Enucleación prostática con láser de holmio (HoLEP) mediante cirugía sin ingreso: una alternativa posible y segura / Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option

Objetivo Estudiar la viabilidad de la enucleación prostática con láser de holmio (HoLEP) en circuito de cirugía mayor ambulatoria. Material y métodos Se realiza un estudio prospectivo observacional en el que se incluyen 25 pacientes intervenidos de HoLEP que han sido dados de alta el mismo día de la cirugía según criterios previamente establecidos. Resultados La edad media de los pacientes intervenidos fue de 65,1 años. El volumen prostático medio fue de 45,8cc. Todos los pacientes fueron dados de alta el día de la cirugía (alta efectiva 100%). El porcentaje de complicaciones en nuestra serie fue del 12%, todas ellas grado I según la Clasificación Clavien Dindo. Ningún paciente precisó reingreso en los 30 días posteriores al procedimiento. El porcentaje de satisfacción con el circuito de cirugía ambulatoria fue del 95%. Conclusiones Tras el análisis inicial de nuestros datos podemos concluir que el HoLEP ambulatorio es una técnica eficaz y segura con bajo riesgo de complicaciones. El circuito de cirugía ambulatoria es el preferido por los pacientes intervenidos de HoLEP (AU)

Objective To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. Material and methods Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. Results The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. Conclusions The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP (AU)

Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option.

OBJECTIVE: To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS: Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS: The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS: The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.

Anestesia para cirugía de mama en una paciente con síndrome de Eisenmenger / Anaesthetic management of breast surgery in a patient with Eisenmenger syndrome

El síndrome de Eisenmenger (SE) es una combinación compleja de anomalías cardiovasculares definida por hipertensión pulmonar con inversión o bidireccionalidad del flujo a través de una comunicación intracardiaca o aortopulmonar, generalmente secundaria a cardiopatías congénitas no solucionadas oportunamente. Conlleva un riesgo significativo de mortalidad perioperatoria, pudiendo alcanzar valores próximos al 30% para cirugía no cardíaca. Se presenta el caso de una paciente adulta diagnosticada de SE sometida a cirugía mamaria bajo anestesia general combinada con la realización de bloqueos analgésicos torácicos. Se discuten las principales implicaciones fisiopatológicas de este síndrome, subrayando la importancia de una adecuada evaluación preoperatoria con valoración exhaustiva de los riesgos asociados, un cuidadoso manejo intraoperatorio y una vigilancia postoperatoria que inicialmente han de realizarse en una unidad de cuidados críticos. Se incide en la necesidad de individualizar y adaptar la elección de agentes y técnica anestésica al estado hemodinámico del paciente y al procedimiento quirúrgico (AU)

Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted (AU)

Anaesthetic management of breast surgery in a patient with Eisenmenger syndrome. / Anestesia para cirugía de mama en una paciente con síndrome de Eisenmenger.

Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted.