Use of Tranexamic Acid in Liposculpture: A Double-Blind, Multicenter, Randomized Clinical Trial.

BACKGROUND: Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures. METHODS: The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively). RESULTS: The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day ( p = 0.0001) and the fifth postoperative day ( p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups. CONCLUSION: Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding. CLINICAL RELEVANCE STATEMENT: The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Post-anesthesia care unit desaturation in adult deep extubation patients.

OBJECTIVE: Deep extubation refers to endotracheal extubation performed while a patient is deeply anesthetized and without airway reflexes. After deep extubation, patients are sent to the post-anesthesia care unit (PACU) to recover, an area with notably different management and staffing than the operating room (OR). One of the most frequent and concerning complications to occur in the PACU is hypoxemia. As such, this study seeks to evaluate the incidence of desaturation, defined by SpO2 < 90% for longer than 10 s, in the PACU following deep extubation. Additionally, we hope to assess the consequence of desaturation on perioperative workflow by comparing PACU recovery times. RESULTS: Following deep extubation, 4.3% of patients (13/300) experienced desaturation in the PACU. Every episode was notably minor, with patients reverting to normal saturation levels within a minute. Of the 26 case factors assessed, 24 had no significant association desaturation in the PACU, including the amount of time spent in the PACU. History of asthma was the only statistically significant factor found to be positively associated with desaturation. We find that PACU desaturation episodes following deep extubation are rare. Our findings suggest that deep extubation is a viable and safe option for patients without significant respiratory tract pathology.

Incidence of airway complications associated with deep extubation in adults.

BACKGROUND: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as "deep extubation", in order to provide a "smooth" emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. METHODS: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients' demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. RESULTS: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). CONCLUSIONS: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong?

BACKGROUND: Intramuscular gluteal lipoinjection has become one of the most commonly used surgical procedures for achieving improvement in the gluteal contour; however, there are few studies that report and analyze the causes of secondary death from this surgical procedure. METHODS: An analysis of secondary deaths from gluteal lipoinjection procedures was performed in Mexico and Colombia over periods of 10 and 15 years, respectively. In Mexico, the study was performed through a survey of all members of the Mexican Association of Reconstructive, Plastic and Aesthetic Surgery. In Colombia, the study was performed through an analysis of deaths and autopsies documented by the National Institute of Legal Medicine and Forensic Sciences Regional Bogotá. RESULTS: A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery. In the Colombian autopsy results, seven cases of macroscopic fat embolism and two cases with a microscopic embolism were reported, with abundant fatty tissue in the infiltrated gluteal muscles. CONCLUSIONS: In this study, the authors found that intramuscular gluteal lipoinjection is associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism; therefore, buttocks lipoinjection should be performed very carefully, avoiding injections into deep muscle planes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Consenso de la Sociedad Colombiana de Anestesiología y Reanimación, SCARE, y de la Sociedad Colombiana de Cirugía Plástica sobre las recomendaciones para el manejo de pacientes electivos de bajo riesgo(1) / Colombian Society of Anesthesiology and Resuscitation and Colombian Plastic Surgery Society Consensus (1)

Este documento define algunos aspectos particulares al ejercicio de la anestesia en cirugía plástica que pretenden mejorar la seguridad de los pacientes. Se hace énfasis en la presentación de estrategias para reducir las complicaciones graves prevenibles más comunes, como los eventos de trombosis, embolias e infecciones. Se establece que estas metas se logran con la participación de los cirujanos y de los anestesiólogos. Estas recomendaciones son adiciones puntuales a las normas mínimas que ha desarrollado la SCARE.

This document defines some particular aspects involved in practising anaesthesia in plastic surgery which are intended to improve patient safety. It presents strategies for reducing the most common serious preventable complications, such as thrombotic, embolic and infectious events. It should be stressed that these goals have been established and must be achieved with surgeons and anaesthesiologists’ participation. These recommendations provide detailed are additions to the Minimum Standards which SCARE has developed.

Experiencia en el manejo endovascular para el tratamiento de la aorta torácica / Experience in endovascular management for thoracic aorta treatment

Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16 porciento.Objetivo: evaluar los resultados quirúrgicos en términos de morbi-mortalidad de los pacientes sometidos a manejo endovascular de las lesiones de la aorta torácica en la Fundación Cardiovascular de Colombia desde 2003 hasta 2005. Diseño–método: estudio longitudinal tipo descriptivo retrospectivo, en el que se evaluaron las historias clínicas de todos los pacientes sometidos a manejo endovascular de patología toracoabdominal; en éste sólo se incluyeron los pacientes con procedimientos de la aorta torácica, desde 2003 hasta 2005. El análisis de los datos se realizó en Stata/SE 8,0...

Endarterectomía carotídea en pacientes sintomáticos y asintomáticos: resultados de morbi-mortalidad desde 1998 hasta 2005 / Carotid endarterectomy in symptomatic and asymptomatic patients: morbid-mortality results from 1998 to 2005

Antecedentes: el accidente cerebrovascular es la tercera causa de muerte y probablemente la causa más importante de discapacidad a largo plazo. La tasa de mortalidad está entre 15% y 35% con el primer ataque y se eleva a 65% para los accidentes cerebrovasculares subsiguientes. Los resultados a largo y mediano plazo avalan esta técnica quirúrgica para el tratamiento de la enfermedad carotídea, al demostrar altos perfiles de seguridad. Objetivo: determinar los resultados de morbilidad y mortalidad quirúrgica y a 3, 6 y 12 meses de seguimiento, en los pacientes sometidos a endarterectomía carotídea desde 1998 hasta septiembre de 2005. Diseño-método: se evaluaron las historias clínicas de los pacientes sometidos a endarterectomía carotídea, desde 1998 hasta septiembre de 2005. Resultados: se realizaron 42 procedimientos desde 1998 hasta septiembre de 2005; el 57% de los pacientes eran hombres, con edad promedio de 68,8 ± 9,9 años. Los antecedentes de importancia fueron: hipertensión arterial (82%), tabaquismo (61%) y dislipidemia (50%). El 82% de los pacientes mostraban síntomas de enfermedad carotídea. Once pacientes tuvieron lesión de carótida derecha, 16 de carótida izquierda y 15 lesión bilateral, con un promedio de obstrucción de 85 ± 11,4%. La mortalidad fue de 4,7% y no estaba relacionada con el procedimiento quirúrgico. A septiembre de 2005 el 57% de los pacientes egresados estaban libres de síntomas. Conclusiones: la mortalidad para este grupo de pacientes es comparable con los resultados publicados en todo el mundo. La seguridad del procedimiento avala esta técnica quirúrgica como la primera opción en el manejo de la patología carotídea.

Antecedents: cerebrovascular disease is the third cause of death and probably the most common cause of significant long term disability. Mortality rate with first stroke is between 15% and 35% and goes up to 65% with subsequent strokes. Results at long and middle term endorse carotid endarterectomy for carotid artery disease treatment by demonstrating high safety profiles. Objective: to determine the surgical morbidity and mortality results at 3, 6 and 12 months of follow-up in patients submitted to carotid endarterectomy from 1998 to 2005. Design-Method: clinical histories of patients submitted to carotid endarterectomy from 1998 to September 2005 were evaluated. Results: 42 procedures were realized since 1998 until September 2005. 57% of the patients were men with mean age 68.8 ± 9.9 years. Important antecedents were arterial hypertension (82%), cigarette smoking (61) and dyslipidemia (50%). 82% showed symptoms of carotid disease. 11 patients had right carotid lesion and in 15 the lesion was bilateral, with mean obstruction of 85 ± 11.4%. Mortality was 4.7% and was not related to the surgical procedure. At September 2005, 57% of the discharged patients were asymptomatic. Conclusions: mortality for this group of patients is comparable to the worldwide published results. Procedure safety guarantees this surgical technique as the first option in this carotid pathology management.

Tratamiento de aorta abdominal e ilíacas con técnica endovascular / Treatment of abdominal aorta and iliac arteries with endovascular technique

Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los resultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005.Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E...

Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the institutional results in the management of abdominal aortic pathologies through endovascular technique from 2003 to 2005. Design-Method: descriptive, longitudinal, retrospective study in which clinical histories of patients that underwent an endovascular procedure of abdominal aorta and iliac arteries were analyzed. The analysis was performed in Stata 8,0 S/E. Results: 9 patients received exclusively treatment for abdominal aortic and iliac lesions. All were male individuals with mean age 68.9 ± 8.1 years. 6 patients had diagnosis of infra-renal aortic aneurysm and the other 3 had anastomotic aneurysms. Requirement of endoprosthesis was evidenced in an average of 1.9 ± 0.8. Femoro-femoral bypass surgery was performed as simultaneous procedure in 4 of the 9 patients. 77.8% of patients had no complications. Mortality due to the procedure was 22% (2 patients) and it is important to notice that only these 2 patients had complications. Conclusions: exclusion of aortic and iliac aneurysms with modular endoprosthesis is being widely implemented as a valid treatment option, with excellent results that avoid the risks of conventional surgery and its associated morbidity.

Manejo endovascular de la aorta torácica / Endovascular treatment of thoracic aorta

En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.

Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

Arteria carótida y placa carótida un órgano / Carotid artery and plaque. Carotid: an organ

En estos momentos es posible hacer recomendaciones sobre las indicaciones de la endarterectomía carotídea, basadas en los ensayos clínicos publicados y en la revisión de grandes series quirúrgicas. Las indicaciones para la cirugía dependerán del grado de estenosis y de la morfología de la placa, así como del estado clínico del paciente y de la morbi-mortalidad del equipo quirúrgico. Este al igual que otros estudios con grandes series de casos, evidencia que la endarterectomía carotídea y/o el manejo endovascular, realizado por equipos expertos, es un procedimiento seguro en pacientes con indicación quirúrgica.

It is now possible to recommend indications for aortic endarterectomy, based on published clinical essays and revision of large surgical series. Surgery indications will depend on the stenosis degree and the plaque morphology, as well as on the patient's clinical state and the morbid-mortality in this surgical team. As other studies with large case series, evidences that carotid endarterectomy and/or endovascular management, when realized by expert teams, is a safe procedure in patients with surgical indication.

Succinilcolina versus Rocuronio en intubación de secuencia inversa en pacientes con alto riesgo de broncoaspiración / Succinylcholine vs. Rocuronium in intubation of inverse sequence in patients with high risk of bronchoaspiration

El objetivo del estudio es comparar las condiciones de entubación de la tráquea, segun escala Sandor-Agoston, tiempos de latencia e indices de recuperación después de la administración de succinilcolina a dosis de 1.5 mg/kg y rocuronio a dosis de 0.6 mg/kg a los 40 segundos despues de su administración. Para esto se realizó un estudio prospectivo, controlado, doble ciego, aleatorizado, comparativo, en el cual se incluyó 80 pacientes en 2 grupos que ingresaron al Hospital Ramon gonzalez Valencia en el último semestre de 1999, con edades entre 18 y 60 años, ASA I o II y que iban a ser llevados a anestesia general. Al monitorear la relajación muscular por acelerometria no se encontraron diferencias estadísticamente significativas entre los dos grupos en cuanto a las condiciones de intubación, tiempos de latencia, pero los tiempos de recuperación del rocuronio fueron sustancialmente prolongados. Se concluyó que la succinilcolina y el rocuronio presentan iguales tiempos de latencia y excelentes condiciones de intubación a los 40 segundos, que hace que este último se convierta en una alternativa útil, y eficaz para la intubación rápida en pacientes con estómago lleno a quienes se contraindique la succinilcolina. Se recomienda trabajos posteriores para establecer tiempos de recuperación del rocuronio.

Meningitis Bacteriana en Menores de Doce Años: Experiencia de Nueve Años en el Servicio de Pediatría del Hospital Universitario Ramón González Valencia de Bucaramanga / Bacterial Meningitis in Children Under Twelve Years of Age: Experience of Nine Years in the Pediatrics Service of the Hospital Universitario Ramón González Valencia in Bucaramanga

Estudio retrospectivo descriptivo que busca establecer el perfil clínico-epidemiológico de la meningitis bacteriana en nuestro medio. Se analizaron 326 historias clínicas de pacientes entre 0 y 12 años hospitalizados en el Departamento de Pediatría del Hospital Ramón González Valencia de Bucaramanga emtre el 1 de enero de 1987 y el 31 de diciembre de 1995, con diagnóstico de meningitis bacteriana. El número de casos por año aumentó desde 19 en 1987 hasta 64 en 1993. Hubo 199 casos (61 por ciento) de sexo masculino y 127 (39 por ciento) femeninos (relación 1.6:1). Por grupos etareos fueron 63 por ciento lactantes, 18 por ciento preescolares, 11 por ciento escolares y 8 por ciento recién nacidos. 178 (55 por ciento) procedían del área metropolitana de Bucaramanga. Por estado nutricional 61 por ciento eran eutróficos, 20 por ciento desnutridos grado I; 1.8 por ciento desnutridos grado II y 6 por ciento desnutridos grado III. Los gérmenes aislados fueron Haemophilus influenzae 59 por ciento, Streptococcus pneumoniae 20 por ciento, Neisseria meningitidis 9.5 por ciento, Staphylococcus aureus 5 por ciento, Streptococcus B 4 por ciento, Salmonella 1 por ciento, Pseudomonas 0.5 por ciento, Citrobacter 0.5 por ciento y Escherichia coli 0.5 por ciento. El líquido cefalorraquideo mostró células aumentadas en el 98.4 por ciento de los pacientes, la relación glucorraquia/glicemia en el 83 por ciento estuvo por debajo del 50 por ciento y el Gram fue positivo en el 51 por ciento de los casos; la correlación con cultivo positivo fue del 91 por ciento. Látex para términos patógenos se realizó en 15 pacientes, mientras que la tomografía axial computadorizada se practicó en 92 (28 por ciento). Cultivos de líquido cefalorraquideo se realizaron en 263 pacientes de los cuales fueron positivos 167 (63.5 por ciento). Se presentaron complicaciones en 129 (39.5 por ciento): Convulsiones persistentes (77.5 por ciento) y en menor proporción hidrocefalia, empiemas, secreción inadecuada de hormona antidiurética y absceso cerebral. Las secuelas más frecuentes fueron los trastornos motores leves en 58 pacientes, epilepsia en 27, retardo mental en 20, hemiparesia en 18, cuadriparesia en diez. Fallecieron 25 de los 326 pacientes (7.7 por ciento)