Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. / Recomendaciones de la Sociedad Española de Cirugía Torácica y de la Sección de Cardiotorácica y Cirugía Vascular de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor, para los pacientes sometidos a cirugía pulmonar incluidos en un programa de recuperación intensificada.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Tromboembolismo pulmonar (TEP) y síndrome de Klinefelter, ¿es un factor de riesgo? / No disponible

Describimos el caso clínico de un paciente de 36 años diagnosticado de síndrome de Klinefelter a la edad de 24 años, en tratamiento sustitutivo con testosterona, que ingresa con diagnóstico de tromboembolia pulmonar (TEP) aguda sintomática de bajo riesgo. En el momento del diagnóstico no se objetivó ningún factor desencadenante del evento trombótico. El paciente recibió tratamiento anticoagulante con antagonistas de la vitamina K durante 6 meses, sin complicaciones clínicas. El estudio de trombofilia fue negativo y se decidió tratamiento anticoagulante indefinido, ante un evento no provocado y bajo riesgo de hemorragia. Se desconoce si el síndrome de Klinefelter o su tratamiento se asocian a un riesgo aumentado de enfermedad tromboembólica venosa (ETEV) (AU)

A 36-year-old man who had a history of Klinefelter syndrome and was receiving treatment with testosterone, was admitted into our hospital with the diagnosis of low-risk acute symptomatic pulmonary embolism (PE). After receiving 6 months of anticoagulant therapy with vitamin K antagonists, the patient was asymptomatic and free from clinical events. He had a normal hypercoagulability workup. He was offered indefinite anticoagulation, since the risk of bleeding was low. Currently, it has not been elucidated whether there is an association between Klinefelter syndrome or its treatment and venous thromboembolism (VTE). Advising patients with Klinefelter syndrome about the optimal duration of anticoagulation following acute VTE is complex (AU)