Disminución de las transfusiones alogénicas por la generalización del uso de recuperadores de sangre postoperatorios en cirugía de prótesis de rodilla / Decrease in allogenic transfusions due to the spread of use of postoperative retransfusion systems in knee replacement surgery

Objetivos. Los equipos medicoquirúrgicos disponen de múltiples herramientas para reducir la necesidad de transfusión alogénica perioperatoria. En nuestro centro se ha generalizado el uso de recuperadores de sangre filtrada en el postoperatorio de la cirugía de prótesis total de rodilla desde 2006. El objetivo de este estudio fue evaluar si el uso de recuperadores de sangre filtrada disminuyó la tasa de transfusiones en nuestra práctica clínica habitual. Material y métodos. Estudio de cohortes retrospectivo: grupo 2004, pacientes intervenidos de prótesis total de rodilla durante 2004, antes del uso de recuperadores de sangre filtrada; y grupo 2008, pacientes intervenidos de prótesis total de rodilla durante 2008, usando recuperadores. Se registraron sexo, niveles de hemoglobina preoperatorio y al cuarto día, masa total eritrocitaria perdida, reinfusión de sangre recuperada y transfusión de banco durante la estancia hospitalaria. Resultados. Ambos grupos fueron homogéneos en cuanto a sexo, hemoglobinas en el preoperatorio y el cuarto día, y masa total eritrocitaria perdida. La proporción de pacientes transfundidos fue significativamente menor en el grupo 2008 frente al grupo 2004 (20,18 vs. 42,19%), con un riesgo relativo de ser transfundido de 0,47 y NNT de 4,54; p = 0,0017. Conclusiones. En nuestro centro el uso de recuperadores disminuyó la proporción de pacientes transfundidos durante el ingreso para cirugía de prótesis total de rodilla, aunque este resultado no puede generalizarse debido a la ausencia de un criterio definido para indicar las transfusiones(AU)

Objectives. Surgical teams have several tools in order to reduce the need for postoperative allogenic transfusion. Postoperative autotransfusion of unwashed shed blood has become common practice for total knee replacement surgery since 2006 in our hospital. This study was designed to evaluate if this practice has reduced allogenic blood transfusions. Material and methods. A retrospective study comparing two cohorts, group 2004 with patients operated on for total knee replacement during the year 2004, before the use of the retransfusion system, and group 2008, patients operated on in the year 2008, with regular use of the retransfusion system. Gender, preoperative and postoperative haemoglobin levels, total amount of calculated erythrocytes lost, reinfusion of shed blood and allogenic blood transfusion during hospital stay were recorded. Results. Both groups were similar as regards gender, preoperative and postoperative hemoglobin levels, and total amount of erythrocytes lost. The proportion of transfused patients was significantly lower in group 2008 versus group 2004 (20.18% versus 42.19%), with a relative risk of being transfused of 0.47 and a NNT of 4.54. P = .0017. Conclusions. In our hospital the use of postoperative retransfusion systems has reduced the proportion of transfused patients during hospitalization for total knee replacement surgery, although this result cannot be generalized due to the lack of a fixed transfusion trigger(AU)

[Decrease in allogenic transfusions due to the spread of use of postoperative retransfusion systems in knee replacement surgery]. / Disminución de las transfusiones alogénicas por la generalización del uso de recuperadores de sangre postoperatorios en cirugía de prótesis de rodilla.

OBJECTIVES: Surgical teams have several tools in order to reduce the need for postoperative allogenic transfusion. Postoperative autotransfusion of unwashed shed blood has become common practice for total knee replacement surgery since 2006 in our hospital. This study was designed to evaluate if this practice has reduced allogenic blood transfusions. MATERIAL AND METHODS: A retrospective study comparing two cohorts, group 2004 with patients operated on for total knee replacement during the year 2004, before the use of the retransfusion system, and group 2008, patients operated on in the year 2008, with regular use of the retransfusion system. Gender, preoperative and postoperative haemoglobin levels, total amount of calculated erythrocytes lost, reinfusion of shed blood and allogenic blood transfusion during hospital stay were recorded. RESULTS: Both groups were similar as regards gender, preoperative and postoperative hemoglobin levels, and total amount of erythrocytes lost. The proportion of transfused patients was significantly lower in group 2008 versus group 2004 (20.18% versus 42.19%), with a relative risk of being transfused of 0.47 and a NNT of 4.54. P=.0017. CONCLUSIONS: In our hospital the use of postoperative retransfusion systems has reduced the proportion of transfused patients during hospitalization for total knee replacement surgery, although this result cannot be generalized due to the lack of a fixed transfusion trigger.

[Diaphragmatic paralysis after the catheterization of the internal jugular vein]. / Parálisis diafragmática post cateterización de la vena yugular interna.

The complications derived from the puncture and catheterization of the veins of the neck, cause symptoms and signs on physical examination which facilitate their diagnosis. The phrenic paralysis which we present, is characterized by few accompanying symptoms, with the elevation of the hemidiaphragm being a radiological finding. The suspicion is confirmed by fluoroscopy. We reviewed the mechanisms, the cases described in the literature, and the possible risk factors.

[Anesthesia in two patients with motor neuron disease]. / Anestesia en dos pacientes con enfermedad de la motoneurona.

We report two cases of patients diagnosed of motoneuron disease. First patient had amyotrophic lateral sclerosis with bulbar involvement and developed prolonged apnea after general anesthesia for elective hemorrhoidectomy. Second patient had Kugelberg-Welander disease or type III hereditary mononeuron disease, underwent laparotomy and had no anesthetic complications. Patients with motoneuron disease should be considered as high anesthetic risk patients because they may develop respiratory complications accordingly to their previous muscle involvement so neurologic and respiratory assessment is basic. The use of succinylcholine should be limited to cases in whom external denervation and muscle atrophy may be ruled out. Short half-life muscle relaxants such as atracurium and vecuronium are advised with monitoring of neuromuscular function. Currently, local-regional techniques are not contraindicated.