas, al no producir alteraciones hemodinámicas y no interferir con la terapia antiagregante y anticoagulante, siendo una alternativa a tener en cuenta en cirugía cardíaca. Presentamos un caso de implantación de asistencia ventricular izquierda con realización de dicho bloqueo previo al procedimiento quirúrgico e infusión postoperatoria a través de catéter, obteniéndose resultados satisfactorios en el manejo del dolor perioperatorio.(AU)

In recent years, left ventricular assist devices have become an important element in the management of left ventricular failure refractory to pharmacological treatment. Their implantation (performed by left thoracotomy or sternotomy) generates significant perioperative pain, which can be managed with locoregional anesthesia techniques. However, opinions vary on their use in cardiac surgery due to interference with the anticoagulant therapy required in these patients.The erector spinae plane block is an alternative to classic locoregional techniques. It does not produce hemodynamic alterations and does not interfere with antiplatelet and anticoagulant therapy, and is therefore an alternative to be considered in cardiac surgery. We present a case of left ventricular assist device implantation under this block prior to the surgical procedure and postoperative infusion through a catheter, obtaining satisfactory results in the management of perioperative pain.(AU)

Perioperative analgesia by erector spinae plane block in left ventricular assist implant.

In recent years, left ventricular assist devices have become an important element in the management of left ventricular failure refractory to pharmacological treatment. Their implantation (performed by left thoracotomy or sternotomy) generates significant perioperative pain, which can be managed with locoregional anaesthesia techniques. However, opinions vary on their use in cardiac surgery due to interference with the anticoagulant therapy required in these patients. The erector spinae plane block is an alternative to classic locoregional techniques. It does not produce hemodynamic alterations and does not interfere with antiplatelet and anticoagulant therapy, and is therefore an alternative to be considered in cardiac surgery. We present a case of left ventricular assist device implantation under this block prior to the surgical procedure and postoperative infusion through a catheter, obtaining satisfactory results in the management of perioperative pain.

Registro de Hipertensión Arterial en consultas privadas en Venezuela: Estudio RHAVEN / Arterial Hypertension register in private clinics in Venezuela: RHAVEN Study

Introducción: En Venezuela no se ha realizado un estudio grande para conocer el nivel de control de la hipertensión arterial (HTA). Objetivo: El objetivo primario fue conocer la prevalencia de la HTA controlada entre hipertensos tratados farmacológicamente. Materiales y métodos: Es un estudio de corte transversal realizado en pacientes mayores de 18años. Resultados: Se registraron 4.320 pacientes. La prevalencia de HTA controlada fue del 52,6% (IC95%: 51,1-54,1). La falta de control de la HTA se asoció con diabetes (p<0,001), cardiopatía hipertensiva (p<0,001), enfermedad renal crónica (p<0,001) y enfermedad arterial periférica (p=0,02). El incumplimiento del tratamiento también se asoció con HTA no controlada (5,1% [117/2.274] en los controlados versus 43,2% [885/2.046] en los no controlados; p<0,001). Conclusión: La prevalencia detectada de HTA controlada fue del 52,6%

Introduction: In Venezuela, no large studies have been conducted to determine the level of control of hypertension (HT). Objective: The primary objective was to know the prevalence of controlled HT among hypertensive patients treated pharmacologically. Materials and methods: A cross-section study was conducted on patients 18years and older. Results: A total of 4,320 patients were included. The prevalence of controlled hypertension was 52.6% (95%CI: 51.1-54.1%). The lack of control of HT was associated with diabetes (P<.001), hypertensive heart disease (P<.001), chronic kidney disease (P<.001), and peripheral arterial disease (P=.02). Non-compliance of treatment was also associated with uncontrolled HT (5.1% [117/2,274] in the controlled versus 43.2% [885/2,046] in the uncontrolled; (P<.001). Conclusion: The prevalence detected of controlled hypertension was 52.6%

[Arterial Hypertension register in private clinics in Venezuela: RHAVEN Study]. / Registro de Hipertensión Arterial en consultas privadas en Venezuela: Estudio RHAVEN.

INTRODUCTION: In Venezuela, no large studies have been conducted to determine the level of control of hypertension (HT). OBJECTIVE: The primary objective was to know the prevalence of controlled HT among hypertensive patients treated pharmacologically. MATERIALS AND METHODS: A cross-section study was conducted on patients 18years and older. RESULTS: A total of 4,320 patients were included. The prevalence of controlled hypertension was 52.6% (95%CI: 51.1-54.1%). The lack of control of HT was associated with diabetes (P<.001), hypertensive heart disease (P<.001), chronic kidney disease (P<.001), and peripheral arterial disease (P=.02). Non-compliance of treatment was also associated with uncontrolled HT (5.1% [117/2,274] in the controlled versus 43.2% [885/2,046] in the uncontrolled; (P<.001). CONCLUSION: The prevalence detected of controlled hypertension was 52.6%.

Ecocardiografía transesofágica durante el trasplante ortotópico hepático / Transoesophageal echocardiography during orthotopic liver transplantation

A pesar de la importancia del manejo hemodinámico en los pacientes sometidos a trasplante hepático, en la actualidad no existe consenso acerca del tipo de monitorización más apropiada a emplear. En este contexto, la ecocardiografía transesofágica puede aportar información muy útil a los profesionales implicados, aunque sus limitaciones impiden que se extienda su uso aún más en la actualidad (AU)

Despite the importance of haemodynamic management in patients undergoing liver transplantation, there is currently no consensus on the most appropriate type of monitoring to use. In this context, transoesophageal echocardiography can provide useful information to professionals, although their use constraints prevent further spread today (AU)

Transoesophageal echocardiography during orthotopic liver transplantation. / Ecocardiografía transesofágica durante el trasplante ortotópico hepático.

Despite the importance of haemodynamic management in patients undergoing liver transplantation, there is currently no consensus on the most appropriate type of monitoring to use. In this context, transoesophageal echocardiography can provide useful information to professionals, although their use constraints prevent further spread today.

Manejo anestésico en la resección traqueal distal toracoscópica / Anaesthetic management in thoracoscopic distal tracheal resection

La resección quirúrgica de los tumores traqueales, especialmente los distales, supone un reto para los anestesiólogos implicados, principalmente por las dificultades para asegurar un adecuado control de la vía aérea y de la ventilación. Presentamos el caso de una paciente que se somete a la resección de tercio distal traqueal y anastomosis terminoterminal mediante videotoracoscopia, enfatizando sobre el manejo anestésico (AU)

Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management (AU)

Anaesthetic management in thoracoscopic distal tracheal resection. / Manejo anestésico en la resección traqueal distal toracoscópica.

Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management.

Gran absceso intracardiaco secundario a endocarditis sobre válvula aórtica protésica / Great intracardiac abscess secondary to prosthetic aortic valve endocarditis

No disponible

Analgesia epidural para la cirugía del trasplante renal / Epidural analgesia for renal transplant surgery

No disponible

Anesthesia for bariatric surgery: 8-Year retrospective study: are our patients now easier to manage? / Anestesia para la cirugía bariátrica, estudio retrospectivo de 8 años: ¿son más fáciles de tratar nuestros pacientes en la actualidad?

Objectives. To review the perioperative management of patients who had undergone bariatric surgery in our institution during an 8-year period, with the aim of identifying variables that correlated with improved clinical outcomes and changes in perioperative practice. Methods. This was a retrospective observational study of 437 patients who had undergone bariatric surgery from January 2005 to June 2013. Of these patients, 163 had undergone open or laparoscopic biliopancreatic diversion (Group 1), and 274 had been managed according to a Tailored Laparoscopic Approach Program (TLAP) (Group 2). We analyzed major cardiocirculatory, pulmonary, and surgery-related complications, mortality rate, intensive care unit (ICU) admissions, post-anesthetic care unit (PACU) length of stay, and perioperative management standards, throughout the study period. Results. Changes were observed in anesthetic patterns and perioperative care standards during the study period: 25% of patients had combined epidural anesthesia in 2005, compared with none at present; ICU admissions decreased from 28.6% in 2005 to 3.1% at present; and time in PACU declined from a median of 23 h in 2005 to 5.12 h at present. Duration of postoperative opioid therapy was also significantly reduced (from 48 h to 6 h). Group 2 had a significantly lower mortality rate than Group 1 (0.37% versus 4.3%, respectively, P = 0.004). Conclusions. In our institution, adoption of a TLAP for bariatric surgery has led to changes in perioperative care standards that have been followed by clear improvements according to morbidity, mortality and management indicators (AU)

Objetivos. Analizar el tratamiento perioperatorio de los pacientes que hayan sido intervenidos de cirugía bariátrica en nuestro centro durante un período de 8 años de duración, con el objetivo de identificar variables que puedan guardar relación con resultados clínicos mejorados y cambios en la práctica perioperatoria. Metodología. Estudio de observación retrospectivo de 437 pacientes que se sometieron a cirugía bariátrica entre enero de 2005 y junio de 2013. De ellos, 163 fueron intervenidos mediante derivación biliopancreática abierta o laparoscópica (Grupo 1) y 274 fueron tratados conforme al Programa de Abordaje LaparoscópicoPersonalizado (Grupo 2). Analizamos las principales complicaciones cardiovasculares, pulmonares y quirúrgicas, la tasa de mortalidad, los ingresos en UCI, el tiempo en la Unidad de Reanimación y las pautas del tratamiento perioperatorio durante el período del estudio. Resultados. Apreciamos cambios en los patrones de anestesia y las pautas de tratamiento perioperatorio durante el período del estudio: un 25% de los pacientes combinaron la anestesia epidural en 2005 en comparación con ninguno en la actualidad; los ingresos en la UCI disminuyeron del 28,6% en 2005 al 3,1% en la actualidad; y la estancia en la Unidad de Reanimación se redujo en una mediana de 23 h en 2005 a 5,12 h en la actualidad. La duración del tratamiento perioperatorio con opiodes también se acortó de manera significativa (de 48 a 6 h). El Grupo 2 presentó una tasa de mortalidad considerablemente más baja que el Grupo 1 (0,37 frente a 4,3%, respectivamente; p = 0,004). Conclusiones. En nuestro centro, la implantación del Programa de Abordaje Laparoscópico Personalizado para la cirugía bariátrica ha fraguado cambios en las pautas de tratamiento perioperatorio que han supuesto mejoras evidentes en lo que a morbimorbilidad e indicadores de gestión se refiere (AU)

Anesthesia for bariatric surgery: 8-year retrospective study: are our patients now easier to manage?

OBJECTIVES: To review the perioperative management of patients who had undergone bariatric surgery in our institution during an 8-year period, with the aim of identifying variables that correlated with improved clinical outcomes and changes in perioperative practice. METHODS: This was a retrospective observational study of 437 patients who had undergone bariatric surgery from January 2005 to June 2013. Of these patients, 163 had undergone open or laparoscopic biliopancreatic diversion (Group 1), and 274 had been managed according to a Tailored Laparoscopic Approach Program (TLAP) (Group 2). We analyzed major cardiocirculatory, pulmonary, and surgery-related complications, mortality rate, intensive care unit (ICU) admissions, post-anesthetic care unit (PACU) length of stay, and perioperative management standards, throughout the study period. RESULTS: Changes were observed in anesthetic patterns and perioperative care standards during the study period: 25% of patients had combined epidural anesthesia in 2005, compared with none at present; ICU admissions decreased from 28.6% in 2005 to 3.1% at present; and time in PACU declined from a median of 23 h in 2005 to 5.12h at present. Duration of postoperative opioid therapy was also significantly reduced (from 48 h to 6h). Group 2 had a significantly lower mortality rate than Group 1 (0.37% versus 4.3%, respectively, P=0.004). CONCLUSIONS: In our institution, adoption of a TLAP for bariatric surgery has led to changes in perioperative care standards that have been followed by clear improvements according to morbidity, mortality and management indicators.

Early mortality after cardiac transplantation: comparison of demographic, clinical, biological and surgical variables.

Cardiac transplantation is the last alternative for those patients in terminal heart failure. However, its mortality is high, and approximately 20% of patients die in the first month after cardiac transplantation. We retrospectively reviewed 116 patients transplanted at our center in the last 6 years. Data about clinical, biological and surgical variables were collected. We undertook a multivariate analysis in order to find differences between those patients who died in the first month and those who survived. We found statistically significant differences in total ischemia time (P = .036) and extracorporeal circulation time (P = .001), with those patients that died in the first month having longer times. We also found a statistically significant difference in the weight of the recipient, with those recipients that died in the first month having a higher weight (P = .03). No statistically significant differences were found in the other variables. Of particular interest was the absence of a significant association in both groups (survival <1 month vs survival >1 month) in the variables related to pulmonary hypertension (pulmonary half-time pressure, pulmonary systolic pressure, vascular pulmonary resistances).

Ultra scale-down stress analysis of the bioprocessing of whole human cells as a basis for cancer vaccines.

This study examines the use of a capillary shear device for the rapid characterization of human cell lines in terms of their resistance to hydrodynamic stress. An ultra scale-down (USD) approach is presented to allow the use of small quantities of cells available at the early discovery stage and to expose them to a wide range of hydrodynamic stresses. In this way an indication is gained of the relative properties of different cell lines and the challenge which may be faced during full-scale processing. A design of experiments approach allowed the interaction between a number of key processing factors such as capillary length, flow rate, and number of passes to be studied in a limited number of experiments. Out of this an USD test based on flow rate in a device of fixed geometry was proposed. Based on observations made elsewhere (Ma et al., 2002, Biotechnol Bioeng 80(4): 428-437) a detailed analysis of possible geometries was performed using a combination of USD experiments and computational fluid dynamics analysis of the capillary entry region. This allowed the properties of the cells to be characterized in terms of a critical stress below which there is no significant loss of cell integrity. The results suggested that the OnyCap23 and P4E6 cell lines, used as components of a whole cell prostate cancer vaccine, are resistant to damage below critical elongational shear stress values of 235 and 275 N/m(2), respectively. Above these stress values the loss of intact cells is predicted to be significant; such loss being due to a combination of whole cells becoming permeable to trypan blue and complete breakage of cells into debris at extreme stresses. The sensitivity of cell surface markers CD9, CD44, CD59, CD81, CD147, and MHC-1 to exposure to shear stress was considerably less than for cell membrane integrity. The surface marker levels for recovered whole cells (i.e., both with and without intact cell membranes) were either independent of shear stress or showed a slight decrease with increased shear stress, for example, as for CD9. The results were used to predict successfully a capillary design where no damage would occur at a specified high flow rate; for example, as required for cell dispensing or vialling operations. Equally, the extent of loss of cell integrity was also successfully predicted in a capillary flow system designed to yield high levels of break up as may be required in intracellular analysis without the use of chemical lysing reagents or relying on autolytic damage.

Kinetics of the neuroinflammation-oxidative stress correlation in rat brain following the injection of fibrillar amyloid-beta onto the hippocampus in vivo.

The purpose of this study was to describe-following the injection of a single intracerebral dose of fibrillar amyloid-beta(1-40) in vivo-some correlations between proinflammatory cytokines and oxidative stress indicators in function of time, as well as how these variables fit in a regression model. We found a positive, significant correlation between interleukin (IL)-1beta or IL-6 and the activity of the glutathione peroxidase enzyme (GSH-Px), but IL-1beta or IL-6 maintained a strong, negative correlation with the lipid peroxidation (LPO). The first 12 h marked a positive correlation between IL-6 and tumor necrosis factor-alpha (TNF-alpha), but starting from the 36 h, this relationship became negative. We found also particular patterns of behavior through the time for IL-1beta, nitrites and IL-6, with parallel or sequential interrelationships. Results shows clearly that, in vivo, the fibrillar amyloid-beta (Abeta) disrupts the oxidative balance and initiate a proinflammatory response, which in turn feeds the oxidative imbalance in a coordinated, sequential way. This work contributes to our understanding of the positive feedbacks, focusing the "cytokine cycle" along with the oxidative stress mediators in a complex, multicellular, and interactive environment.

Orally administered melatonin reduces oxidative stress and proinflammatory cytokines induced by amyloid-beta peptide in rat brain: a comparative, in vivo study versus vitamin C and E.

To determine the efficacy of antioxidants in reducing amyloid-beta-induced oxidative stress, and the neuroinflammatory response in the central nervous system (CNS) in vivo, three injections of fibrillar amyloid-beta (fAbeta) or artificial cerebrospinal fluid (aCSF) into the CA1 region of the hippocampus of the rat were made. Concomitantly, one of the three free radical scavengers, i.e. melatonin, vitamin C, or vitamin E was also administered. Besides being a free radical scavenger, melatonin also has immunomodulatory functions. Antioxidant treatment reduced significantly oxidative stress and pro-inflammatory cytokines. There were no marked differences between melatonin, vitamin C, and vitamin E regarding their capacity to reduce nitrites and lipoperoxides. However, melatonin exhibited a superior capacity to reduce the pro-inflammatory response induced by fAbeta.