ABSTRACT
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
Subject(s)
Anesthesia , Anesthesiology , Thoracic Surgery , Humans , Lung , Physical Therapy Modalities , Pneumonectomy/adverse effects , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methodsSubject(s)
Humans , Male , Aged, 80 and over , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapyABSTRACT
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
ABSTRACT
La Sección de Vía Aérea de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD) presenta la actualización de las recomendaciones para la evaluación y manejo de la vía aérea difícil con el fin de incorporar los avances técnicos y los cambios observados en la práctica clínica desde la publicación de la primera edición en 2008. La metodología elegida fue la adaptación de 5 guías internacionales recientemente publicadas, cuyo contenido fue previamente analizado y comparado de forma estructurada, y el consenso de expertos de los 19 centros participantes. El documento final fue sometido a la valoración de los miembros de la SCARTD y a la revisión por parte de 11 expertos independientes. Estas recomendaciones están pues sustentadas en la evidencia científica actualmente disponible y en un amplio acuerdo de los profesionales de su ámbito de aplicación. En esta edición se amplía la definición de vía aérea difícil, abarcando todas las técnicas de manejo, y se hace mayor hincapié en la valoración de la vía aérea y en la clasificación en 3 categorías según el potencial grado de dificultad y las consideraciones de seguridad adicionales, que guiarán la planificación de la estrategia a seguir. La preparación previa al manejo de la vía aérea, no solo relativa al paciente y al material, sino también a la comunicación e interacción entre todos los agentes implicados, ocupa un lugar destacado en todos los escenarios incluidos en el presente documento. El texto refleja el aumento progresivo del uso de los videolaringoscopios y de los dispositivos de segunda generación en nuestro entorno y promueve tanto su uso electivo como el uso precoz en la vía aérea no prevista. También recoge la creciente utilización de la ecografía como herramienta de apoyo en la exploración y toma de decisiones. Se han abordado nuevos escenarios como el riesgo de broncoaspiración y la extubación considerada difícil. Finalmente, se trazan las líneas maestras de los programas de entrenamiento y formación continuada en vía aérea necesarios para garantizar la implementación efectiva y segura de las recomendaciones
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines
Subject(s)
Humans , Airway Management/methods , Anesthesia, Endotracheal/methods , Anesthetics/administration & dosage , Intubation, Intratracheal/methods , Airway Extubation/methods , Consensus , Airway Obstruction/prevention & control , Preoperative Care/methodsABSTRACT
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.
Subject(s)
Airway Management/standards , Airway Management/methods , Anesthesia , Critical Care , Decision Trees , Humans , Pain ManagementABSTRACT
BACKGROUND: Over the last years, different works have been published about the importance of incorporating new diagnosis techniques in allergic patients such as component-resolved diagnosis (CRD). The objective of this study is to compare the evolution of allergic sensitisation profiles by means of CRD and cutaneous tests (SPT) on pollen-allergic patients. METHODS: A total of 123 patients aged between 2 and 14 years were included in an open, prospective, multicentre study. All the children had symptoms suggestive of seasonal respiratory allergic disease, with the diagnosis confirmed by cutaneous tests. Specific-IgE to major pollen-allergens (CRD) and SPT were performed at basal and after three years of follow-up. RESULTS: Out of 123 patients included, a total of 85 were analysed. The mean age was 8±3 years. Significant changes in the allergic sensitisation profiles were observed for the most prevalent allergens (Olea and grass) but it is in grass, the most relevant allergen in terms of allergen pressure, where changes in both absolute and relative frequencies between SPT and CRD were more evident. CONCLUSION: CRD seems to be an essential tool to carry out an appropriate follow-up of patients with allergic respiratory disease, as well as to decide on the immunotherapy composition that best matches the allergic sensitisation profile of patients
No disponible
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Diagnostic Techniques, Respiratory System/standards , Diagnostic Techniques, Respiratory System , Skin Tests/methods , Rhinitis, Allergic, Seasonal/diagnosis , Immunotherapy/methods , Follow-Up Studies , Cohort Studies , Hypersensitivity, Immediate/diagnosis , Immunoglobulin E/analysis , Prospective StudiesABSTRACT
BACKGROUND: Over the last years, different works have been published about the importance of incorporating new diagnosis techniques in allergic patients such as component-resolved diagnosis (CRD). The objective of this study is to compare the evolution of allergic sensitisation profiles by means of CRD and cutaneous tests (SPT) on pollen-allergic patients. METHODS: A total of 123 patients aged between 2 and 14 years were included in an open, prospective, multicentre study. All the children had symptoms suggestive of seasonal respiratory allergic disease, with the diagnosis confirmed by cutaneous tests. Specific-IgE to major pollen-allergens (CRD) and SPT were performed at basal and after three years of follow-up. RESULTS: Out of 123 patients included, a total of 85 were analysed. The mean age was 8±3 years. Significant changes in the allergic sensitisation profiles were observed for the most prevalent allergens (Olea and grass) but it is in grass, the most relevant allergen in terms of allergen pressure, where changes in both absolute and relative frequencies between SPT and CRD were more evident. CONCLUSION: CRD seems to be an essential tool to carry out an appropriate follow-up of patients with allergic respiratory disease, as well as to decide on the immunotherapy composition that best matches the allergic sensitisation profile of patients.
Subject(s)
Allergens/immunology , Pollen/immunology , Rhinitis, Allergic, Seasonal/diagnosis , Skin Tests , Adolescent , Child , Child, Preschool , Cohort Studies , Environmental Exposure/adverse effects , Female , Follow-Up Studies , Humans , Immunization , Immunoglobulin E/blood , Male , Olea/immunology , Pilot Projects , SeasonsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Predictive Value of Tests , Sensitivity and Specificity , Intubation/trends , Intubation , Intubation, Intratracheal/standards , Intubation, Intratracheal/trends , Anesthesia, Local/instrumentation , Anesthesia, Local/methods , Tracheotomy , Algorithms , Hypoxia/complications , Laryngoscopy/standards , LaryngoscopyABSTRACT
BACKGROUND AND OBJECTIVE: This randomized, double-blinded, prospective study compared the effects of clonidine, esmolol or alfentanil on the level of hypnosis and haemodynamic responses to intravenous induction of anaesthesia and endotracheal intubation. METHODS: Forty-five patients scheduled for elective surgery were allotted to one of three groups. They were given either alfentanil 3 microg kg(-1) min(-1) (n = 15); esmolol 1 mg kg(-1) min(-1) (n = 16) or clonidine 3 microg kg(-1) (n = 14) as a 10 min infusion. The infusions of alfentanil and esmolol, but not of clonidine, were maintained during endotracheal intubation. Anaesthesia was induced with midazolam (2 mg) and thiopental as required to suppress the eyelash reflex. Atracurium (0.5 mg kg(-1)) was given to produce neuromuscular block. Mean arterial pressure, heart rate, and bispectral index were recorded on arrival (baseline), after study drug infusion, after injecting midazolam and thiopental, as well as after endotracheal intubation. ANOVA and chi2-test were used for analysis. RESULTS: Blood pressure, heart rate and the bispectral index were unaltered by the study drugs, but thiopental requirements were reduced by alfentanil and clonidine (P < 0.014). Mean arterial pressure values (mean +/- standard error of mean) in the alfentanil, esmolol and clonidine groups were: baseline: 107.8 +/- 3.8; 106.6 +/- 3.9; 103.4 +/- 3.7 mmHg; after thiopental: 74.0 +/- 4.2; 85.6 +/- 4.3; 94.2 +/- 4.1 mmHg and after endotracheal intubation: 91.7 +/- 5.3; 114.1 +/- 6.9; 123.6 +/- 5.6 mmHg, respectively (two-way ANOVA, P < 0.001). Mean arterial pressure changed significantly after intubation from baseline (P < 0.001) after alfentanil (-15%) and clonidine (+20%) but not after esmolol (+7%), while the changes between pre- and postintubation values were similar in all groups (24-33% increase). The bispectral index indicated that all patients had an adequate level of hypnosis, but the variability was higher in the esmolol group (P < 0.002). CONCLUSIONS: None of the study drugs blocked the increase in mean arterial pressure induced by endotracheal intubation, but esmolol provided better overall haemodynamic stability. All groups had an adequate level of hypnosis.
Subject(s)
Adjuvants, Anesthesia , Anesthesia, General , Adjuvants, Anesthesia/administration & dosage , Adjuvants, Anesthesia/pharmacology , Adrenergic beta-Antagonists/administration & dosage , Adult , Aged , Aged, 80 and over , Alfentanil/administration & dosage , Analgesics/administration & dosage , Anesthetics, Intravenous/administration & dosage , Blood Pressure/drug effects , Clonidine/administration & dosage , Double-Blind Method , Electroencephalography/drug effects , Female , Heart Rate/drug effects , Humans , Infusions, Intravenous , Male , Middle Aged , Propanolamines/administration & dosageABSTRACT
Objetivos: Las benzodiacepinas son drogas sedantes utilizadas frecuentemente en pacientes con trauma craneoencefálico. Su empleo altera la valoración neurológica del paciente, por lo que es útil disponer de un antagonista. La reversión de sus efectos puede alterar las respuestas hemodinámicas y neurológicas de estos pacientes. Nos proponemos analizar estas respuestas en un grupo de pacientes con trauma craneoencefálico grave en tratamiento con benzodiacepinas en perfusión continua a los que se revierte su acción con el antagonista flumazenil. Métodos: Estudio prospectivo, intervencional, en pacientes con trauma craneal grave (tomografía computadorizada craneal en todos los pacientes), ingresados en una UCI de un hospital universitario, con monitorización de presión intracraneal (PIC) y sin datos de hipertensión intracraneal y estabilidad hemodinámica. Tras 48 horas de perfusión de benzodiacepinas, reversión con 0.5-1 mg de flumazenil. Valoración antes y después (5 minutos) de nivel de conciencia (GCS), PIC, tensión arterial media (TAM), frecuencia cardíaca, presión de perfusión cerebral (PPC).Resultados: Se incluyeron 25 pacientes con trauma cerrado. Edad media: 31,5 +/-12,94 años. Varones 80 por ciento. Lesiones focales 72 por ciento. Lesiones asociadas 48 por ciento. GCS previo 5,0+/-2,6 PIC basal: 15,16+/-5,5, PPC: 75,22 +/-15,1. (TAM): 90,84+/-13,4 y frecuencia cardíaca: 87,1 +/-21,1. Tras flumazenil GCS: 6,64 +/-3,34 (p< 0,05) PIC: 20,76 +/-12,3 (p<0,05). TAM: 98,2 +/-23,1 (NS). PPC: 77,58 +/-17,6 (NS).Conclusiones: Aunque nuestra serie tiene el sesgo de ser un grupo de pacientes sin hiperPIC, el GCS se elevó tras flumazenil, pero se acompañó de aumento de la PIC, contraindicando su empleo en pacientes incluso con PIC normal si se sospecha trauma craneal (AU)
Subject(s)
Adolescent , Female , Male , Humans , Flumazenil/pharmacology , Craniocerebral Trauma/drug therapy , Benzodiazepines/antagonists & inhibitors , Intracranial Pressure , Prospective StudiesABSTRACT
Aqui se describe detalladamente cuáles son las últimas tecnologías, como deben ser aplicadas y cuáles son las ventajas de su aplicación en los servicios de urgencias y emergencias (AU)
Subject(s)
Humans , Ambulatory Care , Emergency Medical Services/trends , Technological Development , Telemedicine/methods , Computer Communication Networks , Internet , Medical RecordsABSTRACT
No disponible
Subject(s)
Humans , Emergency Medicine/organization & administration , Emergency Medical Services/organization & administration , Critical Pathways/organization & administration , Program DevelopmentABSTRACT
We report a case of accidental subdural block after epidural anesthesia that manifested as cardiac arrest due to extensive spinal blockade 20 minutes after administration of 50 mg of 0.5% bupivacaine. The event resolved without sequelae. Subdural placement of the catheter was verified by computed axial tomography contrast medium. Clinical signs of subdural block are highly variable, extensive neural block being among the possible rare presentations, with latency ranging from a few minutes to as long as 30. Recent electron microscope observations with new methods for fixing and preparing tissues suggest that the dubdural space does not exist naturally, but rather forms artificially within a low-resistance cell plane composed of neurothelial cells, as a result of trauma or the injection of a local anesthetic. The characteristics of the space depend, therefore, on factors that come together at the site. These data explain the great variability in the clinical manifestations of a subdural block. The case of cardiopulmonary arrest we report is rare in the literature.
