Laceración traqueal post-intubacion Postintubation tracheal laceration / No disponible

No disponible

Transoesophageal Doppler-guided fluid management in massive obstetric haemorrhage.

Massive postpartum haemorrhage is a major worldwide cause of maternal mortality. Management requires intensive fluid resuscitation and blood transfusion. Although fluid therapy is often directed by the results of a full blood count and clotting screen, recent technological advances allow monitoring of haemodynamic function and cardiac output. Transoesophageal Doppler technology has been used during haemorrhagic shock in non-obstetric patients. We present the case of a caesarean delivery complicated by massive haemorrhage where transoesophageal Doppler monitoring with the CardioQ-ODM™ was used to guide fluid therapy and the use of vasoactive drugs.

Enseñanza y aprendizaje de la anestesia obstétrica en los nuevos tiempos. Reflexiones sobre una mortalidad materna / No disponible

Los cambios socio sanitarios precisan unos médicos especialistas distintos para el futuro. La declaración de Helsinki del Board de Anestesia de la UEMS, las propuestas de seguridad de la OMS, World Federation of Societies of Anaesthesiologists van orientadas hacia la seguridad y la calidad. Aproximadamente 30-40 % de las muertes maternas pueden ser prevenidas. La enseñanza debe ir dirigida hacia la mejoría de la asistencia de las enfermedades cardiovasculares, tromboembolismo, estados hipertensivos del embarazo, sepsis y la patología crítica, lo que podría disminuir la morbilidad materna y fetal. La aplicación del marco Europeo de Bolonia y de las recomendaciones de la UEMS debe ser una prioridad en España, que llevar a modificar la duración de la residencia y de los programas formativos (AU)

The social and health changes need a new type of physician for the future. The Helsinki declaration on patient safety in anaesthesiology of the UMS/EBA, the international standards for a safe practice of anaesthesia of the Worls Federation of Societies of Aanesthesiologist and WHO check lists are orientated for better security and quality of anaesthetic care. Approximately 30-40% of maternal deaths are potentially preventable. Teaching must be orientated on cardiovascular diseases, thromboembolism, hemorrhage, hypertensive disorders of pregnancy, sepsis and critical illness could decrease maternal and fetal morbility. The application of the Bologna principles and the transfer of the educational principles of UEMS in Spain must be a priority. We must modify duration of training and programs (AU)

Evidencias científicas sobre el uso de coloides como liquido de elección en la optimización hemodinámica perioperatoria / No disponible

No disponible

Miocardiopatia periparto. A proposito de un caso / No disponible

La miocardiopatía periparto es una cardiomiopatía dilatada, acompañada de insuficiencia cardiaca secundaria a disfunción ventricular izquierda, que se presenta entre el último trimestre del embarazo y los 5 primeros meses posteriores al parto, y cuya etiología es desconocida. Constituye un reto para el anestesiólogo, debido al riesgo de descompensación hemodinámica de la paciente, principalmente en el parto o cesárea. Se recomienda realizar buen control del dolor por lo que la anestesia regional es la mejor opción. Presentamos el caso de una mujer, secundigesta, quien desarrolla una insuficiencia cardiaca descompensada posterior a ser intervenida de cesárea, con favorable respuesta al tratamiento y recuperación parcial de la función ventricular a los 3 meses después del parto (AU)

The peripartum cardiomiopathy is a dilated myocardiopathy associated with cardiac failure as a consequence of a left ventricular dysfunction. It is usually occurs between the last trimester of pregnancy and 5 months after delivery, its’ etiology being still unknown. The management of such patients is a challenge for anesthesiologists due to the risk of hemodynamic instability during labor or cesarean section. For this reason a good control of pain is recommended, and regional anesthesia is the best option. We present the case of a woman at the end of her second pregnancy who developed a decompensated cardiac failure after a cesarean section. The instauration of Afterwards she improves as a result of the treatment and partially recovers her left ventricular functionality 3months postpartum (AU)

Anestesia general y hemorragia obstétrica con transfusión en la cesárea. Experiencia durante un año en un hospital universitario / General anaesthesia and obstetric bleeding in caesarean section. One year's experience in a university hospital

Introducción. La hemorragia obstétrica es una causa frecuente de mortalidad y morbilidad en el mundo. La anestesia general es cada vez menos frecuente para la cesárea. Nuestro objetivo es analizar la incidencia, causas y factores de riesgo asociados a la anestesia general en la cesárea, y la prevalencia de hemorragia obstétrica (HO), sus factores de riesgo y los predictores de HO poscesárea junto al uso de hemoderivados en la población de estudio. Material y métodos. Se ha realizado un estudio retrospectivo de los informes de alta de la URPA durante el año 2008. Resultados. El 12,4% de nuestras pacientes requirieron anestesia general. El fallo del catéter epidural como causa de anestesia general, fue poco frecuente (2,8%) y dentro de los estándares recomendados. Conclusiones. Las indicaciones de cesárea más frecuentes bajo anestesia general incluyeron principalmente urgencias vitales, que coincide con los factores de riesgo de anestesia general más significativos (alteraciones de la coagulación, hemorragia del tercer trimestre, riesgo de pérdida de bienestar fetal y preeclampsia grave). La anestesia general es un factor de riesgo de transfusión, como también lo es las alteraciones de la placentación y la preeclampsia(AU)

Introduction. Obstetric haemorrhage is an important worldwide cause of morbidity and mortality. General anaesthesia for caesarean section is rarely used. Our goal is to analyse the incidence, causes and risk factors associated with general anaesthesia for caesarean section, and the prevalence of obstetric haemorrhage (HO), its risk factors and predictors of post-caesarean HO together with the use of blood in our hospital population. Methods. A retrospective study was conducted on all caesarean section discharge reports from PACU in 2008. Results. General anaesthesia was required in 12.4% of the patients. Epidural catheter failure as a cause of general anaesthesia was infrequent (2.8%) and within the recommended standards. Conclusions. The most frequent indications for caesarean section under general anaesthesia included mainly life-threatening emergencies, and the most important risk factors for general anaesthesia, including coagulation disorders, bleeding in the third trimester, foetal distress and severe pre-eclampsia. General anaesthesia is a risk factor for transfusion, as is abruptio placentae, placenta previa and pre-eclampsia(AU)

[General anaesthesia and obstetric bleeding in caesarean section. One year's experience in a university hospital]. / Anestesia general y hemorragia obstétrica con transfusión en la cesárea. Experiencia durante un año en un hospital universitario.

INTRODUCTION: Obstetric haemorrhage is an important worldwide cause of morbidity and mortality. General anaesthesia for caesarean section is rarely used. Our goal is to analyse the incidence, causes and risk factors associated with general anaesthesia for caesarean section, and the prevalence of obstetric haemorrhage (HO), its risk factors and predictors of post-caesarean HO together with the use of blood in our hospital population. METHODS: A retrospective study was conducted on all caesarean section discharge reports from PACU in 2008. RESULTS: General anaesthesia was required in 12.4% of the patients. Epidural catheter failure as a cause of general anaesthesia was infrequent (2.8%) and within the recommended standards. CONCLUSIONS: The most frequent indications for caesarean section under general anaesthesia included mainly life-threatening emergencies, and the most important risk factors for general anaesthesia, including coagulation disorders, bleeding in the third trimester, foetal distress and severe pre-eclampsia. General anaesthesia is a risk factor for transfusion, as is abruptio placentae, placenta previa and pre-eclampsia.

Concentrado de fibrinógeno. Su uso en la práctica clínica anestesiológica / No disponible

Para lograr una hemostasia eficaz son necesarios niveles adecuados de fibrinógeno. El fibrinógeno es el primer factor del plasma en deplecionarse en la hemorragia, facilita la agregación plaquetaria y cuando se activa mediante la trombina, forma polímeros de fibrina, que son la base de la formación del coágulo. La fluidoterapia en la hemorragia grave diluye los factores de la coagulación facilitando la aparición de una coagulopatía. Los valores de fibrinógeno plasmático predicen la hemorragia perioperatoria. Podemos aportar fibrinógeno mediante plasma fresco congelado, crioprecipitados y concentrado de fibrinógeno. El fibrinógeno no requiere pruebas de compatibilidad para su administración y se administra con rapidez. Las guías europeas de hemorragia recomiendan la administración de fibrinógeno en los traumatismos con hemorragia grave, siempre que el tromboelastograma muestre déficit del mismo y/o los niveles plasmáticos de fibrinógeno sean inferiores a 2 g/l. Revisiones retrospectivas de traumatismos con hemorragia sugieren que la administración de fibrinógeno con/sin complejo protombínico y guiadas por el tromboelastograma, reduce la tasa transfusional. El plasma fresco congelado contiene aproximadamente 2 g/l de fibrinógeno, por lo que se requiere un volumen importante de plasma. El crioprecipitado es un producto derivado del plasma, que contiene unas concentraciones de fibrinógeno más elevadas. La dosis más habitual administrada es de 2-4 g. El fibrinógeno es un fármaco seguro(AU)

To achieve effective hemostasis it is needed an adequate level of fibrinogen. Fibrinogen is the first factor in getting low levels in plasma in case of severe hemorrhage, and platelet aggregation is facilitated and when fibrinogen is activated by thrombin, fibrin polymers can be formed, which is the basis of clot formation. The dilution with intravenous fluids in severe bleeding affects coagulation factors facilitating the development of a coagulopathy. Plasma fibrinogen levels can predict perioperative bleeding. We can provide fibrinogen with fresh frozen plasma, cryoprecipitate and fibrinogen concentrate. Fibrinogen does not require compatibility testing for its administration and it can be administered quickly. European guidelines recommend administration of fibrinogen in patients with severe haemorrhage secondary to a bleeding trauma, whenever the thromboelastogram parameters show its deficit and / or plasma fibrinogen levels are less than 2 g / L. Retrospective reviews of trauma with bleeding suggest that administration of fibrinogen with / without prothrombin complex and reposition guided by thromboelastography, reduces transfusion rate. Fresh frozen plasma contains about 2 g / l of fibrinogen, so it requires a large volume of plasma to increase plasmatic levels significatively. The cryoprecipitate is a plasma derived product, which contains a high fibrinogen concentration. The usual dose administered is from 2-4 g. Fibrinogen is a safe drug (AU)

Estudio predictivo de las necesidades transfusionales en el paciente quemado quirúrgico / No disponible

A pesar de las técnicas de conservación de sangre, la hemorragia durante las intervenciones quirúrgicas en los quemados sigue siendo sustancial. Es difícil predecir la pérdida sanguínea y cuantas unidades debe requerir el paciente. Estimar las pérdidas sanguíneas preoperatoriamente es importante para así prevenir unidades cruzadas innecesarias. El propósito de este estudio fue repasar la fisiopatología del paciente quemado, la reanimación inicial y las terapias de transfusión para tratar de encontrar la mejor fórmula que estime el número de unidades que puede requerir un paciente quemado durante su hospitalización y cuales son los factores de riesgo relacionados con la transfusión y la mortalidad(AU)

Despite blood-conservation techniques, hemorrhage and blood transfusion during burns surgery remain substantial. Moreover, it is very difficult to predict the blood loss and how many units of blood the patient will require. Estimating blood loss preoperatively is important and thus prevent unnecessary use of blood-cross-matching. The purpose of this study was to review the pathophysiology of burned patients, initial resuscitation and transfusion therapies to try to find the best formula to estimate the number of blood units that will require a burn patient during hospitalization; and which are the factors related to transfusion and mortality(AU)

Ahorro de sangre en la artopalstia total de rodilla / No dsiponible

La hemorragia en el postoperatorio de artroplastia total de rodilla y la necesidad de transfusión son frecuentes. La transfusión de sangre homóloga (TSH) ha pasado a considerarse un procedimiento que conlleva mínimos riesgos proporcionando una mejor oxigenación a los tejidos. Sin embargo, la TSH puede ir acompañada de complicaciones como infecciones, reacciones de incompatibilidad, lesión pulmonar aguda, inmunodepresión, mayor tiempo de ingreso y un incremento de la mortalidad. El objetivo de este trabajo es revisar todas aquellas técnicas alternativas que tenemos a nuestro alcance para minimizar la hemorragia perioperatoria y optimizar la transfusión de forma individualizada en cada paciente en la cirugía protésica de rodilla(AU)

Postoperative bleeding in total knee arthroplasty and the need for transfusion are frequent. Homologous blood transfusion (TSH) is considered actually a procedure with minimal risks, providing a better tissue oxygenation. However, TSH may be accompanied by complications such as infections, incompatibility reactions, acute lung injury, immune suppression, increased length of hospital stay and increased mortality. Our goal is to review all the available techniques to minimize perioperative bleeding and transfusion optimization for each patient individually in knee prosthetic surgery(AU)

A randomized control trial of patient-controlled epidural analgesia (PCEA) with and without a background infusion using levobupivacaine and fentanyl.

BACKGROUND: Continuous infusion associated with patient-controlled epidural analgesia (PCEA) is used in many maternal units. This randomized controlled study evaluated the effect of a 10 mL/h background infusion associated with a 10 mL-20 minutes lockout time demand-only PCEA protocol using L-bupivacaine plus fentanyl in terms of local anaesthetic consumption, pain management and maternal satisfaction. METHODS: Forty consenting parturients were randomly assigned to receive a 0.125% levobupivacaine plus 1.5 mcg/mL fentanyl PCEA (10 mL bolus with a 20 min lock time) with or without a 10 mL/h background infusion. The total volume of local anesthetic, the number of PCEA demand boluses, pain levels, delivery outcome and maternal satisfaction were evaluated. RESULTS: The total volume of local anaesthetic was 35[20-120] mL in demand-only PCEA group versus 63.8[22.5-123] mL in PCEA plus background infusion group (P<0.001). This decrease in total volume was associated with an increase of self-administrated boluses in demand-only group (3.5[2-12] boluses, versus 1[0-3] bolus in PCEA plus background infusion group) (P<0.001). Pain scores were comparable between groups at any time of the study (P>0.05). Maternal satisfaction did not differ between groups (10[8-10] vs. 10[7-10]; P=0.11). CONCLUSION: When a levobupivacaine plus fentanyl PCEA protocol with high volume boluses and long lockout interval is used for labour analgesia, the background infusion increased the total local anesthetic dose with no change in pain management and maternal satisfaction.