[Low-dose aspirin doesn't increase surgical bleeding nor transfusion rate in total knee arthroplasty]. / El tratamiento preoperatorio con aspirina a dosis bajas no aumenta la hemorragia quirúrgica ni la tasa transfusional en la prótesis total de rodilla.

OBJECTIVES: Surgical bleeding. transfusion rate and cardiovascular complications were analized in patients undergoing chronic treatment with low-doses aspirin and scheduled to unilateral primary knee arthroplasty. PATIENTS AND METHODS: We retrospectively studied 117 patients between 2005 and 2006 scheduled for elective knee replacement that received antiplatelet therapy with aspirin (100mg/day). Aspirin medication was maintained or discontinued preoperatively according to medical criteria. We analyzed the biological, clinical and anesthetic data, blood-saving techniques used, surgical bleeding, allogeneic blood transfusion rate, cardiocirculatory complications (myocardial, cerebral or peripheral ischemia), hospital stay and mortality. This population was compared with 190 patients (control group) who underwent the same operation at the same time interval but did not receive aspirin therapy. RESULTS: The aspirin-treated group was significantly older, with higher weight and poorer health state (higher incidence of ischemic heart disease, cerebral ischemia and diabetes). The hidden and external surgical bleeding and transfusion rate were similar if the aspirin were interrupted or not, preoperatively. Bleeding and transfusion rates were independent of time of interruption of the aspirin. Hospital mortality was zero in the 2 groups. A acute myocardial infarction and a transient stroke happened in two patients wich aspirin treatment was discontinued. CONCLUSIONS: Preoperative treatment with low doses of aspirin does not increase surgical bleeding and transfusion rate in total knee arthroplasty. Preoperative discontinuation can cause severe cardiocirculatory complications.

El tratamiento preoperatorio con aspirina a dosis bajas no aumenta la hemorragia quirúrgica ni la tasa transfusional en la prótesis total de rodilla / Low-doses aspirin doesn’t increase surgical bleedind nor transfusion rate in total knee arthroplasty

Objetivos. Analizar la hemorragia quirúrgica, índice transfusional y complicaciones cardiovasculares en pacientes en tratamiento crónico con aspirina y sometidos a artroplastia total primaria unilateral de rodilla. Pacientes y métodos. Se estudió retrospectivamente a 117 pacientes programados entre 2005 y 2006 para cirugía electiva de artroplastia de rodilla y en tratamiento preoperatorio con aspirina (100mg/día). La medicación fue mantenida o interrumpida preoperatoriamente a criterio médico. Se analizaron las características biológicas, clínicas, anestésicas, técnicas de ahorro de sangre, hemorragia quirúrgica, transfusión alogénica, complicaciones cardiocirculatorias (isquemia miocárdica, cerebral o periférica), estancia y mortalidad hospitalarias. Se compararon con 190 pacientes (grupo control) intervenidos de la misma operación en el mismo intervalo de tiempo, pero sin tratamiento crónico con aspirina. Resultados. El grupo tratado con aspirina era significativamente de mayor edad, peso y con más enfermedades asociadas (mayor incidencia de cardiopatía isquémica, isquemia cerebral y diabetes). La hemorragia quirúrgica externa, oculta y total fue similar en ambos grupos, así como la transfusión alogénica. La hemorragia y tasa transfusional fueron independientes del tiempo de interrupción de la aspirina. La mortalidad hospitalaria fue nula en los 2 grupos. Dos pacientes en los que se interrumpió el tratamiento tuvieron un infarto agudo de miocardio y un accidente vascular cerebral transitorio, respectivamente. Conclusiones. El tratamiento preoperatorio con aspirina no incrementa la hemorragia quirúrgica ni el índice transfusional en la artroplastia total de rodilla. La interrupción preoperatoria puede ocasionar complicaciones cardiocirculatorias graves(AU)

Objectives. Surgical bleeding. transfusion rate and cardiovascular complications were analized in patients undergoing chronic treatment with low-doses aspirin and scheduled to unilateral primary knee arthroplasty. Patients and methods. We retrospectively studied 117 patients between 2005 and 2006 scheduled for elective knee replacement that received antiplatelet therapy with aspirin (100mg/day). Aspirin medication was maintained or discontinued preoperatively according to medical criteria. We analyzed the biological, clinical and anesthetic data, blood-saving techniques used, surgical bleeding, allogeneic blood transfusion rate, cardiocirculatory complications (myocardial, cerebral or peripheral ischemia), hospital stay and mortality. This population was compared with 190 patients (control group) who underwent the same operation at the same time interval but did not receive aspirin therapy. Results. The aspirin-treated group was significantly older, with higher weight and poorer health state (higher incidence of ischemic heart disease, cerebral ischemia and diabetes). The hidden and external surgical bleeding and transfusion rate were similar if the aspirin were interrupted or not, preoperatively. Bleeding and transfusion rates were independent of time of interruption of the aspirin. Hospital mortality was zero in the 2 groups. A acute myocardial infarction and a transient stroke happened in two patients wich aspirin treatment was discontinued. Conclusions. Preoperative treatment with low doses of aspirin does not increase surgical bleeding and transfusion rate in total knee arthroplasty. Preoperative discontinuation can cause severe cardiocirculatory complications(AU)

Respuesta a la carta al director "Comentarios al artículo comparación de la eficacia y seguridad de tres técnicas analgésicas (epidural, bloqueo femoral y bloqueo femoral-ciático) en el postoperatorio de prótesis total de rodilla" / No disponible

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[Epidural analgesia versus femoral or femoral-sciatic nerve block after total knee replacement: comparison of efficacy and safety]. / Comparación de la eficacia y seguridad de tres técnicas analgésicas (epidural, bloqueo femoral y bloqueo femoral-ciático) en el postoperatorio de prótesis total de rodilla.

OBJECTIVE: Pain after total knee replacement surgery is intense. The aim of this study was to compare 3 techniques for providing postoperative analgesia (epidural analgesia, femoral nerve block, and a combined femoral-sciatic nerve block) in total knee arthroplasty. MATERIAL AND METHODS: Observational study of 1550 elective primary unilateral total knee replacement operations. The safety and efficacy of the following 3 techniques were compared: epidural analgesia, femoral nerve block, and femoral-sciatic nerve block. Demographic, anesthetic, and surgical data were recorded. Study variables included pain intensity on a visual analog scale every 4 hours, need for rescue analgesia (morphine), complications and adverse events within 5 postoperative days. RESULTS: No significant differences were found in demographic, anesthetic, or surgical variables. In the first 24 hours after surgery, pain intensity was significantly less for patients who received a femoral-sciatic nerve block. The mean levels of morphine consumption in the first 96 hours after surgery were similar in the femoral-sciatic nerve block group (3.18 mg) and the epidural analgesia group (3.19 mg); morphine consumption in the femoral block group was significantly higher (4.51 mg). Epidural analgesia was associated with the highest rate of complications (17%). CONCLUSIONS: A sciatic nerve block combined with a femoral nerve block attenuates pain more effectively and is associated with less postoperative morphine consumption in comparison with a femoral nerve block alone. Peripheral nerve block techniques have fewer adverse side effects than epidural analgesia.

Comparación de la eficacia y seguridad de tres técnicas analgésicas(epidural, bloqueo femoral y bloqueo femoral-ciático) en elpostoperatorio de prótesis total de rodilla / Epidural analgesia versus femoral or femoralsciatic nerve block after total knee replacement: comparison of efficacy and safety

OBJETIVOS: El dolor postoperatorio de la prótesis totalde rodilla es de una gran intensidad. El objetivo fuecomparar tres técnicas de analgesia postoperatoria (epidural,bloqueo del nervio femoral y bloqueo de los nerviosfemoral y ciático combinados) después de intervenciónde prótesis total de rodilla.MATERIAL Y MÉTODOS: Estudio observacional de 1.550intervenciones de prótesis de rodilla unilateral primariaselectivas. Se compararon tres técnicas de analgesia postoperatoria(epidural, bloqueo femoral y bloqueo femoralciático)para valorar eficacia y seguridad. Se recogierondatos demográficos, anestésicos y quirúrgicos, intensidaddel dolor según escala visual analógica cada 4 horas,rescate analgésico con morfina, complicaciones e incidenciasdurante los 5 primeros días del postoperatorio.RESULTADOS: No hallamos diferencias en las variablesdemográficas, anestésicas y quirúrgicas. La intensidad deldolor fue significativamente menor en el grupo bloqueofemoral y ciático respecto a los grupos epidural y bloqueofemoral durante las primeras 24 horas del postoperatorio.El consumo medio de morfina a las 96 horas tras la intervenciónfue similar en el grupo con bloqueo femoral y ciático(3,18 mg) y epidural (3,19 mg), y significativamentemayor con el bloqueo femoral (4,51 mg). La analgesia epiduralpresento el mayor índice de complicaciones (17%).CONCLUSIONES: Asociar un bloqueo ciático al bloqueofemoral disminuye el dolor y el consumo de morfina postoperatoriorespecto al bloqueo femoral aislado. Las técnicasanalgésicas de bloqueo periférico presentan menosefectos indeseables que la analgesia epidural (AU)

OBJECTIVE: Pain after total knee replacement surgeryis intense. The aim of this study was to compare 3techniques for providing postoperative analgesia(epidural analgesia, femoral nerve block, and acombined femoral-sciatic nerve block) in total kneearthroplasty.MATERIAL AND METHODS: Observational study of 1550elective primary unilateral total knee replacementoperations. The safety and efficacy of the following 3techniques were compared: epidural analgesia, femoralnerve block, and femoral-sciatic nerve block.Demographic, anesthetic, and surgical data wererecorded. Study variables included pain intensity on avisual analog scale every 4 hours, need for rescueanalgesia (morphine), complications and adverse eventswithin 5 postoperative days.RESULTS: No significant differences were found indemographic, anesthetic, or surgical variables. In thefirst 24 hours after surgery, pain intensity wassignificantly less for patients who received a femoralsciaticnerve block. The mean levels of morphineconsumption in the first 96 hours after surgery weresimilar in the femoral-sciatic nerve block group(3.18 mg) and the epidural analgesia group (3.19 mg);morphine consumption in the femoral block group wassignificantly higher (4.51 mg). Epidural analgesia wasassociated with the highest rate of complications (17%).CONCLUSIONS: A sciatic nerve block combined with afemoral nerve block attenuates pain more effectively andis associated with less postoperative morphineconsumption in comparison with a femoral nerve blockalone. Peripheral nerve block techniques have feweradverse side effects than epidural analgesia (AU)

[Patients' perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received]. / Percepción de seguridad en la decisión del paciente quirúrgico: relación con la información previa recibida.

OBJECTIVE: To evaluate the certainty of patients deciding whether or not to undergo a proposed operation and the relationship between the degree of certainty and the prior information received. METHODS: A cross-sectional study was performed using the decisional conflict scale (DCS) to evaluate the degree of certainty of patients deciding to undergo surgery. A standardized questionnaire was used to obtain demographic data (age, sex, and level of education) and details about the information the patients had received regarding the surgical procedure. Patients were classified as certain or uncertain of their decision to undergo surgery according to the DCS score. A logistic regression model was constructed to adjust for confounding factors and to analyze the relationship between certainty and variables reflecting the information received by the patient. RESULTS: A total of 358 patients were included. Thirty percent of the patients stated that they had not received prior information and 31.6% showed uncertainty in their decision. Younger men with a higher level of education felt more certain of their decision. After adjusting for age, sex, and level of education, we found that uncertainty was related to the perception of not having received enough prior information (odds ratio, 43; 95% confidence interval, 2.4-7.7). CONCLUSION: The perception of certainty is clearly linked to patients' understanding of prior information received. The results show a need to improve the information given to patients--particularly to elderly patients and those with a low level of education.

Percepción de seguridad en la decisión del paciente quirúrgico: Relación con la información previa recibida / Patients’ perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received

OBJETIVO: Evaluar la seguridad mostrada por elpaciente ante el proceso quirúrgico propuesto y su relacióncon la información previa recibida.MÉTODO: Se realizó un estudio transversal en el quese valoró la seguridad en la decisión de operarse delpaciente mediante la “Decisional Conflict Scale” (DCS).Con un cuestionario estandarizado se obtuvo informaciónsobre datos demográficos (edad, sexo y nivel deestudios) y sobre la información recibida relativa a laintervención quirúrgica. En función de la puntuaciónobtenida en la DCS, se clasificaron los pacientes en segurose inseguros en su decisión de operarse. Se creó unmodelo de regresión logística para ajustar posibles factoresde confusión y analizar la seguridad con las variablesrelativas a la información recibida.RESULTADOS: Se incluyeron 358 pacientes. El 31,6%de pacientes mostraron inseguridad en la decisión tomaday un 30% manifestaron no haber recibido información.Los hombres más jóvenes, con nivel de estudiossuperior mostraron más seguridad en la decisión. Lainseguridad del paciente guardó relación con la percepciónde no haber recibido suficiente información previa(OR = 4,3; 95% IC = 2,4-7,7) ajustando por edad, sexo ynivel de estudios.CONCLUSIÓN: La percepción de seguridad en la decisióndel paciente está en clara relación con la comprensiónde la información previa recibida. Los resultadosobtenidos muestran la necesidad de mejorar la informaciónque damos a los pacientes, principalmente enpacientes mayores y con bajo nivel de estudios (AU)

OBJETIVE: To evaluate the certainty of patientsdeciding whether or not to undergo a proposedoperation and the relationship between the degree ofcertainty and the prior information received.METHODS: A cross-sectional study was performedusing the decisional conflict scale (DCS) to evaluate thedegree of certainty of patients deciding to undergosurgery. A standardized questionnaire was used toobtain demographic data (age, sex, and level ofeducation) and details about the information thepatients had received regarding the surgical procedure.Patients were classified as certain or uncertain of theirdecision to undergo surgery according to the DCS score.A logistic regression model was constructed to adjust forconfounding factors and to analyze the relationshipbetween certainty and variables reflecting theinformation received by the patient.RESULTS: A total of 358 patients were included. Thirtypercent of the patients stated that they had not receivedprior information and 31.6% showed uncertainty intheir decision. Younger men with a higher level ofeducation felt more certain of their decision. Afteradjusting for age, sex, and level of education, we foundthat uncertainty was related to the perception of nothaving received enough prior information (odds ratio,4.3; 95% confidence interval, 2.4-7.7).CONCLUSION: The perception of certainty is clearlylinked to patients’ understanding of prior informationreceived. The results show a need to improve theinformation given to patients—particularly to elderlypatients and those with a low level of education (AU)

Antiagregantes plaquetarios y anestesias medulares / Platelet anti-aggregants and spinal anesthesia

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¿Tienen diferente valor científico las comunicaciones libres orales o pósters en los congresos internacionales de anestesiología? / Have oral and poster comunications in anesthesiology international congressess a different scientific work?

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[Addition of fentanyl to mepivacaine in axillary brachial plexus block. Effects on the anesthetic and postoperative analgesic quality]. / Adición de fentanilo a la mepivacaína en el bloqueo axilar del plexo braquial. Efectos sobre la calidad anestésica y analgésica postoperatoria.

The possible potentiating effect of phentanyl on mepivacaine in brachial plexus blockade was evaluated, both for operative anesthesia and postoperative analgesia. Sixty ASA I patients, scheduled for upper limb surgery, were selected and distributed in 3 groups: 1) Mepivacaine 1% 40 ml (control group); 2) Mepivacaine 1% 40 ml + phentanyl 100 micrograms; 3) Mepivacaine 1% 40 ml + subcutaneous phentanyl 100 micrograms. The latency time and the quality of anesthesia were evaluated. The duration of analgesia was evaluated on the basis of the time from the administration of the first analgesic. There were no significant differences between the 3 groups in the latency times of the development of blockade nor in the quality of surgical anesthesia. Also, there were no significant differences in the duration of postoperative analgesia (307, 316 and 326 minutes, respectively, in each group). It was concluded that the addition of phentanyl 100 micrograms to the local anesthetic in the axillary blockade of the brachial plexus does not change the anesthetic characteristics nor the time of postoperative analgesia.

[Temperature variations of respiratory gases during episodes of anesthetic circuit disconnection in controlled ventilation]. / Variaciones de la temperatura de los gases respiratorios durante los episodios de desconexión del circuito anestésico en la ventilación controlada.

Temperature variations of respiratory gases during episodes of disconnexion of the anesthetic circuit in controlled ventilation were measured with a temperature sensor located in the anesthetic circuit close to the endotracheal tube which was connected to a temperature monitor with alarm limits of 0.5 degrees C. We compared the activation times of the ventilator pressure alarm with those of the temperature. The activation time of the respirator alarm (8.9 +/- 1.6 sec) was significantly shorter (p less than 0.001) than that of the temperature monitor. This difference was more apparent when the anesthetic circuit was disconnected distantly from the sensor (10.5 +/- 1.8 sec for disconnexion between the tracheal tube and the sensor, and 36.8 +/- 12.2 sec when the disconnexion occurred at the entrance of the respiratory branch of the ventilator tubes). The maximal individual value for the activation time of the temperature alarm was 67 seconds. In all instances hemoglobin saturation (SpO2) during anesthetic circuit disconnexion was higher than 95%. In each group there was a positive and significant correlation between the temperature alarm time and the adjustment of the predetermined alarm level with respect to the basal temperature of the respiratory gases. Temperature monitorization of the respiratory gases did not offer additional advantages to the conventional monitorization of the respiratory circuit disconnexion.