[Severe perioperative thrombocytosis in a patient undergoing lung resection]. / Trombocitosis severa perioperatoria en un caso de resección pulmonar.

Severe thrombocytosis (platelet count > 1,000,000 microL(-1)) is a rare, usually reactive, process and few perioperative cases have been reported. We describe the management of a patient who developed severe reactive thrombocytosis in the preoperative period before undergoing segmentectomy to remove a malignant nodule. A platelet count of 2,086,000 microL(-1) was observed during the first few days after surgery; we therefore started antiplatelet therapy to prevent thrombotic complications. We analyze the factors that might have contributed to the development of severe thrombocytosis in this case and discuss the different treatment options that may affect perioperative outcomes in these patients.

[Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale]. / Adaptación al español y validez diagnósticade la Yale Global Tics Severity Scale.

AIM: The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global Tics Severity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument for quantifying the clinical evolution of patients with Tourette syndrome. PATIENTS AND METHODS: Analysis of the properties of the adapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis), internal consistency (Cronbach's alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change (Wilcoxon rank sum test). RESULTS: The factor analysis confirmed the existence of two dimensions on the scale, which account for 76.3% of the variability. The internal consistency, measured by Cronbach's alpha, was 0.997 for the motor tic dimension and 0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to or greater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the global scores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for the first interview (incorporation into the study group) and the second one (after 15 days' treatment). CONCLUSIONS: The Spanish version of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity and reliability is greater in the motor and phonic tic dimensions than in that of disability.

[Obstetric analgesia for a patient with a history of 3 previous operations on the spine]. / Analgesia obstétrica en una paciente con tres cirugías previas de columna.

A history of spinal surgery is not currently considered a contraindication for regional obstetric analgesia. However, there are highly complex cases in which choosing the best analgesic technique presents genuine problems. We report the case of a woman in labor at full-term with 4-cm dilatation of the cervix who had undergone 3 operations for scoliosis and a herniated disk treated by T5-L4 and L4-sacral arthrodesis, laminectomy, and diskectomy. No previous anesthetic plan was in place, so we chose intravenous patient-controlled analgesia for labor and vaginal delivery and spinal anesthesia for a cesarean delivery. However, general anesthesia became necessary because it was impossible to reach the dura mater. The literature was reviewed to assess alternative forms of obstetric analgesia for patients who have undergone scoliosis surgery.

[Prevalence of burnout among anesthesiologists at Hospital Universitario Virgen Macarena de Sevilla]. / Prevalencia del síndrome de burnout en los anestesiólogos del Hospital Universitario Virgen Macarena de Sevilla.

Burnout, characterized by emotional exhaustion, depersonalization, and lowered sense of professional accomplishment, is a consequence of chronic stress. Few studies have been published on burnout in anesthesiology even though this specialty is considered particularly stressful. We surveyed members of the department of anesthesiology and postoperative care in our hospital, using an anonymous questionnaire including items on social and personal characteristics and the Spanish language version of the Maslach Burnout Inventory. Forty-valid questionnaires were returned, for a response rate of 69.4%. Mean (SD) scores were 19.5 (9.5) points for emotional exhaustion, 7.4 (5.5) for depersonalization, and 32.5 (9.1) for professional accomplishment. We detected high levels of emotional exhaustion in 19.5% of the anesthesiologists and of depersonalization in 31.7%. Scores reflecting low levels of sense of personal accomplishment were recorded for 41.4%. Scores for concern on at least 1 subscale were noted for 58.3% of the anesthesiologists, on 2 subscales for 21.8%, and on 3 subscales for 12.1%. No significant differences were detected in relation to gender, age, stage in professional life, or employment status. Burnout levels in our department are similar to those reported for anesthesiologists in other countries and detectably lower than those of other specialties in Spain.

[Lazarus phenomenon: spontaneous resuscitation]. / El fenómeno de lázaro: reanimación espontánea.

A 94-year-old woman undergoing surgery for simple repair of a duodenal perforation experienced a sudden massive hemorrhage (1500 mL) when the duodenum was separated from adjacent structures. Hemodynamic stability was re-established when fluids were replaced. After the abdominal wall was closed, increased amplitude of the QRS wave was observed and heart rate slowed until there was no pulse. Electromechanical dissociation (EMD) was diagnosed and cardiopulmonary resuscitation was started. When EMD persisted after 40 minutes, resuscitative measures were stopped and the ventilator was disconnected, though orotracheal intubation and arterial and electrocardiographic monitoring were maintained. After 2 or 3 minutes, heart rhythm restarted spontaneously and arterial pressure waves reappeared on the monitor. The patient progressed well for 72 hours, after which she developed septic shock and multiorgan failure, dying 18 days later. The Lazarus phenomenon may be more common than the medical literature would indicate, possibly because a large gap in our understanding of the pathophysiology of the phenomenon underlies anecdotes about "miracles". As we wait for adequate international consensus on a protocol for monitoring the withdrawal of resuscitative measures, we should act prudently before definitively certifying death. The case we report occurred during a surgical intervention in which the patient had received general anesthesia. We believe that the causes that might explain the Lazarus phenomenon are quite different in that context than they would be in a nonsurgical setting, such that it would be useful to create a national database to keep a record of such intraoperative events.

[Controversies surrounding pain and inhalation anesthesia in nineteenth century Spain]. / Controversias en torno al dolor y la anestesia inhalatoria en la España del siglo XIX.

The introduction of inhaled anesthetics to Spain in 1847 brought appearances by enthusiastic promotors, prudent and reserved admirers and stubborn adversaries - sparking controversy over the use of the new gases. In some cases debate involved the discussion of various concepts of pain, as is shown by heated exchanges among Eusebio Castelo Serra, Manuel Santos Guerra and Zacarías Benito González in the pages of the journal Boletín de Medicina, Cirugía y Farmacia, in three articles appearing between 1850 and 1851 on the concept of pain: Sobre el dolor de las enfermedades y principalmente en las operaciones quirúrgicas, Modificación de dos instrumentos and Estudios sobre el dolor. Investigation into the authors' biographies and an analysis of the content of the articles has permitted us to reconstruct some aspects of the concept of pain in Spain in the middle of the nineteenth century.

[Arrhythmias in the pulmonary exeresis postoperative period]. / Arritmias en el postoperatorio de cirugía para exéresis pulmonar.

OBJECTIVES: To determine the frequency of episodes of cardiac arrhythmia during the period following elective exeresis of the pulmonary parenchyma (pneumonectomies, double and single lobectomies), and to study the temporal patterns of occurrence and the association of arrhythmia and certain risk factors. PATIENTS AND METHODS: Retrospective analysis of data recorded in the case histories of 100 patients admitted to the postoperative intensive care unit (PICU) between November 1991 and March 1995. RESULTS: We monitored changes in heart rate after surgery by continuous electrocardiography in 38 of the 100 patients (38%). Changes were more common in certain subgroups: older patients, those with preoperative cardiovascular and electrocardiographic abnormalities, and those who needed prolonged postoperative mechanical ventilation. Most arrhythmias were supraventricular (97.3%), the most common being atrial fibrillation (55.3%). Most diagnoses of arrhythmia (87%) were made within the first three days after surgery. Several drugs were used for treatment, based on the diagnosing anesthesiologist's criteria. Digitalis was the drug most often prescribed. Seven patients (7%) died in the PICU. Three were discharged with atrial fibrillation with ventricular response of less than 100 beats per minute. Postoperative cardiac arrhythmia was a direct cause of death of only one patient, who had ventricular fibrillation upon admission to the PICU.

[Unilateral post-bilobectomy pulmonary edema originating from thrombosis of the pulmonary vein]. / Edema pulmonar unilateral posbilobectomía originado por trombosis de la vena pulmonar.

Foucart (1875) and Ortner (1899) were the first to describe unilateral pulmonary edema as a complication of drainage of hydrothorax. Although various causes have been reported for this entity, it continues to be rare. We report a case of right unilateral pulmonary edema due to thrombosis of the superior pulmonary vein that was detected while a patient was in the recovery room after bilateral lobectomy for pulmonary tumors. The possible pathophysiological mechanisms contributing to pulmonary edema are discussed.