Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar / Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery

INTRODUCCIÓN: En cirugía de resección pulmonar se recomienda la fluidoterapia restrictiva debido al riesgo de lesión pulmonar aguda. Por contra, esta recomendación aumenta el riesgo de hipoperfusión. La terapia guiada por objetivos permite individualizar el aporte de fluidos. El uso de parámetros dinámicos de respuesta a volumen no está validado durante la ventilación unipulmonar. El objetivo principal es la validación de los parámetros dinámicos, la variación de volumen sistólico (VVS) y la variación de presión de pulso (VPP) durante la cirugía de resección pulmonar como predictores de respuesta a fluidos tras la administración de cargas de volumen de 250ml de cristaloides, si IC<2,5ml/min/m2 y si VVS≥8% y/o VPP≥10%. MATERIAL Y MÉTODOS: Estudio piloto, prospectivo, observacional y unicéntrico. Se incluyeron 25 pacientes monitorizados con el sistema PiCCO durante la cirugía abierta de resección pulmonar con el paciente en posición de decúbito lateral, ventilación unipulmonar con VC: 6ml/kg y tórax abierto. Se recogieron variables hemodinámicas antes y después de la carga de volumen. Los resultados se clasificaron en dos grupos: respondedores a volumen (aumento de IC≥10% y/o VSI≥10% tras la carga de volumen) y los no respondedores (no aumento o aumento del IC<10% y/o VSI<10% tras la carga de volumen). Evaluamos la eficacia diagnóstica de VVS y VPP mediante el estudio del área bajo a curva (AUC) de las curvas ROC. RESULTADOS: En el análisis de curvas ROC, VVS y VPP no alcanzaron un valor discriminativo (AUCVVS: 0,47; AUCVPP: 0,50), a pesar de la disminución del valor umbral de VVS y de VPP para iniciar una sobrecarga de volumen durante la ventilación unipulmonar, en decúbito lateral y con el tórax abierto. CONCLUSIONES: Los resultados obtenidos muestran que los valores de los parámetros dinámicos de respuesta a volumen (VVS≥8% y VPP≥10%) no discriminan a los pacientes respondedores y a los no respondedores durante la cirugía de resección pulmonar abierta

INTRODUCTION: In lung resection surgery, restrictive fluid therapy is recommended due to the risk of acute lung injury. In contrast, this recommendation increases the risk of hypoperfusion. Guided fluid therapy allows individualization of fluid intake. The use of dynamic volume response parameters is not validated during one-lung ventilation. The main objective is the validation of dynamic parameters, stroke volume variation (SVV) and pulse pressure variation (PPV), during lung resection surgery as fluid response predictors, after the administration of 250ml crystalloid volume loads, if IC<2.5ml/min/m2 and if SVV≥8% and/or PPV≥10%. MATERIAL AND METHODS: Pilot, prospective, observational and single centre study. Twenty-five patients monitored with the PiCCO system were included during open lung resection surgery with the patient in a lateral position, one lung ventilation with tidal volume (TV): 6ml/kg and open chest. Hemodynamic variables were collected before and after volume loading. The results were classified into two groups: volume responders (increase IC≥10% and/or VSI≥10% after volume loading) and non-responders (no increase or increase IC<10% and/or VSI<10% after volume loading). We assess the diagnostic efficacy of SVV and PPV by analyzing the AUC (area under curve) in the ROC curves. RESULTS: In the analysis of ROC curves, SVV and PPV did not reach a discriminative value (AUCSVV: 0.47; AUCPPV: 0.50), despite the decrease in the threshold value of SVV and PPV to initiate an overload of volume during one-lung ventilation, in lateral position and open chest. CONCLUSIONS: The results obtained show that the values of the dynamic parameters of volume response (SVV≥8% and PPV≥10%) do not discriminate against responders patients and non-responders during open lung resection surgery

Septoplasty: under general or sedation anesthesia. Which is more efficacious?

The objective of the study was to assess the more efficacious anesthesia method in septal surgery. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 60 patients, between the ages of 16 and 65, who underwent septal surgery under general (GA) or sedation (SDA) anesthesia during 1-year period was done. Mean age of the patients was 44.30 ± 13.29. Patients were divided into two groups according to the anesthesia method: general (group 1) or sedation (group 2). Intraoperative hemodynamic variables, surgery time, intraoperative blood loss volume, length of hospital stay, postoperative vomiting and nausea, postoperative pain score according to the visual analog scale (VAS) and cost analysis of each method were compared. Thirty-six males and 24 females with a mean age 44.30 ± 13.29 were included to the study. Total operation time, operation time, intraoperative and postoperative bleeding volume, postoperative nausea and vomiting, duration of hospital stay after surgery, were better in group 2. Postoperative pain scores and patient satisfaction about surgery were not statistically different. Cost of anesthesia in group 1 per patient was $44.35 ± 10.81 and in group 2, $16.29 ± 11.88 (p < 0.01). Hospital stay after surgery was much longer in group 1 than group 2 (p < 0.01). Using SDA is better in many ways including cost-effectiveness than using GA for septoplasty operation.

Schedule of controlled substances; placement of fospropofol into schedule IV. Final rule.

With the issuance of this final rule, the Deputy Administrator of the Drug Enforcement Administration (DEA) places the substance fospropofol, including its salts, isomers and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible, into schedule IV of the Controlled Substances Act (CSA). As a result of this rule, the regulatory controls and criminal sanctions of schedule IV will be applicable to the manufacture, distribution, dispensing, importation, and exportation of fospropofol and products containing fospropofol.