Hacia una conexión no-Luer para técnicas del neuroeje: lento, pero seguro / Towards a No-Luer connection for neuraxial procedures: slow and safe

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National critical incident reporting systems relevant to anaesthesia: a European survey.

BACKGROUND: Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. METHODS: We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. RESULTS: Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. CONCLUSIONS: We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

Errores de medicación y etiquetado de las jeringas / Medication errors and syringe labeling

Los problemas asociados con el tratamiento farmacológico en el entorno hospitalario son frecuentes y se asocian, en ocasiones, a daño para el paciente y mayores costes. La Declaración de Helsinki sobre seguridad del paciente en anestesiología incluye, entre otras recomendaciones, que todos los servicios de anestesia tengan protocolos para el adecuado etiquetado de las jeringas que contienen la medicación necesaria durante la anestesia. Recientemente, el Sistema Español de Notificación de Seguridad en Anestesia y Reanimación y la Sociedad Española de Anestesiología y Reanimación, junto al Instituto para el Uso Seguro de los Medicamentos-España, han publicado las recomendaciones de etiquetado de jeringas, líneas y envases de acuerdo a dichas normas. En este trabajo se revisan brevemente los errores de medicación en anestesia y el papel del etiquetado de la medicación en la seguridad del paciente (AU)

Drug-related problems are frequent in the hospital setting and sometimes lead to patient harm and increased costs. The “Helsinki Declaration on Patient Safety in Anesthesiology” includes, among other recommendations, that all anesthesia departments have protocols for the correct labelling of syringes containing the medication required for anesthesia. In accordance with this document, the Spanish System of Safety Reporting in Anesthesia and Resuscitation and the Spanish Society of Anesthesiology and Resuscitation, together with the Institute for Safe Medication Practices in Spain have recently published their recommendations on the labelling of syringes, lines and bags. The present article briefly reviews medication errors in anesthesia and the role of medication labelling in patient safety (AU)

Etiquetado de los medicamentos inyectables que se administran en anestesia. Recomendaciones de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR) e Instituto para el Uso Seguro de los Medicamentos (ISMP-España) / No disponible

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[Intravenous remifentanyl for labor analgesia]. / Remifentanilo intravenoso para analgesia del trabajo del parto.

BACKGROUND: Intravenous remifentanil may be the preferred analgesic when regional techniques are contraindicated. OBJECTIVE: To perform a systematic review on the use of remifentanil for analgesia in labor. METHODS: We searched MEDLINE (January 1995-August 2007) for studies on obstetric analgesia with remifentanil. RESULTS: We found 32 references representing the use of remifentanil in 257 women in labor. In most cases, patients reported relief of pain and a high level of satisfaction, with no severe side effects in mothers or neonates. When compared with meperidine and nitrous oxide in clinical trials, remifentanil provided better analgesia with fewer adverse effects. CONCLUSION: Analgesia with intravenous remifentanil is more effective and safer than other alternatives to regional analgesic techniques in obstetrics. Nevertheless, the optimum system for infusing the drug must b e established and further studies of maternal and fetal safety should be carried out.

[Removal of an epidural catheter from a patient receiving anticoagulant and antiplatelet therapy]. / Retirada de catéter epidural en un paciente con doble antiagregación.

We describe the management of anticoagulant and antiplatelet therapy to reduce the risk of hematoma on removal of an epidural catheter. The situation arose following major vascular surgery complicated by an acute myocardial infarction that required anticoagulant and antiplatelet therapy following implantation of a coronary stent.

Remifentanilo intravenoso para analgesia del trabajo del parto / Intravenous remifentanyl for labor analgesia

La analgesia con remifentanilo intravenoso podría serla primera alternativa a las técnicas regionales cuandoéstas se encuentran contraindicadas.OBJETIVO: Revisión sistemática de la bibliografía disponiblesobre el uso de remifentanilo como analgesia delparto. Método: Búsqueda en MEDLINE (enero 1995-marzo 2009) y revisión de bibliografía de las publicacionessobre la analgesia obstétrica con remifentanilo.RESULTADOS: Se encontraron 37 referencias con untotal de 281 embarazadas tratadas con remifentanilo. Enla mayoría de los casos las pacientes mostraron descensoen el dolor referido y alto grado de satisfacción, sinefectos secundarios graves en las madres o neonatos.Comparándolo en ensayos clínicos con meperidina y óxidonitroso, el remifentanilo obtuvo mejores resultados enanalgesia y menores efectos secundarios.CONCLUSIÓN: La analgesia con remifentanilo intravenosoes una alternativa más eficaz y segura que otras técnicasno regionales en la analgesia obstétrica. Aún debeestablecerse el sistema óptimo de administración y se precisanestudios más amplios de seguridad materno-fetal(AU)

BACKGROUND: Intravenous remifentanil may be the preferredanalgesic when regional techniques are contraindicated.OBJETIVE: To perform a systematic review on the use ofremifentanil for analgesia in labor.METHODS: We searched MEDLINE (January 1995-August 2007) for studies on obstetric analgesia withremifentanil.RESULTS: We found 32 references representing the use ofremifentanil in 257 women in labor. In most cases, patientsreported relief of pain and a high level of satisfaction, with nosevere side effects in mothers or neonates. When compared withmeperidine and nitrous oxide in clinical trials, remifentanilprovided better analgesia with fewer adverse effects.CONCLUSION: Analgesia with intravenous remifentanil ismore effective and safer than other alternatives to regionalanalgesic techniques in obstetrics. Nevertheless, the optimumsystem for infusing the drug must be established and furtherstudies of maternal and fetal safety should be carried out(AU)

Retirada de catéter epidural en un paciente con doble antiagregación / Removal of an epidural catheter from a patient receiving anticoagulant and antiplatelet therapy

Describimos el manejo de la anticoagulación y laantiagregación para la reducción de riesgo de hematomapor la retirada de un catéter epidural. El problema seplanteó en el postoperatorio de una cirugía vascularmayor complicada con un infarto agudo de miocardioque requirió doble antiagregación tras la implantaciónde un stent coronario(AU)

We describe the management of anticoagulant andantiplatelet therapy to reduce the risk of hematoma onremoval of an epidural catheter. The situation arose followingmajor vascular surgery complicated by an acutemyocardial infarction that required anticoagulant andantiplatelet therapy following implantation of a coronarystent(AU)

Radial to femoral arterial blood pressure differences during liver transplantation.

This observational study compared femoral and radial arterial blood pressure in 72 patients undergoing liver transplant surgery. Simultaneous femoral and radial arterial blood pressures, cardiac index, core temperature and vasoconstrictor therapy were recorded at seven time points during the operation. No significant differences between radial and femoral pressures were found at the start of surgery. Femoral and radial systolic arterial blood pressures were statistically significantly different during liver reperfusion (mean (SD) arterial pressure = 92 (22) mmHg vs. 76 (22) mmHg, p < 0.01). Mean arterial blood pressures showed no statistically significant differences throughout the study. Vasoconstrictor drug administration was associated with a larger systolic pressure difference between femoral and radial arteries (28 (24) mmHg in patients being given vasoconstrictor drugs vs. 9 (19) mmHg in patients not needing vasoconstrictors during reperfusion, p < 0.001). In conclusion, differences in systolic arterial blood pressure occur between femoral and radial arterial monitoring sites during liver reperfusion, and in particular in patients being given vasoconstrictor therapy. Thus, if femoral arterial monitoring is not available, clinicians should rely on mean rather than systolic arterial pressure measurements from a radial artery catheter during liver transplantation.

[Paravertebral analgesia in thoracic surgery]. / Analgesia paravertebral en cirugía torácica.

Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. The thoracic paravertebral block, following its rediscovery, is being used with increasing frequency and success for both surgery and recovery from thoracotomy, challenging the supremacy of thoracic epidural analgesia, which to date has been considered the gold standard. We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.

[Recombinant activated factor VII used in a man with refractory bleeding from a stab wound injuring the liver and kidney]. / Factor VII activado recombinante en un paciente con hemorragia incoercible por lesión traumática hepatorrenal.

A 30-year-old man bled massively from a stab wound that injured his liver and right kidney and entered a life-threatening cycle of transfusion, hypothermia, coagulopathy, and rebleeding in spite of surgery and aggressive resuscitation. He was given a single dose of recombinant activated factor VII (rVIIa; NovoSeven, Novo Nordisk, Denmark) in a final attempt to save his life. The patient responded favorably, as bleeding stopped almost immediately and coagulation markers became normal. Clinical course following rVIIa administration was good. Severe bleeding in the trauma patient needing massive transfusion can become complicated by dilutional coagulopathy and hypothermia. Therapy with rVIIa is a promising aid to controlling bleeding in the repeatedly transfused patient who does not respond to standard replacement of blood products.

Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation.

INTRODUCTION: End-stage liver disease is frequently associated with autonomic neuropathy (AN). The hemodynamic changes during liver transplantation (LT) require an adequate autonomic response to maintain cardiovascular stability. PATIENTS AND METHODS: Forty-one patients undergoing LT were evaluated for the influence of AN on the evolution after LT. AN was previously evaluated by seven cardiovascular tests assessing sympathetic (Sy) or parasympathetic (P) function. Patients were classified as absent (A), early (E), or definite dysfunction (D). A hemodynamic study was performed before and after vascular clampings. The analysis included the duration of LT, transfusion requirements, intra-operative artenal hypotensive episodes, incidence of postreperfusion syndrome (PRS), cardiac arrhythmias and vasoactive drug requirements. RESULTS: The hyperdynamic circulation worsened during surgery in D patients, as shown by a significantly increased cardiac output and a significantly decreased systemic vascular resistance. The incidence of PRS was greater in the AN group. Arterial hypotension during the neohepatic period was more frequent among patients with AN, more frequently requiring vasoconstrictor and inotropic therapy. CONCLUSIONS: AN is associated with hemodynamic impairment and with increased vasoactive drug requirements during liver transplantation, probably associated with impaired reflex vasoconstrictor responses to surgical manipulations and changes of blood volume. AN may be associated with a greater surgical risk during LT. Preoperative evaluation of AN may select a high-risk population of LT recipients.

[The surgical treatment of aneurysms of the ascending aorta with associated aortic insufficiency. Total replacement with reimplantation of the coronary arteries]. / Tratamiento quirúrgico de los aneurismas de aorta ascendente con insuficiencia aórtica asociada. Reemplazo completo con reimplantación de coronarias.

We reviewed our experience with replacement of the ascending aorta and aortic valve with a composite graft and reimplantation of coronary arteries to the tube graft during 8 years interval from April, 1982, to April 1990. 24 patients underwent repair, the mean age was 49.83 years. Annuloaortic ectasia was the most common indication (58.33%), followed by aortic dissection (acute or chronic). Emergency operation was carried out in nine patients with aortic dissection (37.5%) and elective in 15. The mean duration of cardiopulmonary bypass was 118 +/- 4 minutes and of aortic clamping 83.85 +/- 2 minutes. Hospital mortality was 4.17%, reoperation for hemorrhage was 12.5% and perioperative morbidity for other causes was 34.7%. There were one late death. 20 patients were follow-up with a total of 638 patients-months (two patients excluded with insufficient follow-up and one late death). At last follow-up 14 patients were in functional class I. Eight year actuarial survival for the 24 patients was 91%. We believe that replacement of the ascending aorta and aortic valve with a composite graft and coronary arteries reimplantation to the tube graft is more than one satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all abnormal aortic tissue, eliminating the risk for later development of complications in the non excluded disease aorta. It supposes the method of choice for patients with anuloaortic-ectasia, aneurysms of the sinuses of Valsalva with aortic insufficiency, and aortic dissection with proximal affectation of coronary arteries and aortic valve.

[Original method of multivariate analysis, adapted for comparison of mean evoked potentials: E2 test]. / Une méthode originale d'analyse multivariée, adaptée à la comparaison des potentiels évoqués moyens: le test E2.

This paper describes a multivariate statistical method of analysis for the comparison of 2 paired series. For such paired series, this test, called E2, is analogous to the generalized Hotteling T2 test, as epsilon test (pairing method) is analogous to Student's t test. Here we give an example of its application to a comparison of curves, in this particular case average auditory evoked potentials, picked up at symmetrical points on the scalp.