ABSTRACT
BACKGROUND: Neuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain. METHODS: A decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537,931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros () and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/- 50%. RESULTS: The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of 57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was 70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex. CONCLUSIONS: This economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries.
Subject(s)
Neuromuscular Blockade/methods , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Patient Safety/economics , Patient Safety/statistics & numerical data , Sugammadex/economics , Sugammadex/pharmacology , Humans , Neuromuscular Blockade/economics , Neuromuscular Nondepolarizing Agents/economics , SpainABSTRACT
BACKGROUND: Radical cystectomy (RC) is the urological procedure associated with the highest rates of morbidity, mortality and hospital stay. The implementation of fast-track programs seeks to speed postsurgical recovery. Its application to radical cystectomy has yielded positive results. OBJECTIVES: To assess the results of the fast-track protocol in RC at our hospital, in terms of morbidity, mortality and hospital stay, comparing these results with those of patients who underwent RC following the classic protocol. To thereby ascertain whether the implementation of the fast-track protocol represents a reduced number and severity of complications and shorter hospital stays. MATERIAL AND METHODS: Ambispective cohort study of patients who underwent RC between January 2010 and October 2012 by either protocol (classic and fast-track). We analyzed the patient characteristics, intraoperative variables, postoperative complications (according to the Clavien classification), hospital stay and recovery stay. RESULTS: Ninety-nine patients were included, 51 following the classic protocol and 48 following the fast-track protocol. The groups were homogeneous. The hospital stay and recovery stay were longer in the classic group than in the fast-track group (29 and 2 days, respectively, vs. 17 and 1 day). There was less intraoperative bleeding in the fast track group (600mL) than in the traditional group (1,000mL). Of the 99 patients, 31 (60.8%) of the classic group presented a postoperative complication, while the fast-track group had 14 (29.2%), most of which were minor (Clavien degrees 1 and 2). In the multivariate analysis, the type of protocol and the number of comorbidities were significant. CONCLUSIONS: The implementation of the fast-track protocol in RC was associated with a significant reduction in intraoperative and postoperative complications and hospital stay.
Subject(s)
Cystectomy/methods , Urinary Bladder Neoplasms/surgery , Aged , Clinical Protocols , Cohort Studies , Critical Pathways , Female , Humans , Length of Stay , Male , Postoperative Complications/prevention & control , Prospective Studies , Retrospective Studies , Tertiary Care Centers , Time FactorsABSTRACT
Objetivo. Valorar qué factores determinan el ingreso de los pacientes quirúrgicos en una unidad de críticos tras la cirugía. Material y métodos. Se incluyó un censo del 10% de todos los pacientes intervenidos por los servicios de Cirugía General, Cirugía Torácica, Cirugía Maxilofacial, Cirugía Vascular, Urología y Otorrinolaringología durante el año 2012. Se realizó un estudio prospectivo, observacional. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Se compararon aquellos pacientes ingresados en críticos con los ingresados en planta, y los intervenidos de urgencia con los programados, mediante la χ2 de Pearson con un intervalo de confianza del 95%. Resultados. e introdujeron en el estudio 764 pacientes, siendo ingresados 304 en críticos tras la cirugía y 460 en planta. Los antecedentes patológicos mostraron asociación estadísticamente significativa con el ingreso de los pacientes en críticos, así como el ser marcado con alto riesgo por las escalas de predicción de riesgo quirúrgico. La complejidad y duración de la cirugía mostraron una asociación estadísticamente significativa con el ingreso en críticos, así como el presentar complicaciones intraoperatorias. La cirugía de urgencia no se asoció significativamente con el ingreso en críticos de los pacientes quirúrgicos, aunque estos pacientes sí presentaron significativamente mayor número de complicaciones intraoperatorias y posoperatorias, y más exitus que los sometidos a cirugía programada. Conclusiones. Un mayor índice de ingreso en críticos de los pacientes intervenidos de urgencia se presume disminuiría la morbimortalidad quirúrgica. Protocolos específicos de ingreso para cirugía de urgencia y una mayor disponibilidad de camas podrían ser útiles en este sentido (AU)
Objective. Assess what factors determine the income of surgical patients in critical care unit after surgery. Material and methods. It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ2 of Pearson correlation with a confidence interval of 95%. Results. Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. Conclusions. A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard (AU)
Subject(s)
Humans , Male , Female , Intensive Care Units , Risk Factors , Intraoperative Complications/drug therapy , Intraoperative Complications/surgery , Factor Analysis, Statistical , Prospective Studies , Hospitals, University , Indicators of Morbidity and Mortality , /methodsABSTRACT
OBJECTIVE: Assess what factors determine the income of surgical patients in critical care unit after surgery. MATERIAL AND METHODS: It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ(2) of Pearson correlation with a confidence interval of 95%. RESULTS: Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. CONCLUSIONS: A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard.
Subject(s)
Patient Admission , Recovery Room , Adult , Aged , Aged, 80 and over , Critical Care , Diagnosis-Related Groups , Elective Surgical Procedures , Emergencies , Female , Hospital Mortality , Hospitals, University/statistics & numerical data , Humans , Intraoperative Complications/epidemiology , Male , Middle Aged , Patient Admission/statistics & numerical data , Postoperative Complications/epidemiology , Prospective Studies , Risk , Tertiary Care Centers/statistics & numerical dataSubject(s)
Intraoperative Complications/surgery , Intubation, Intratracheal/adverse effects , Lacerations/surgery , Mediastinal Emphysema/etiology , Subcutaneous Emphysema/etiology , Suture Techniques , Thoracotomy , Trachea/injuries , Bronchoscopy , Cholecystectomy, Laparoscopic , Cough/complications , Esophagus/surgery , Female , Fiber Optic Technology , Humans , Iatrogenic Disease , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/therapy , Intubation, Intratracheal/methods , Lacerations/diagnosis , Lacerations/etiology , Lacerations/therapy , Middle Aged , Rupture/diagnosis , Rupture/etiology , Rupture/surgery , Rupture/therapy , Trachea/surgery , Wound HealingABSTRACT
Complex regional pain syndrome has multiple causes. The clinical picture includes pain that can be debilitating, along with vascular and motor abnormalities, changes in sweating, delayed recovery, eating disorders, and occasionally psychological changes. Treatment is complex and should be started early if symptoms are to be reversed. We report the case of a man who developed complex regional pain syndrome type 2 in his left arm after surgery with extracorporeal circulation to repair an interatrial septal defect. The clinical picture was believed to have been triggered by catheterization of the radial artery.
Subject(s)
Catheterization/adverse effects , Causalgia/etiology , Extracorporeal Circulation/adverse effects , Radial Artery , Humans , Male , Middle AgedABSTRACT
El Síndrome de dolor regional complejo es un síndromede etiología múltiple, caracterizado por la presenciade una clínica que incluye entre otros, dolor, enocasiones muy invalidante; trastornos vaso y sudomotores,retraso en la recuperación funcional, trastornos tróficosy apareciendo, en ocasiones alteraciones psicológicas.Su tratamiento es complejo, debiéndose instaurarprecozmente, para poder revertir su sintomatología.Presentamos el caso de un paciente, al que se realizóbajo circulación extracorpórea, el cierre de una comunicacióninterauricular y que en el postoperatorio inmediatopresentó un Síndrome de dolor regional complejotipo II en su extremidad superior izquierda. El desencadenantedel cuadro se atribuyó a la cateterización de laarteria radial
Complex regional pain syndrome has multiple causes.The clinical picture includes pain that can be debilitating,along with vascular and motor abnormalities,changes in sweating, delayed recovery, eating disorders,and occasionally psychological changes. Treatment iscomplex and should be started early if symptoms are tobe reversed.We report the case of a man who developed complexregional pain syndrome type 2 in his left arm after surgerywith extracorporeal circulation to repair an interatrialseptal defect. The clinical picture was believed tohave been triggered by catheterization of the radialartery
Subject(s)
Male , Middle Aged , Humans , Causalgia/etiology , Radial Artery/injuries , Cardiac Catheterization/adverse effects , Anesthetics, Local/therapeutic use , Extracorporeal Circulation , Anesthetics, Local/administration & dosageABSTRACT
La Cardiografía por Impedancia Torácica es una técnica de monitorización hemodinámica no invasiva. Se basa en el principio físico de impedancia, que puede definirse como la resistencia al flujo de una corriente eléctrica. Presentamos un caso de un paciente que fue sometido a trasplante cardiaco ortótopico, en el que se halló intraoperatoriamete la existencia de una vena cava superior con drenaje en el seno coronario. Ante la imposibilidad de una monitorización hemodinámica invasiva a través de catéter de Swan-Ganz, se optó por cardiografía por impedancia torácica. Se revisan las principales aplicaciones de esta técnica y la descripción de esta rara anomalía vascular
Thoracic impedance cardiography is a noninvasive hemodynamic monitoring technique based on the physical principal of impedance, which can be defined as resistance to electrical flow. We report the case of a man who underwent orthotopic heart transplantation, during which the superior vena cava was found to drain into the coronary sinus. Impedance cardiography was used because hemodynamics could not be monitored invasively with a Swan-Ganz catheter. We describe the main applications of impedance cardiography and the characteristics of this rare vascular anomaly
Subject(s)
Male , Humans , Cardiography, Impedance/instrumentation , Cardiography, Impedance/methods , Coronary Vessel Anomalies/diagnosis , Monitoring, Physiologic/methods , Vena Cava, Superior/abnormalities , Cardiovascular Abnormalities/diagnosis , Cardiovascular Abnormalities/physiopathology , Coronary Vessel Anomalies/physiopathology , Cardiac Catheterization , Heart Transplantation , Hemodynamics , Postoperative Care , Pulmonary Edema/etiology , Pulmonary Edema/surgery , Cardiomyopathy, Dilated/surgeryABSTRACT
No disponible
No disponible
Subject(s)
Humans , Intubation, Intratracheal/methods , Case Management , Equipment Design , Intubation, Intratracheal/instrumentation , Mouth , Nasal CavityABSTRACT
A 42-year-old patient, diagnosed with Alagille syndrome when he was 1 month old, was admitted to the general surgery department to undergo right hepatectomy for right lobe carcinoma. Alagille syndrome, also known as biliary duct hypoplasia, is an extremely rare genetic condition with multiorganic implications. Liver and heart dysfunction will play key roles in the course of the disease and its prognosis. An exhaustive preoperative assessment of liver and heart function, blood chemistry and the skeleton will be essential for managing these patients. This article reviews the main principles underlying the anesthetic management of patients with Alagille syndrome.
Subject(s)
Alagille Syndrome , Anesthesia , Adult , Anesthesia/methods , Female , Humans , Risk FactorsABSTRACT
Paciente de 42 años, diagnosticada de Síndrome de Alagille en el primer mes de vida. Ingresa en el Servicio de Cirugía General con diagnóstico de hepatocarcinoma de lóbulo derecho, para la realización de hepatectomía derecha. El Síndrome de Alagille, también conocido como Síndrome de escasez de conductos biliares, es una enfermedad genética extremadamente rara, de afectación multiorgánica. La disfunción hepática y cardíaca será fundamental para la evolución y pronóstico de la enfermedad. Un estudio preoperatorio exhaustivo de la función hepática, cardiológico, hematológica y ósea se antoja funda- mental para el manejo de estos pacientes. En el presente trabajo se revisan los principales pun- tos de la actuación anestésica en los pacientes portado- res de este síndrome
A 42-year-old patient, diagnosed with Alagille syndrome when he was 1 month old, was admitted to the general surgery department to undergo right hepatectomy for right lobe carcinoma. Alagille syndrome, also known as biliary duct hypoplasia, is an extremely rare genetic condition with multiorganic implications. Liver and heart dysfunction will play key roles in the course of the disease and its prognosis. An exhaustive preoperative assessment of liver and heart function, blood chemistry and the skeleton will be essential for managing these patients. This article reviews the main principles underlying the anesthetic management of patients with Alagille syndrome
Subject(s)
Female , Adult , Humans , Alagille Syndrome/pathology , Alagille Syndrome/genetics , Cholestasis/etiology , Cholestasis/pathology , Genetic Diseases, Inborn , Multiple Organ Failure , Liver/physiopathology , Heart/physiopathology , Bile Duct Diseases , Prospective Studies , Anesthesia, General , PrognosisABSTRACT
Thoracic impedance cardiography is a noninvasive hemodynamic monitoring technique based on the physical principal of impedance, which can be defined as resistance to electrical flow. We report the case of a man who underwent orthotopic heart transplantation, during which the superior vena cava was found to drain into the coronary sinus. Impedance cardiography was used because hemodynamics could not be monitored invasively with a Swan-Ganz catheter. We describe the main applications of impedance cardiography and the characteristics of this rare vascular anomaly.
Subject(s)
Cardiography, Impedance , Coronary Vessel Anomalies/diagnosis , Monitoring, Physiologic/methods , Vena Cava, Superior/abnormalities , Cardiac Catheterization , Cardiography, Impedance/instrumentation , Cardiography, Impedance/methods , Cardiomyopathy, Dilated/surgery , Cardiovascular Abnormalities/diagnosis , Cardiovascular Abnormalities/physiopathology , Coronary Vessel Anomalies/physiopathology , Heart Transplantation , Hemodynamics , Humans , Male , Middle Aged , Postoperative Care , Pulmonary Edema/etiology , Pulmonary Edema/surgerySubject(s)
Hypnotics and Sedatives/administration & dosage , Myotonic Dystrophy , Nerve Block , Piperidines/administration & dosage , Brachial Plexus , Cholinesterase Inhibitors , Colles' Fracture/complications , Colles' Fracture/surgery , Contraindications , Female , Fracture Fixation, Internal , Hemodynamics/drug effects , Humans , Hypnotics and Sedatives/pharmacology , Intraoperative Complications/prevention & control , Middle Aged , Myotonic Dystrophy/complications , Neuromuscular Nondepolarizing Agents , Piperidines/pharmacology , Remifentanil , SuccinylcholineABSTRACT
No disponible
Subject(s)
Middle Aged , Female , Humans , Myotonic Dystrophy , Nerve Block , Succinylcholine , Piperidines , Brachial Plexus , Cholinesterase Inhibitors , Neuromuscular Nondepolarizing Agents , Hypnotics and Sedatives , Intraoperative Complications , Hemodynamics , Fracture Fixation, Internal , Colles' FractureABSTRACT
No disponible
Subject(s)
Middle Aged , Female , Humans , Scleroderma, Systemic , Laryngeal MasksABSTRACT
We describe a patient with a tentative diagnosis of Brugada syndrome who was given general anesthesia without complications. We review the main characteristics of Brugada syndrome.
