Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca / Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery

Objetivo: Determinar la incidencia del síndrome coronario agudo (SCA) sintomático con y sin elevación del ST, los factores con los que se relacionó, la estancia media y la mortalidad atribuible en el periodo postoperatorio en pacientes de cirugía no cardiaca. Material y métodos: Se registraron prospectivamente los datos de una cohorte de pacientes intervenidos de cirugía no cardíaca que pasaron por la unidad de reanimación postoperatoria del Hospital General de Ciudad Real en el periodo comprendido entre abril de 2006 y diciembre de 2009. Se evaluó la incidencia de SCA sintomático. Resultados: Treinta y dos de 1.919 pacientes presentaron SCA (incidencia 1,7%). Los factores asociados fueron: sexo varón (p = 0,046), edad (p = 0,001), hipertensión arterial (68,8%; p = 0,012) y cardiopatía isquémica previa (34,4% p = 0,001). Los pacientes que sufrieron intervenciones quirúrgicas que presentaron SCA postoperatorio de forma significativa (p < 0,004) fueron cirugía general (37,5%), ortopedia-traumatología (28,1%) y cirugía vascular (15,6%). Fueron transfundidos el 20% de los pacientes en general, y el 50% de los que tuvieron SCA (p = 0,001). El tratamiento fue médico en el 87,5% de los pacientes. La estancia media de los pacientes en la unidad fue de 2,96 ± 6,3 días frente a 3,88 ± 5 días en los pacientes con SCA (p = 0,39) y la mortalidad del 5% frente al 6% respectivamente (p = 0,45). El análisis multivariante mostró como variables independientes para presentar SCA en el periodo postoperatorio: antecedentes de cardiopatía isquémica (OR = 4,59; IC 95% 1,98-10,62), y sangrado quirúrgico (OR =3,18; IC 95%, 1,51-6,71). La cirugía ginecológica (OR = 0,063; IC 95%, 0,004-1,09) mostró la menor probabilidad de presentar dicha alteración en el postoperatorio. Conclusión: La incidencia de SCA en nuestra cohorte en el postoperatorio de cirugía no cardiaca es del 1,7%. Son factores de riesgo la edad, el sexo masculino, los antecedentes de hipertensión arterial y cardiopatía isquémica, el tipo de cirugía y la hemorragia operatoria que precisó transfusión de concentrados de hematíes. Dada la gravedad de esta complicación es importante estratificar el riesgo de estos pacientes preoperatoriamente(AU)

Objetives: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. Material and methods: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. Results: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). Conclusions: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery(AU)

[Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery]. / Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca.

OBJECTIVES: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. MATERIAL AND METHODS: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. RESULTS: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). CONCLUSIONS: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery.

Bloqueo paravertebral torácico. Resultados a corto plazo en relación con la recidiva del cáncer de mama después de la cirugía / No disponible

Objetivo: Existen estudios en animales con cáncer de mama y estudios retrospectivos en humanos que sugieren una reducción de riesgo de metástasis tras realizar una anestesia regional en la cirugía de mama. Hemos estudiado si la realización de bloqueo paravertebral torácico (BPVT) asociado a una anestesia general comparado con una anestesia general sin BPVT reduce la incidencia de metástasis a corto plazo en las pacientes sometidas a cirugía oncológica de mama. Métodos: Se recogieron retrospectivamente 138 pacientes sometidas a cirugía de mama (bien cirugía conservadora, o bien mastectomía, en ambos casos con o sin linfadenectomía) en el periodo entre enero de 2008 hasta junio de 2009. Se consideraron las siguientes variables: edad, peso, antecedentes personales, tipo de tumor, grado histológico, TNM, índice de Nottingham, si recibió o no terapia sistémica, tipo de cirugía, tipo de anestesia, metástasis a 6 meses y a 12 meses, y la supervivencia libre de enfermedad. Resultados: En 40 pacientes se practicó un BPVT más anestesia general, y en 98 anestesia general solamente. En cuanto al grado histológico, clasificación TNM, índice de Nottingham y terapia sistémica no presentaban diferencias entre los dos grupos. La aparición de metástasis a 6 meses fue de 2,5% en el grupo de anestesia con BPVT y de un 6,1% en el grupo de anestesia general (p = 0,673), y a 12 meses, un 2,5% en el grupo de anestesia general con BPVT, y un 9,2% en el de anestesia general (p = 0,281). El consumo intraoperatorio de fentanilo y remifentanilo y de analgesia postoperatoria fue mayor en el grupo con anestesia general. Conclusiones: En este estudio retrospectivo el porcentaje de metástasis fue menor tanto a 6 como a 12 meses en las pacientes en las que se realizó un bloqueo paravertebral con respecto a las que se realizó anestesia general exclusivamente, sin que la diferencia fuera estadísticamente significativa(AU)

Objectives: A reduction in risk of metastasis after performing regional anesthesia in breast surgery has been suggested in both animal studies and retrospectives human studies with breast cancer. We studied whether thoracic paravertebral block (TPVB) associated with general anesthesia compared with general anesthesia reduces the metastases incidence in short term in patients undergoing breast cancer surgery. Methods: 138 patients undergoing breast surgery (either conservative breast surgery or mastectomy, both of them with or without lymphadenectomy) were retrospectively examined between January 2008 and June 2009. The following variables were recorded: age, weight, medical history, type of tumor, histological grade, TNM, Nottingham Index, adjuvant therapy, type of surgery, type of anesthesia, metastasis at 6 and 12 months and disease-free survival. Results: In 40 patients a TPVB combined with general anesthesia were performed, and 98 patients had general anesthesia alone. There were no differences in histological grade, TNM classification, Nottingham index and adjuvant therapy between the two groups. Metastasis at 6 months was 2.5% in the group of anesthesia combined with TPVB and 6.1% in the General Anesthesia group (p = 0.673). At 12 months was 2.5% and 9.2%, respectively (p = 0.281). The intraoperative consumption of fentanyl and remifentanil and postoperative analgesia requirements were higher in the group with general anesthesia. Conclusions: In this retrospective study, the rate of metastasis was lower at both 6 and 12 months in patients who underwent the paravertebral block combined with general anesthesia compared to general anesthesia. However, differences between both groups were not found to be significant(AU)

Perfusión continúa de ropivacaína más fentanilo mediante bloqueo paravertebral torácico guiado con neuroestimulador para el manejo del dolor de un paciente con fracturas costales múltiples / No disponible

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Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidism.

Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia.