Veno-arterial extracorporeal membrane oxygenation (ECMO VA) as part of a multimodal approach for the protection of spinal cord ischemia in surgical repair of a thoracoabdominal aneurysm.

Spinal cord ischaemia leading to paraplegia or paraparesis is one of the most devastating complications of aortic surgery. The risk of ischaemia is particularly high in repairs involving both the thoracic and abdominal segments, because in these cases blood flow to the spinal arteries can be interrupted. Multimodal protocols have now been developed to reduce the incidence of this complication, and include measures such as cerebrospinal fluid (CSF) drainage, avoidance of hypotension and anaemia, systemic hypothermia, neuromonitoring, maintaining distal perfusion during proximal clamping of the aorta, and reimplantation of intercostal or lumbar arteries, whenever feasible. We describe a case in which, due to the special characteristics of the surgery, veno-arterial extracorporeal membrane oxygenation (VA ECMO) was used to maintain distal blood flow in the lumbar, inferior mesenteric, and hypogastric arteries during aortic clamping. This approach reduced the risk of spinal cord and visceral ischaemia, and also eliminated the need for thoracotomy because partial left bypass was not required.

Ultrasound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair. / Bloqueo de la fascia transversalis versus bloqueo plano transverso del abdomen anterior ecoguiados en cirugía ambulatoria de hernia inguinal.

INTRODUCTION: The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair. MATERIALS AND METHODS: Retrospective observational study conducted on ASA I-II patients. Two groups (TAP-A and TFP), which were given 30ml of 0.25% levobupivacaine prior to surgical incision. The primary endpoint was the post-operative pain evaluated by verbal numerical scale (VRN at rest and movement) at 10, 30, 60, 90min, coinciding with ambulation, and 24hours by telephone. An evaluation was also made of the sensory block level reached prior to surgery, the need for additional analgesia, side effects, ease of performing the technique, and the level of satisfaction of patients with the anaesthetic-analgesic technique. RESULTS: A total of 61 patients were included, 30 patients in the TAP-A group and 31 in the TFP group. The analgesic efficacy obtained in both groups was similar, although some higher values were found in the VNR on moving in the TAP-A group, reaching statistical difference at 10minutes (P=.014) and 30minutes (P=.013) post-operatively. A higher level of sensory block was achieved in the TFP group than in the TAP-A group (P<.01). There were no significant differences in additional analgesia requirements, and the cumulative dose of morphine was similar in both groups in the post-operative period. There were no differences in side effects or complications. The technical ease of the block was similar in both groups and the level of satisfaction of patients very high. CONCLUSIONS: Both blocks with a multimodal approach achieve good post-operative analgesia of inguinal hernia repair, are easy to perform and have few complications. TFP achieves the highest sensory level, but there are no differences in the requirements for additional analgesia.

Efectos de ozurdex en la presión intraocular. Estudio en la práctica clínica / Effects of ozurdex on intraocular pressure. A real life clinical practice study

OBJETIVO: El implante biodegradable de dexametasona ozurdex está aprobado por la Agencia Europea del Medicamento para el tratamiento de uveítis intermedia y posterior y el edema macular tras oclusión venosa retiniana y edema macular diabético. El propósito de este estudio es evaluar los efectos en la presión intraocular en una cohorte de pacientes de la práctica clínica en la vida real. MÉTODOS: Estudio retrospectivo de pacientes tratados con ozurdex en el Hospital Universitario Cruces en un periodo de seguimiento de 6 meses. Se registraron las siguientes variables: edad, sexo, diagnóstico e historia de glaucoma, presión intraocular, tratamiento antihipertensivo y grosor macular medidos antes de la inyección y después de ella tras 1, 2, 4 y 6 meses. Los test estadísticos utilizados fueron: prueba U de Mann-Whitney, test de Chi cuadrado (con corrección de Fisher en caso necesario) y test de Wilcoxon. El nivel de significación estadística se estableció en p < 0,05. RESULTADOS: Se evaluaron los efectos de 75 inyecciones en 67 pacientes (35 mujeres: 52%; edad media: 62 años). La presión intraocular media previa a la inyección fue 15,9 mmHg y 1, 2, 4 y 6 meses tras la inyección: 18,80 (p = 0,627); 18,84 (p = 0,494); 17,02 (p = 0, 796) y 15,5 (p = 0,829). No se observaron diferencias estadísticamente significativas en las medidas de presión intraocular entre pacientes con historia previa de glaucoma y aquellos sin diagnóstico previo. CONCLUSIONES: Ozurdex muestra un perfil de seguridad excelente en términos de presión intraocular en la práctica clínica. Incluso los pacientes con antecedente de glaucoma muestran tal perfil. Ozurdex es una buena opción terapéutica para enfermedades retinianas en estos pacientes

OBJECTIVE: The dexamethasone biodegradable implant, ozurdex, is approved by the US Food and Drug Administration and by the European Medical Agency for the treatment of intermediate and posterior uveitis, and for the treatment of macular edema following retinal vein occlusion and diabetic macular edema. The aim of this study was to assess the effects of intraocular pressure in a cohort of patients from a real-life clinical practice. METHODS: Retrospective review was performed on the clinical records of patients treated with Ozurdex in Hospital Universitario Cruces in a 6 month period. The following variables were recorded: age, gender, diagnosis and history of glaucoma; intraocular pressure, antihypertensive treatment and macular thickness were recorded before the injection, and in the 1st, 2nd, 4th, and 6th months after the injection. Statistical tests: Mann-Whitney U test, Chi square test (with Fisher correction when needed) and Wilcoxon test. The level of statistical significance was set at P<.05. RESULTS: The effects of 75 injections given to 67 patients (35 women: 52%; mean age: 62) were evaluated. Mean intraocular pressure before the injection was 15.9 mmHg and at 1st, 2nd, 4th and 6th months after de injection it was 18.80 (P=.627), 18.84 (P=.494), 17.02 (P=.796) and 15.5 (P=.829), respectively. No statistically significant differences were observed in intraocular pressure measurements at the mentioned follow-up visits between patients with and without a history of glaucoma. CONCLUSIONS: In real-life clinical practice, ozurdex shows an excellent safety profile in terms of intraocular hypertension. Patients with a history of glaucoma may also show this profile, with ozurdex being a good option to treat retinal diseases in these patients

[Effects of ozurdex on intraocular pressure. A real life clinical practice study]. / Efectos de ozurdex en la presión intraocular. Estudio en la práctica clínica.

OBJECTIVE: The dexamethasone biodegradable implant, ozurdex, is approved by the US Food and Drug Administration and by the European Medical Agency for the treatment of intermediate and posterior uveitis, and for the treatment of macular edema following retinal vein occlusion and diabetic macular edema. The aim of this study was to assess the effects of intraocular pressure in a cohort of patients from a real-life clinical practice. METHODS: Retrospective review was performed on the clinical records of patients treated with Ozurdex in Hospital Universitario Cruces in a 6 month period. The following variables were recorded: age, gender, diagnosis and history of glaucoma; intraocular pressure, antihypertensive treatment and macular thickness were recorded before the injection, and in the 1st, 2nd, 4th, and 6th months after the injection. STATISTICAL TESTS: Mann-Whitney U test, Chi square test (with Fisher correction when needed) and Wilcoxon test. The level of statistical significance was set at P<.05. RESULTS: The effects of 75 injections given to 67 patients (35 women: 52%; mean age: 62) were evaluated. Mean intraocular pressure before the injection was 15.9 mmHg and at 1st, 2nd, 4th and 6th months after de injection it was 18.80 (P=.627), 18.84 (P=.494), 17.02 (P=.796) and 15.5 (P=.829), respectively. No statistically significant differences were observed in intraocular pressure measurements at the mentioned follow-up visits between patients with and without a history of glaucoma. CONCLUSIONS: In real-life clinical practice, ozurdex shows an excellent safety profile in terms of intraocular hypertension. Patients with a history of glaucoma may also show this profile, with ozurdex being a good option to treat retinal diseases in these patients.

Infecciones relacionadas con catéteres vasculares de corta permanencia en cuidados críticos / Short term catheter related infections in critical care

Las infecciones por catéter son la tercera causa de infección nosocomial en UCI. El riesgo de infección depende del tipo de dispositivo, el sitio de inserción y las adecuadas medidas de prevención. Su manejo implica la decisión de retirar el catéter y la terapia antimicrobiana sistémica. Esta revisión se centra en la epidemiología, patogénesis, diagnóstico y manejo de las infecciones relacionadas con catéter, centrándose en el manejo de acorde con el patógeno (AU)

Catheter related infections are third cause of nosocomial infections in the ICU. The risk of infection depends on the tapy of device, the site of insertion and the appropriate prevention measures. Management involves deciding on catheter removal and systemic antimicrobial therapy. This review outlines the epidemiology, pathogenesis, diagnosis and management of catheter related infections, mainly focusing on the management according to the patogen (AU)

Anafilaxia perioperatoria / Perioperative anaphylaxis

La anafilaxia perioperatoria es un cuadro clínico que puede amenazar la vida del paciente, producido por fármacos o sustancias usados durante la anestesia. Después de una anafilaxia debe realizarse un estudio alergológico para identificar el agente responsable y prevenir recurrencias. La incidencia global se estima de 1 entre 10.000-20.000 anestesias. Los agentes más frecuentemente implicados son los bloqueantes neuromusculares, látex y antibióticos. El diagnóstico inicial es clínico y en el tratamiento es esencial la adrenalina. En este artículo se describe la clínica, pruebas diagnósticas, así como protocolos de prevención y tratamiento del cuadro de anafilaxia perioperatoria. Será importante desarrollar protocolos de detección y manejo precoz de estas reacciones en circuitos de cirugía ambulatoria y establecer un adecuado seguimiento posterior (AU)

Perioperative anaphylaxis may be a life threatening clinical condition and is typically due to the results of drugs used for anesthesia. Once anaphylaxis occurs, allergy studies are essential to identify the responsible agent so to prevent recurrences. The overall incidence is estimated at 1 in 10,000-20,000 anesthetic procedures. The most commonly involved agents are neuromuscular blocking agents, latex and antibiotics. The initial diagnosis is presumptive; including clinical signs and adrenalin is the treatment of choice. The aim of this article is to review etiology, diagnosis, prevention and treatment of perioperative anaphylaxis. It will be important to produce action protocols to ensure the detection of these reactions of anaphylaxis in outpatient surgery and to establish the correct follow-up (AU)

Bloqueo transverso abdominal ecoguiado vs. infiltración de herida quirúrgica en cirugía ambulatoria de hernia inguinal / Transversus abdominis plane block ultrasound-guided vs. surgical wound infiltration in outpatient inguinal hernia repair

Introducción: recientemente se han descrito numerosos bloqueos periféricos a nivel abdominal. El bloqueo del plano transverso abdominal (TAP) ha mostrado su utilidad para reducir el dolor y los requerimientos analgésicos en cirugía de pared abdominal. El objetivo de nuestro estudio fue valorar la eficacia y seguridad del bloqueo TAP ecoguiado en comparación con la infiltración de la herida quirúrgica en pacientes programados para cirugía de hernia inguinal unilateral en régimen ambulatorio. Material y métodos: estudio prospectivo, aleatorizado, simple ciego, en pacientes ASA I y II, divididos en dos grupos: grupo TAP a los que se les realizó un bloqueo TAP ecoguiado con 30 ml levobupivacaína 0,25 %, previo a la cirugía; grupo IH con infiltración de la herida quirúrgica con levobupivacaína 0,25 %. Se evaluó la eficacia analgésica mediante la escala verbal numérica (en reposo y movimiento) a los 10, 30, 60 y 90 min del postoperatorio, coincidiendo con la deambulación y en domicilio a las 24 h mediante llamada telefónica. Se registró la analgesia de rescate administrada, los efectos secundarios y el grado de satisfacción de los pacientes con la técnica anestésica. Resultados: se incluyeron 41 pacientes, 20 en el grupo TAP y 21 en el grupo IH. La eficacia analgésica obtenida en ambos grupos fue similar, con mayor demanda de analgesia adicional en postoperatorio en el grupo IH a los 10, 30 y 60 min, llegando a ser estadísticamente significativo a los 60 min. Mediante llamada telefónica a domicilio, a las 24 h se encontró un mayor consumo deo (..) (AU)

Introduction: Recently numerous peripheral blocks have been described at abdominal wall. The transversus abdominis plane block (TAP), has proven useful in reducing pain and analgesic requirements in abdominal wall surgery. The aim of our study was to evaluate the efficiency and safety of ultrasound-guided TAP block compared to surgical wound infiltration in patients scheduled for unilateral inguinal hernia surgery in outpatients. Materials and methods: A prospective, randomized, single-blind, ASA I and II patients, divided into two groups: the TAP group who underwent ultrasound guided TAP block with 30 ml levobupivacaine 0.25% prior to surgery; and a IH group with surgical wound infiltration with levobupivacaine 0.25%. Analgesic efficacy was evaluated by a numerical verbal scale (at rest and in movement) in 10, 30, 60, 90 minutes post surgery, coinciding with ambulation and through (..) (AU)

Comentarios al artículo «Cefalea postpunción dural en obstetricia» / Comments on the article "Postdural puncture headache in obstetrics"

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Alergia al látex (I): implicaciones para el anestesiólogo / No disponible

La alergia al látex es una patología importante en el ámbito sanitario. Son grupos de riesgo para desarrollar alergia al látex los pacientes multioperados y los profesionales sanitarios. La prevalencia en la población general es calcula en un 1%, mientras que en los trabajadores sanitarios es del 2,6 al 19,6%, siendo mayor en los trabajadores de las áreas quirúrgicas. La clínica varía desde rinitis hasta shock anafiláctico, pudiendo ser causa de muerte. El diagnóstico se basa en una buena historia clínica, test cutáneos y, si es necesario, pruebas de provocación controlada. Existen protocolos para prevenir el desarrollo de síntomas en los pacientes alérgicos, cuando van a ser intervenidos quirúrgicamente. El tratamiento etiológico se basa en la inmunoterapia yen nuevas técnicas de ADN recombinante. En este artículo, se describe la clínica, protocolos diagnósticos, así como protocolos de prevención y tratamientos etiológicos de la alergia al látex (AU)

Hypersensitivity to natural rubber latex has been recognized as an important health problem. Risks groups for natural rubber latex allergy included health workers and patients who have under gone multiple surgical procedures. The prevalence of latex allergy among general population is probably 1%, in heath workers the estimated prevalence is between 2.6 to 19.6% and tends to be higher in surgical settings. Symptoms vary between rhinitis to anaphylaxis, even death. Diagnosis of latex allergy is based in clinical history, skin test and provocation test. Several protocol shave been described to avoid symptoms in allergy patients when they undergo surgical procedures. Etiological treatment is based on specific immunotherapy and recombinant allergens techniques. The aim of this article was to review etiology, diagnosis, prevention and treatment of latex allergy (AU)

Actualización en el tratamiento del trastorno por déficit de atención/hiperactividad / Update on Attention-deficit/hyperactive disorder treatment

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos neuropsiquiátricos más frecuentes y mejor estudiados en la población infantil, y su relevancia aumenta al entender las interferencias que provoca sobre el desarrollo de quienes lo presentan. Objetivo. Actualizar las bases conceptuales y las evidencias del tratamiento del TDAH bajo el enfoque multimodal, es decir, la combinación del tratamiento psicofarmacológico y psicológico según los casos. Desarrollo. El TDAH debe entenderse como un proceso de larga evolución, por lo que se debe elaborar cuidadosamente su plan de tratamiento. Tiene que ser lo más completo posible y considerar la evidencia más reciente, las preferencias y preocupaciones de familiares y pacientes, y la psicoeducación. Los psicoestimulantes han sido los fármacos más estudiados y usados en el tratamiento del TDAH, con unas tasas de respuesta del 65-85% de los pacientes. La atomoxetina, un inhibidor de la recaptación noradrenérgica, es otra alternativa para el tratamiento del TDAH recientemente aprobada por la Food and rug Administration estadounidense y la Agencia Europea del Medicamento. Conclusiones. La planificación del tratamiento la decisión del fármaco que se debe utilizar tienen que individualizarse en cada paciente, atendiendo a los objetivos terapéuticos y, de manera relevante, ajustándose a la presencia de comorbilidades, muy frecuentes en este trastorno. En los pacientes no respondedores o resistentes a los tratamientos habituales, es más necesaria, si cabe, la evaluación minuciosa de la presencia de otros trastornos comórbidos que estén influyendo en la respuesta (AU)

Introduction. Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient’s every day life. Aim. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. Development. As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. Conclusions. The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient’s family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders’ patients (AU)

[Update on attention-deficit/hyperactive disorder treatment]. / Actualización en el tratamiento del trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient's every day life. AIM. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. DEVELOPMENT: As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. CONCLUSIONS: The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient's family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders' patients.