Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases.

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).

Algoritmo diagnóstico-terapéutico de las microangiopatías trombóticas. A propósito de 2 casos / Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases

Las microangiopatías trombóticas (MAT) son un conjunto de síndromes clínicos que asocian anemia hemolítica, trombocitopenia y disfunción orgánica, principalmente renal o neurológica. Están asociados a una morbimortalidad significativa, por lo que su diagnóstico y tratamiento precoz son esenciales. En este artículo detallamos 2 casos de MAT; una paciente con una púrpura trombocitopénica trombótica (PTT) y otra paciente con un síndrome hemolítico urémico atípico (SHUa).(AU)

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).(AU)

Tranexamic acid in cardiac surgery: Are low doses enough?

OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12 h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12 h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P = .014) and ID (P = .040) but more fresh frozen plasma than group ID (P = .0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.

Tranexamic acid in cardiac surgery: Are low doses enough? / Ácido tranexámico en cirugía cardíaca: ¿las dosis bajas son suficientes?

OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P=.014) and ID (P=.040) but more fresh frozen plasma than group ID (P=.0002). CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.

Analysis of Candida auris candidemia cases in an Intensive Care Unit of a tertiary hospital.

Candida auris is a multi-resistant emerging fungus. OBJECTIVES: To analyze the relationship between colonization by C. auris and the appearance of invasive candidiasis. Description of the sample of colonized patients, risk factors for colonization and/or infection, and calculation of mortality rates. METHODOLOGY: Longitudinal observational study in an anesthesia intensive care unit in 2018. RESULTS: 2130 patients were admitted. Surveillance studies were positive in 124 patients; 118 cases involved skin colonization and 52 were pharyngeal. Patients with a positive blood culture were identified. A statistically significant association was found between pharyngeal colonization and the appearance of a positive blood culture. There were significant differences between patients with a high Candida Score as a risk factor for candidemia. In total, 67% of pharyngeal carriers negativized at 1 month compared to 21% of cutaneous carriers, who negativized after 3-4 months. Of the patients with positive blood cultures, 70% of non-survivors received only monotherapy, although this difference was not statistically significant due to the small sample size. CONCLUSIONS: The incidence of C. auris, a multi-resistant pathogen that is difficult to diagnose, treat and eradicate, is steadily increasing among critically ill patients. Its status as an emerging threat to global health calls for the urgent implementation of early in-hospital detection systems.

Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases. / Algoritmo diagnóstico-terapéutico de las microangiopatías trombóticas. A propósito de 2 casos.

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).

Metahemoglobinemia severa por intoxicación con anilina / No disponible

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[Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial]. / Analgesia postoperatoria en la intervención abierta de hallux valgus en Cma. comparación entre analgesia oral y bloqueo perineural contínuo del nervio tibial posterior.

INTRODUCTION: This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery. MATERIAL AND METHODS: Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend. RESULTS: The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique. CONCLUSION: Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.

Analgesia postoperatoria en la intervención abierta de hallux valgus en CMA. Comparación entre analgesia oral y bloqueo perineural continuo del nervio tibial posterior / Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial

INTRODUCCIÓN: El presente trabajo valora la seguridady eficacia del bloqueo continuo del nervio tibial posterioren el tobillo, mediante la infusión domiciliaria porelastómero de ropivacaína al 0,375%, en pacientes intervenidosde hallux valgus en cirugía ambulatoria (CMA).MATERIAL Y MÉTODO: Se compara la analgesia oralconvencional de la unidad de CMA, metamizol 575 mgVO c/6h (AC) con la analgesia perineural (AP), infusióncontinua a 5 mL h-1 de ropivacaína 0,375% en nerviotibial posterior, en dos grupos de 20 pacientes, distribuidosaleatoriamente. Intervenciones realizadas bajo anestesiaintradural con mepivacaína hiperbara e infiltraciónintra-articular con bupivacaína al 0,25%. Ambos gruposutilizaron tramadol 50 mg VO c/8h como analgésico derescate. El servicio de atención domiciliaria realizó loscontroles: valoración del dolor según la escala analógicavisual (EVA 0-10), calidad sueño, necesidad de analgesiade rescate, aceptación de la técnica, incidencias y efectossecundarios, a las 12, 24 y 48 h de la intervención. Trabajodescriptivo, comparaciones mediante prueba U deMann Whitney; para el análisis de calidad del sueño ynecesidad de analgesia se utilizó el test de tendencia linealChi cuadrado.RESULTADOS: El grupo AP presentó valores de EVAsignificativamente menores a las 4 h, 12 h y 24 h y menornecesidad de analgesia de rescate. No diferencias en calidaddel sueño (p=0,07). No incidencias ni efectos secundarios.No hubo casos de reingreso. Los pacientes manifestaronun alto grado de aceptación de la técnica.CONCLUSIÓN: La analgesia perineural continua domiciliariase muestra efectiva y segura en nuestro ámbito

INTRODUCTION: This trial assessed the safety and efficacyof a continuous posterior tibial nerve block in theankle provided in the patient’s home by elastomericpump infusion of 0.375% ropivacaine after ambulatoryhallux valgus surgery.MATERIAL AND METHODS: Patients were randomizedto 2 groups of 20 each to receive either the conventionaloral analgesia prescribed by our team after outpatientsurgery (metamizole 575 mg/6 h p.o.) or perineuralanalgesia with a continuous infusion of 5 mL.h-1 of0.375% ropivacaine in the posterior tibial nerve. Surgerywas performed under hyperbaric spinal anesthesiawith mepivacaine and an injection of 0.25% bupivacaineinto the joint. Both groups also received 50 mg/8 hp.o. of tramadol as rescue analgesia. Assessment duringvisits by the home care team 12, 24, and 48 hours aftersurgery included the following variables: pain on avisual analog scale (VAS, 0-10), sleep quality, need forrescue analgesia, acceptance of the technique, sideeffects and adverse events. Descriptive statistics werecalculated and comparisons were performed with theMann-Whitney U test; sleep quality and need for rescueanalgesia were compared by applying the ÷2 statisticwith a test of linear trend.RESULTS: The perineural analgesia group had significantlylower VAS scores at 4, 12, and 24 hours and lessneed for rescue analgesia. No differences in sleep qualitywere found (P0.07). The incidence of side effectsdid not differ, and there were no readmissions. Thepatients expressed a high level of acceptance of thetechnique.CONCLUSION: Continuous perineural analgesia in thehome setting was found to be effective and safe in ourpatients

Descubrimiento de un caso de siringomielia tras una infiltración epidural / Syringomyelia discovered after epidural infusion

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Catéter epidural anudado espontáneamente / Spontaneous kinking of an epidural catheter

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[Convulsions induced by ropivacaine after brachial plexus block]. / Convulsiones inducidas por ropivacaína tras la realización de un bloqueo del plexo braquial.

Ropivacaine is a local anesthetic frequently used to provide regional blocks because its toxicity threshold is favorable and it is highly selective for sensory nerve fibers. Few reports of adverse events and complications related to use of ropivacaine have been published. We report 2 cases of central nervous system toxicity. Each occurred after a brachial plexus block with 0.75% ropivacaine, one performed by an axillary approach and one by an infraclavicular approach with nerve stimulation.