"Low-field" intraoperative MRI: a new scenario, a new adaptation.

AIM: To describe the adaptation of Cruces University Hospital to the use of intraoperative magnetic resonance imaging (ioMRI), and how the acquisition and use of this technology would impact the day-to-day running of the neurosurgical suite. MATERIALS AND METHODS: With the approval of the ethics committee, an observational, prospective study was performed from June 2012 to April 2014, which included 109 neurosurgical procedures with the assistance of ioMRI. These were performed using the Polestar N-30 system (PSN30; Medtronic Navigation, Louisville, CO), which was integrated into the operating room. RESULTS: A total of 159 procedures were included: 109 cranial surgeries assisted with ioMRI and 50 control cases (no ioMRI use). There were no statistical significant differences when anaesthetic time (p=0.587) and surgical time (p=0.792) were compared; however, an important difference was shown in duration of patient positioning (p<0.0009) and total duration of the procedure (p<0.0009) between both groups. CONCLUSIONS: The introduction of ioMRI is necessary for most neurosurgical suites; however, a few things need to be taken into consideration when adapting to it. Increase procedure time, the use of specific MRI-safe devices, as well as a checklist for each patient to minimise risks, should be taken into consideration.

El papel del clevidipino en el tratamiento antihipertensivo: resultados clínicos / The role of clevidipine in hypertension management: clinical results

En la población general adulta la prevalencia de la hipertensión arterial es del 30 al 45%. Los anestesiólogos se enfrentan con frecuencia a la tarea de mantener un control adecuado de la presión arterial perioperatoria. En elevaciones súbitas de la misma su control preciso toma mayor importancia para la prevención de compromiso de órganos diana. Recientemente, clevidipino, un calcioantagonista de acción ultracorta ha sido aprobado por la FDA () como estrategia para el tratamiento intravenoso (IV) de la hipertensión arterial y por la y la Agencia Española de Medicamentos y Productos Sanitarios () para la reducción rápida de la presión arterial en el contexto perioperatorio. Se ha observado que este medicamento tiene un rápido inicio de acción, fácil titulación y ejerce un control preciso de la presión arterial. Además, es altamente efectivo como monoterapia y tiene una adecuada transición a una terapia antihipertensiva oral. Para este artículo se realizó una búsqueda de la literatura disponible en MEDLINE hasta febrero de 2014, utilizando como palabras claves hypertension y clevidipine con el fin de exponer las características farmacocinéticas y farmacodinámicas, y de igual forma los estudios clínicos que proveen evidencia del rápido y efectivo control de la presión arterial producido por el clevidipino, en especial en esos momentos en que el control preciso de esta es altamente relevante (AU)

The prevalence of hypertension in general population is from 30% to 45%. Anesthesiologists frequently deal with the challenge of maintaining adequate control of perioperative blood pressure. On sudden elevations, a precise control is required to prevent end-organ damage. Recently, clevidipine, an ultra-short acting calcium antagonist has been approved by the FDA (), as a strategy for the intravenous treatment of hypertension; and by the Spanish Agency of Medicines and Medical Devices () for the rapid reduction of arterial blood pressure in the perioperative setting. This medication has shown to have a rapid onset, easy titratability, and to exert a precise control of blood pressure. In addition, clevidipine has shown to be highly effective as monotherapy, and to have an excellent transition to oral antihypertensive therapy. For this article, an online search of the Medline literature was conducted up to February 2014 and «clevidipine» and «hypertension» used as keywords in order to analyze pharmacokinetics and pharmacodynamics of clevidipine. There are also clinical studies that provide evidence of the rapid and effective control that clevidipine has on blood pressure, especially in acute perioperative and emergency settings (AU)

[The role of clevidipine in hypertension management: clinical results]. / El papel del clevidipino en el tratamiento antihipertensivo: resultados clínicos.

The prevalence of hypertension in general population is from 30% to 45%(.) Anesthesiologists frequently deal with the challenge of maintaining adequate control of perioperative blood pressure. On sudden elevations, a precise control is required to prevent end-organ damage. Recently, clevidipine, an ultra-short acting calcium antagonist has been approved by the FDA (www.accessdata.fda.gov), as a strategy for the intravenous treatment of hypertension; and by the Spanish Agency of Medicines and Medical Devices (www.aemps.gob.es) for the rapid reduction of arterial blood pressure in the perioperative setting. This medication has shown to have a rapid onset, easy titratability, and to exert a precise control of blood pressure. In addition, clevidipine has shown to be highly effective as monotherapy, and to have an excellent transition to oral antihypertensive therapy. For this article, an online search of the Medline literature was conducted up to February 2014 and "clevidipine" and "hypertension" used as keywords in order to analyze pharmacokinetics and pharmacodynamics of clevidipine. There are also clinical studies that provide evidence of the rapid and effective control that clevidipine has on blood pressure, especially in acute perioperative and emergency settings.