Bispectral index monitoring for sedation in scheduled adult colonoscopy: A randomized controlled trial.

BACKGROUND: Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy. METHODS: We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and time during colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction. RESULTS: Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; p = 0.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI, 1.013-1.091; p = 0.0087) and in men (95% CI, 1.129-7.668; p = 0.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups. CONCLUSIONS: Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.

Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía / Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy

Describimos el manejo de una paciente programada para esofagectomía por neoplasia a la que durante el proceso de reserva de hemoderivados le fueron detectados aloanticuerpos, que prácticamente imposibilitaban la obtención de sangre compatible. El manejo de la anemia perioperatoria («patient blood management») se debe realizar rutinariamente en los pacientes quirúrgicos con riesgo de transfusión. Esta estrategia se ha considerado como una de las medidas a tener en cuenta en la rehabilitación multimodal quirúrgica o programa de recuperación intensificada

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery

Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy. / Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía.

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery.

Anestesia epidural torácica para colecistectomía abierta en enfermedad pulmonar severa. Descripción de un caso y revisión bibliográfica / Thoracic epidural anesthesia for open cholecystectomy in severe lung disease. Description of a case and review of the literature

La enfermedad pulmonar obstructiva crónica presenta una creciente incidencia en la última década. El manejo anestésico de estos pacientes en cirugía de abdomen superior supone un reto para el anestesiólogo, ya que la anestesia general se asocia con una elevada posibilidad de complicaciones pulmonares graves. La búsqueda de una alternativa adecuada ha sido objeto de estudio durante años. Presentamos el caso de un paciente con esta afección pulmonar que precisó ser intervenido de colecistectomía con carácter de urgencia. Se describe el tratamiento y se realiza una breve revisión de la literatura (AU)

The incidence of chronic obstructive pulmonary disease has increased in the last decade. The anesthetic management of these patients in upper abdomen surgery is a challenge to the anesthesiologist, since general anesthesia is associated with a high possibility of severe pulmonary complications. The search for a suitable alternative has been a subject of study for years. The case is presented of a patient with chronic obstructive pulmonary disease, who required an urgent cholecystectomy. The treatment of the case and brief review of the literature is presented (AU)

[Thoracic epidural anesthesia for open cholecystectomy in severe lung disease. Description of a case and review of the literature]. / Anestesia epidural torácica para colecistectomía abierta en enfermedad pulmonar severa. Descripción de un caso y revisión bibliográfica.

The incidence of chronic obstructive pulmonary disease has increased in the last decade. The anesthetic management of these patients in upper abdomen surgery is a challenge to the anesthesiologist, since general anesthesia is associated with a high possibility of severe pulmonary complications. The search for a suitable alternative has been a subject of study for years. The case is presented of a patient with chronic obstructive pulmonary disease, who required an urgent cholecystectomy. The treatment of the case and brief review of the literature is presented.