Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 13 de 13
Filter
1.
Rev Esp Anestesiol Reanim (Engl Ed) ; 71(3): 171-206, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38340791

ABSTRACT

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.


Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, Intratracheal
2.
Rev Esp Anestesiol Reanim (Engl Ed) ; 71(3): 207-247, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38340790

ABSTRACT

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.


Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, Intratracheal
3.
Rev. esp. anestesiol. reanim ; 67(7): 381-390, ago.-sept. 2020. ilus, tab
Article in Spanish | IBECS | ID: ibc-199533

ABSTRACT

ANTECEDENTES: La inducción de secuencia rápida (ISR) en adultos ha experimentadcambios en los últimos años debido a los avances farmacológicos y tecnológicos. El objetivo de esta encuesta fue evaluar la práctica actual entre los anestesiólogos españoles. MÉTODOS: Se envió un cuestionario con 31 preguntas referentes a la práctica de la ISR a anestesiólogos de hospitales del Servicio Nacional de Salud de España. Las diferencias en las respuestas relacionadas con el tipo de hospital o experiencia se compararon para todos los datos utilizando el Chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: Aproximadamente el 15,89% de los anestesiólogos españoles participaron en la encuesta (1.002 cuestionarios). Los resultados muestran una gran heterogeneidad en la mayoría de los aspectos de la ISR. El citrato sódico es administrado por menos del 20% de los participantes. El 64% de los encuestados coloca una sonda nasogástrica en pacientes con obstrucción intestinal. El residuo gástrico se evalúa con ultrasonidos en un 6%. Una cuarta parte de los encuestados controla la eficacia de la preoxigenación con la ETO2 y el 22% utiliza la insuflación nasal de oxígeno con gafas nasales o THRIVE. El 62% de los encuestados aplica presión cricoidea, pero solo se libera en un 50% cuando aparece dificultad en la intubación. Hasta el 40% de los anestesiólogos refirieron haber tenido algún caso de aspiración a pesar de aplicar presión cricoidea. El propofol fue el hipnótico más utilizado (97,6%), mientras que no hubo una diferencia clara en la preferencia del relajante neuromuscular (ratio suxametonio versus rocuronio de aproximadamente 1:1). Solo el 44% de los encuestados calcula la dosis de sugammadex necesaria para una reversión de emergencia del rocuronio. CONCLUSIONES: La encuesta demostró una variación significativa en la práctica de la ISR, similar a la de otros países. Se necesitan estudios prospectivos de calidad para estandarizar la práctica clínica


BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice


Subject(s)
Humans , Airway Management/methods , Anesthesia, General/methods , Anesthetics/administration & dosage , Intubation, Intratracheal/methods , Spain/epidemiology , Health Care Surveys/statistics & numerical data , Intubation, Gastrointestinal/methods , Respiratory Aspiration of Gastric Contents/prevention & control , Metoclopramide/therapeutic use
4.
Article in English, Spanish | MEDLINE | ID: mdl-32564884

ABSTRACT

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.


Subject(s)
Anesthesiology , Practice Patterns, Physicians' , Rapid Sequence Induction and Intubation/standards , Health Care Surveys , Humans , Spain
5.
Br J Anaesth ; 120(4): 734-744, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29576114

ABSTRACT

BACKGROUND: The aim of this study was to evaluate postoperative complications in patients having major elective surgery using oesophageal Doppler monitor-guided goal-directed haemodynamic therapy (GDHT), in which administration of fluids, inotropes, and vasopressors was guided by stroke volume, mean arterial pressure, and cardiac index. METHODS: The FEDORA trial was a prospective, multicentre, randomised, parallel-group, controlled patient- and observer-blind trial conducted in adults scheduled for major elective surgery. Randomization and allocation were carried out by a central computer system. In the control group, intraoperative fluids were given based on traditional principles. In the GDHT group, the intraoperative goals were to maintain a maximal stroke volume, with mean arterial pressure >70 mm Hg, and cardiac index ≥2.5 litres min-1 m-2. The primary outcome was percentage of patients with moderate or severe postoperative complications during the first 180 days after surgery. RESULTS: In total, 450 patients were randomized to the GDHT group (n=224) or control group (n=226). Data from 420 subjects were analysed. There were significantly fewer with complications in the GDHT group (8.6% vs 16.6%, P=0.018). There were also fewer complications (acute kidney disease, pulmonary oedema, respiratory distress syndrome, wound infections, etc.), and length of hospital stay was shorter in the GDHT group. There was no significant difference in mortality between groups. CONCLUSIONS: Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low-moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days. CLINICAL TRIAL REGISTRATION: ISRCTN93543537.


Subject(s)
Cardiotonic Agents/administration & dosage , Fluid Therapy/methods , Hemodynamics/physiology , Postoperative Complications/therapy , Ultrasonography, Interventional/methods , Vasoconstrictor Agents/administration & dosage , Elective Surgical Procedures , Esophagus , Female , Goals , Humans , Male , Middle Aged , Prospective Studies , Risk , Ultrasonography, Doppler/methods
6.
Anaesthesia ; 70(12): 1441-52, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26558858

ABSTRACT

We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p = 0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p = 0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p = 0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p = 0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p = 0.53, and 0.87 (0.65-1.17), p = 0.36 respectively.


Subject(s)
Neostigmine/pharmacology , Neuromuscular Blockade , gamma-Cyclodextrins/pharmacology , Humans , Postoperative Nausea and Vomiting/epidemiology , Sugammadex
7.
Minerva Anestesiol ; 81(9): 1019-30, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25501602

ABSTRACT

The incidence of hypotension associated to spinal anesthesia in elective cesarean section is high. To determine the effects of colloids and crystalloids in the incidence of hypotension induced by spinal anesthesia in elective cesarean section, an attempt was made to define which type of fluid and what total volume should be administered. Following the PRISMA methodology a systematic review and meta-analysis were carried out. A systematic Medline/PubMed, EMBASE and Cochrane Library search was made to identify trials where women were scheduled for elective cesarean section with spinal anesthesia and volume loading (preload or co-load). The primary outcome was the incidence of hypotension. Stratification into subgroups was made for the primary outcome according to the type of colloid administered, differentiating those studies employing new generation colloids (HES 6% 130/0.4) from those not using such colloids, based on the volume of colloid administered and the combination of a vasopressor. The secondary outcome was the incidence of intraoperative nausea and vomiting. Two-hundred and twenty-seven controlled clinical trials were analyzed; eleven randomized clinical trials including 990 patients were included. A significative decrease of incidence of hypotension associated to spinal anesthesia was observed with the use of colloids compared to crystalloids (RR [95% CI] 0.70 [0.53-0.92], P=0.01). However, there was no difference between crystalloid and colloid in the risk of intraoperative nausea and vomiting (RR [95% CI] 0.75 [0.41-1.38]; P=0.33). This meta-analysis shows colloid administration to significantly reduce the incidence of hypotension associated to spinal anesthesia in elective cesarean section compared with of crystalloid use.


Subject(s)
Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Colloids/therapeutic use , Hypotension/prevention & control , Isotonic Solutions/therapeutic use , Plasma Substitutes/therapeutic use , Adult , Anesthesia, Obstetrical , Anesthesia, Spinal/methods , Crystalloid Solutions , Female , Humans , Hypotension/etiology , Pregnancy
8.
Rev. esp. anestesiol. reanim ; 61(9): 517-520, nov. 2014.
Article in Spanish | IBECS | ID: ibc-127401

ABSTRACT

Se presenta el caso de un varón de 62 años programado para una cistectomía radical que a los 10 min de comenzar la cirugía presentó hipotensión arterial severa, taquicardia sinusal y un aumento de las presiones en la vía aérea. No se obtuvo respuesta a la administración de diversos fármacos vasoactivos (efedrina, fenilefrina, dopamina, noradrenalina). Tras descartar otras posibles etiologías se valoró la posibilidad de que se tratara de una reacción de anafilaxia y se inició la administración de adrenalina, con lo que se consiguió estabilizar hemodinámicamente al paciente. En la unidad de reanimación fue preciso mantener la perfusión de adrenalina y la ventilación mecánica durante 4 días (AU)


We present a case of a 62 year-old male scheduled for radical cystectomy, who, ten minutes into the surgery, presented with severe hypotension, tachycardia and increased airway pressure. There was no response to the administration of vasoactive drugs such as, ephedrine, phenylephrine, dopamine and norepinephrine. After ruling out several causes, we evaluated the possibility of an anaphylactic reaction. Adrenaline was given, and the patient stabilized. An adrenaline infusion and mechanical ventilation was required for four days in the critical care unit (AU)


Subject(s)
Humans , Male , Middle Aged , Anaphylaxis/complications , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Epinephrine/therapeutic use , Vasoconstrictor Agents/therapeutic use , Anesthesia/methods , Anesthesia , Midazolam/therapeutic use , Epinephrine/metabolism , Hypotension/chemically induced , Hypotension/complications , Cystectomy/methods , Tachycardia, Sinus/complications , Hemodynamics/physiology , Respiration, Artificial/methods , Respiration, Artificial , Propofol/therapeutic use , Fentanyl/therapeutic use
9.
Rev Esp Anestesiol Reanim ; 61(9): 517-20, 2014 Nov.
Article in Spanish | MEDLINE | ID: mdl-24246959

ABSTRACT

We present a case of a 62 year-old male scheduled for radical cystectomy, who, ten minutes into the surgery, presented with severe hypotension, tachycardia and increased airway pressure. There was no response to the administration of vasoactive drugs such as, ephedrine, phenylephrine, dopamine and norepinephrine. After ruling out several causes, we evaluated the possibility of an anaphylactic reaction. Adrenaline was given, and the patient stabilized. An adrenaline infusion and mechanical ventilation was required for four days in the critical care unit.


Subject(s)
Anaphylaxis/etiology , Intraoperative Complications/etiology , Latex Hypersensitivity/etiology , Anaphylaxis/blood , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Cystectomy , Ephedrine/therapeutic use , Epinephrine/therapeutic use , Humans , Immunoglobulin E/immunology , Intraoperative Complications/blood , Intraoperative Complications/diagnosis , Intraoperative Complications/drug therapy , Latex Hypersensitivity/blood , Latex Hypersensitivity/diagnosis , Latex Hypersensitivity/drug therapy , Male , Middle Aged , Postoperative Complications/blood , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Time Factors , Tryptases/blood
12.
An Med Interna ; 21(3): 135-7, 2004 Mar.
Article in Spanish | MEDLINE | ID: mdl-15043495

ABSTRACT

Kikuchi-Fujimoto disease or necrotizing histiocytic lymphadenitis is a self-limited process of lymphatic system that affects more frequently young women. Fever and adenopathy, often cervical, are typical. Diagnosis is fundamentally based on the affected lymph node biopsy, since laboratory data are often normal. It's a very rare entity in Spain, being more frequent in Oriental countries. It's a benign evolution process, with a spontaneous healing in some weeks or months. This is the reason because of this disease could be infradiagnosed. It's very important the differential diagnosis with malignant lymphomas, because Kikuchi-Fujimoto disease doesn't need any treatment.


Subject(s)
Histiocytic Necrotizing Lymphadenitis/virology , Mumps/complications , Adult , Antibodies, Viral/analysis , Histiocytic Necrotizing Lymphadenitis/diagnosis , Histiocytic Necrotizing Lymphadenitis/therapy , Humans , Lymph Nodes/pathology , Male , Mumps/immunology , Mumps/therapy , Mumps virus/immunology
13.
An. med. interna (Madr., 1983) ; 21(3): 135-137, mar. 2004.
Article in Es | IBECS | ID: ibc-31131

ABSTRACT

La enfermedad de Kikuchi-Fujimoto o linfadenitis necrotizante histiocitaria es un proceso autolimitado del sistema linfático que afecta con más frecuencia a mujeres jóvenes. Clínicamente se caracteriza por la presencia de fiebre y de adenopatías, sobretodo cervicales. El diagnóstico se basa fundamentalmente en la biopsia del ganglio afectado, ya que a menudo los datos de laboratorio son normales. Es una enfermedad rara en España, siendo más frecuente en países orientales. Se trata de un proceso de evolución benigna, con resolución espontánea en semanas o meses, razón por la cual esta enfermedad podría estar infradiagnosticada. Es fundamental su distinción de los linfomas, dado que la enfermedad de Kikuchi no necesita tratamiento (AU)


No disponible


Subject(s)
Male , Adult , Humans , Mumps virus , Mumps , Lymph Nodes , Histiocytic Necrotizing Lymphadenitis , Antibodies, Viral
SELECTION OF CITATIONS
SEARCH DETAIL
...