[Perioperative management of cardiac arrhythmia: part II]. / Parte II: Manejo perioperatorio de las arritmias cardíacas.

Cardiac arrhythmias are an important cause of complications throughout the perioperative period. Although our understanding of arrhythmias has increased considerably in recent years, they remain a source of concern for anesthesiologists. Our objective was to review steps to take when diagnosing arrhythmia. Although treatment is still largely influenced by therapies used in nonsurgical patients, we will review the approaches that are most applicable to practice situations in which anesthesiologists must manage patients with arrhythmias or at high risk of developing them.

Parte II: manejo perioperatorio de las arritmias cardíacas / Perioperative management of cardiac arrhythmia: part II

Las arritmias cardiacas son la causa de un importantenúmero de complicaciones en todo el periodo perioperatorioy aunque en los últimos años se han producidoavances significativos en el conocimiento de las mismas,siguen representando un motivo constante de preocupaciónpara los anestesiólogos, Pretendemos dar a conocerlas estrategias que deben seguirse para el diagnóstico delas arritmias y, aunque el tratamiento mantiene unagran influencia de la terapéutica empleada en enfermosno quirúrgicos, repasamos de forma práctica para losanestesiólogos el enfoque más adecuado en los pacientesportadores de un ritmo patológico o que tengan un altoriesgo de padecerlo

Cardiac arrhythmias are an important cause of complicationsthroughout the perioperative period. Althoughour understanding of arrhythmias has increased considerablyin recent years, they remain a source of concern foranesthesiologists. Our objective was to review steps totake when diagnosing arrhythmia. Although treatment isstill largely influenced by therapies used in nonsurgicalpatients, we will review the approaches that are mostapplicable to practice situations in which anesthesiologistsmust manage patients with arrhythmias or at highrisk of developing them

[Anterior surgical approach to T12 and L1 in recurring vertebral hydatidosis: anesthetic management]. / Hidatidosis vertebral recidivada a nivel T-12 y L-1 con abordaje quirúrgico anterior: manejo anestésico.

A 47-year-old man with recurring vertebral hydatidosis was scheduled for surgical removal of cysts by an anterior approach. Anesthetic management included multimodal monitoring and prophylaxis for the most common neurological, hemodynamic, and respiratory complications, as well as for appropriate control of pain during and after surgery. The spine is a rare location for hydatid cysts. Treatment is surgical, although imidazoles are useful for prevention and protection against recurrence. The prognosis is good.

Gestión de riesgos en anestesia obstétrica / Risk management in obstetric anestesia

El objetivo de este trabajo es analizar la epidemilogía de las complicaciones más graves que pueden presentarse durante la asistencia de pacientes obstétricas, valorando su incidencia, la demanda asistencia que generan y los principales factores de riesgo. Se analizan también los aspectos más generales de la planificación en anestesiología obstétrica, con ejemplos concretos para algunas situaciones

The aim of this piece of work is to analyse the epidemiology of the most serious complications which may appear during the anaesthesia of obstetric patients, assessing their incidence, the health care demand they develop and the main risk factors. The most general aspects in planning obstetric anaesthesia area analysed as well, with some particular examples of certain situations

[Anesthesia and cardiac electrophysiology (Part I)]. / Anestesia y electrofisiología cardiaca (Parte I).

Cardiac arrhythmias are a common complication of surgery and anesthesia. They are more likely to occur in patients with heart disease and the presence of a transitory imbalance can supply the underlying substrate for reentry, triggered activity, or abnormal automaticity. The physiologic impact of a given arrhythmia depends on its duration, on ventricular response, and on the underlying cardiac disease. Optimal management of arrhythmias in the anesthetized patient will depend on knowledge of the trigger mechanisms, the effects of anesthetic drugs on cardiac electrophysiology, and situations that favor arrhythmias. The anesthesiologist must cope with a plethora of problems related to the patient's clinical state and the trauma of surgical manipulation. Experience with electrocardiography and the application of various devices (pacemakers, cardioverters, implantable defibrillators) and knowledge of the pharmacodynamics and pharmacokinetics of new intravenous drugs will be essential for patient management. The purpose of the present review is to provide the anesthesiologist with an overview of current views on the diagnosis and management of arrhythmias during anesthesia.

Hidatidosis vertebral recidivada a nivel T-12 y L-1 con abordaje quirúrgico anterior: manejo anestésico / Anterior surgical approach to T12 and L1 in recurring vertebral hydatidosis: anesthetic management

Varón de 47 años que presenta hidatidosis vertebral recidivada y programado para extirpación por vía anterior. El manejo anestésico incluyó monitorización multimodal y profilaxis de las posibles complicaciones más frecuentes: neurólogicas, hemodinámicas y ventilatorias, así como un manejo apropiado del dolor intra y postoperatorio. La localización raquídea es una forma rara de presentación de la hidatidosis. Su tratamiento es quirúrgico, aunque los fármacos imidazólicos son útiles en la prevención y tratamiento de recidivas. El pronóstico suele ser bueno (AU)

A 47-year-old man with recurring vertebral hydatidosis was scheduled for surgical removal of cysts by an anterior approach. Anesthetic management included multimodal monitoring and prophylaxis for the most common neurological, hemodynamic, and respiratory complications, as well as for appropriate control of pain during and after surgery. The spine is a rare location for hydatid cysts. Treatment is surgical, although imidazoles are useful for prevention and protection against recurrence. The prognosis is good (AU)

Anestesia y electrofisiología cardiaca (Parte I) / Anesthesia and cardiac electrophysiology (Part I)

Las arritmias cardiacas representan una complicación frecuente de la cirugía y de la anestesia. Ocurren de forma más habitual en pacientes con patología cardiaca y la p esencia de una alteración transitoria puede proporcionar el sustrato necesario para que se desencadene una entrada, una actividad "triggered" o un automatismo anormal. El impacto fisiológico de una determina- da arritmia dependerá de su duración, respuesta ventricular y de la enfermedad cardiaca subyacente. El manejo óptimo de las arritmias en el paciente anestesia- do está condicionado por el conocimiento de los mecanismos desencadenantes, de los efectos de los fármacos empleados en la anestesia en la electrofisiología cardiaca y de las causas que favorecen las arritmias. El anestesió- logo se enfrenta en el curso perioperatorio a un gran número de problemas relacionados con el estado clínico del paciente y la agresión que presenta el acto quirúrgico. La experiencia en electrocardiografía, así como en el uso de dispositivos específicos (marcapasos, cardioversión, desfibriladores implantables) y el conocimiento de fármacos nuevos de uso intravenoso, junto a su farmacodinamia y farmacocinética, es esencial para el manejo del paciente. El propósito de esta revisión es proporcionar al anestesiólogo una aproximación a los conceptos actuales del diagnóstico y manejo de las arritmias durante la anestesia

Cardiac arrhythmias are a common complication of surgery and anesthesia. They are more likely to occur in patients with heart disease and the presence of a transitory imbalance can supply the underlying substrate fore entry, triggered activity, or abnormal automaticity. The physiologic impact of a given arrhythmia depends on its duration, on ventricular response, and on the underlying cardiac disease. Optimal management of arrhythmias in the anesthetized patient will depend on knowledge of the trigger mechanisms, the effects of anesthetic drugs on cardiac electrophysiology, and situations that favor arrhythmias. The anesthesiologist must cope with a plethora of problems elated to the patient's clinical state and the trauma of surgical manipulation. Experience with electrocardiography and the application of various devices (pacemakers, cardioverters, implantable defibrillators)and knowledge of the pharmacodynamics and pharmacokinetics of new intravenous drugs will be essential for patient management. The purpose of the present review is to provide the anesthesiologist with an overview of current views on the diagnosis and management of arrhythmias during anesthesia

[Late ischemia and carpal tunnel syndrome secondary to catheterization of the radial artery]. / Isquemia tardía y síndrome del túnel del carpo secundarios a cateterización de la arteria radial.

Invasive measurement of blood pressure has many advantages. Although arterial canalization is a low-risk technique of great benefit to the patient, complications must be looked for. We report the case of a man who underwent triple coronary bypass with arterial canalization requiring several punctures to achieve. Two weeks after the procedure the patient showed signs of hand ischemia and acute carpal tunnel syndrome, which evolved favorably after treatment with heparin sodium and prostaglandin E1. We emphasize the importance of an earlier wrist fracture as the predisposing factor for both conditions and the need to examine collateral circulation in the hand and look for carpal tunnel syndrome before canalization.

[Application of the laryngeal mask in pediatric anesthesiology]. / Aplicación de la mascarilla laríngea en anestesia pediátrica.

To analyze problems with inserting, maintaining and removing a laryngeal mask in children, as well as to assess the possible involvement of certain factors (experience with the laryngeal mask, type of anesthesia, duration of surgery, type of surgery, obesity, etc.) in favoring the development of complications. One hundred eighty-nine children undergoing a variety of surgical procedures under general anesthesia were studied; patients with full stomachs and/or a history of hiatus hernia were excluded. The agent used for anesthetic induction and the method of ventilation were chosen by the anesthesiologist responsible for each case. Variables monitored in all patients were continuous ECG, heart rate, systolic and diastolic arterial pressure, capnography, pulse oximetry, airways pressure and respiratory rate. Values were recorded at five times: before induction (T1), immediately after induction (T2), after placement of the laryngeal mask (T3), before removing the laryngeal mask (T4) and after removing the laryngeal mask (T5). Correct insertion was achieved on the first try in 85%. The remaining 15% required 2 or more tries. There were no cases in which a tracheal tube or face mask were required. We found no correlation between type or duration of surgery and the occurrence of complications. Complications were more frequent when the laryngeal mask was placed by inexperienced personnel, when inhalational anesthetics were used for induction and maintenance, and when a No. 1 laryngeal mask was used. Adequate ventilation was provided for the patients who required it with an airways pressure between 8 and 18 cmH2O, arterial oxygen saturation over 98% and end-expiratory CO2 pressure under 35 mmHg. Cardiovascular repercussions were slight and hemodynamic stability was good.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesiology implications of laparoscopic surgery]. / Implicaciones anestésicas de la cirugía laparoscópica.

Laparoscopic surgery is constantly advancing and has produced a small revolution in how surgery is used in a range of abdominal disease. Against the undisputed advantages laparoscopy brings to surgery (shorter hospital stay, rapid return to normal activity, more comfortable postoperative recovery and so on), we must weight its technical and anesthetic limitations, as well as the possibility of associated complications. At this time, appropriate indications for applying this technique in preference to conventional surgery are still in the process of being established. The solution to this very recently posed problem will come as a result of further developments in laparoscopic procedures, greater experience and larger studies of morbidity and mortality. It seems clear that in spite of their advantages, surgical techniques involving minimal abdominal incisions will be the subject of controversy and debate for some time to come.

[Effect of an intravenous nitroglycerin bolus on the hemodynamic impact of laryngoscopy and intubation]. / Efecto de la nitroglicerina intravenosa en bolo sobre la repercusión hemodinámica de la laringoscopia e intubación.

The aim of this study was to evaluate the effectiveness of intravenous administration of a single dose of nitroglycerin in lessening the hemodynamic effects induced during laryngoscopy and tracheal intubation. In an initial subset of 8 patients we verified that the hemodynamic changes after an intravenous dose of 2, 5, or 10 micrograms/kg of nitroglycerin were comparable. The study included 30 patients with a good clinical condition who were anesthetized with fentanyl, thiopental sodium and succinylcholine. They were allocated into two groups of 15 patients according to the intravenous administration or not of 2 micrograms/kg of nitroglycerin after induction of anesthesia. Increase in systolic blood pressure (SBP) and double product (SBP x heart rate) during laryngoscopy and 15, 30, and 45 seconds thereafter was significantly lower in nitroglycerin treated patients than in controls. Increase in diastolic blood pressure was also lower in nitroglycerin treated patients but this difference was only present during laryngoscopy. There were no significant heart rate differences among the two groups of patients. It is concluded that a single intravenous dose of 2 micrograms/kg of nitroglycerin was able to lessen the increase in blood pressure induced by laryngoscopy and tracheal intubation without deleterious effects.

[Massive transfusion: methods and complications]. / Transfusión masiva: métodos y complicaciones.

Massive blood transfusion is a therapeutic procedure increasingly common in anesthesiologic practice. In the present study we reviewed the literature on cellular changes and biochemical abnormalities developing in the blood components during storage. We also reviewed the different methods for infusion and the flow achieved depending on the type of intravenous catheter, infusion system, pressure methods, characteristics of the fluid, and type of filter. We also assessed the pathophysiology of the complications of massive blood transfusion: abnormalities of coagulation, metabolism, oxygen transportation, pulmonary function, hemodynamics and erythrocyte shape, plasma proteins denaturalization, toxicity of plastic products and hypoglycemia.