Pyrrolizidine alkaloids: their occurrence in Spanish honey collected from purple viper's bugloss (Echium spp.).

The incidence and concentration of pyrrolizidine alkaloids (PAs) from Echium spp. plant have been defined in 103 Spanish honey samples. Each sample was examined to determine total pollen content, the percentage of Echium spp. pollen, and simultaneous measurements of PAs and their N-oxides concentrations by the HPLC-ESI/MS method to identify the potential origin of PAs in honey. PAs were found in 94.2% of the raw honey samples analysed, in the range of 1-237 µg kg(-1) (average concentration = 48 µg kg(-1)). The PA pattern was clearly dominated by echimidine, lycopsamine and their N-oxides, representing the 97.8% of total ∑PAs, and only echimidine and echimidine-N-oxide surpassed the 87% of total ∑PA content. Others PAs, seneciphylline and heliotrine-N-oxide, appear to be reported in a lower incidence and concentration (average of 3 and 1 µg kg(-1), respectively). The Pearson Chi-squared test (p ≤ 0.01) confirms the non-correspondence between pollen plants and PA content. This study was also realised to generate a dataset in order to evaluate the potential risk of Spanish honeys containing PA plants belonging to the genera Echium.

Monitorización continua de la saturación de oxígeno de la hemoglobina en la sange venosa mixta durante la anestesia torácia con ventilación selectiva unipulmonar

Objetivos. El decúbito lateral, la toracotomía y la ventilación selectiva unipulmonar producen graves alteraciones de la oxigenación. El objeto del estudio es examinar la utilidad de la monitorizaciónc continua de la saturación venosa mixta (SvO2) en condiciones especiales. Pacientes y Método. A 23 pacientes programados para reseción pulmonar mediante toracotomía en posición de cúbito lateral con ventilación unipulmonar, se les monitorizó continuamente la SvO2 mediante un sistema de oximetría de reflexión y un catéter de arteria pulmonar de fibra óptica (Abbott Oximetris 3). Se obtuvieron perfiles cardiorespiratoriosa los 15 min. de la inducción (M1), 15 min del decúbito lateral (M2), 5 min de la pleurotomía (M3), a los 5 min (M4) y 20 min (M5) del colapso pulmonar, 5 min del cierre de la pared torácica (M6) y 5 min del decúbito supino (M7). La SVO2 desciende de manera no estadísticamente signoficativa y alcanza su valor mínimo en M5, experimentando un ascenso significativo en M6 (p<0.05). Se encuentra una correlación significativa en todas la mediciones entre los valores de la SVO2 medicos con Oximetrix3 y cooxímetro. Con las C(a-v)O2 y EO2 existe correlación significativa en todas las mediciones con la PV=2 y Qva/Qt, excepto en la M6. el IVO2 presenta correlación inversa de M1 a M5 y el IC directa sólo emn M6 y M7, como el IDO2. Con la PaO2 y SaO2 hay correlación significativa durante la ventilación pulmonar (M4 y M5) y posteriormente M6. Los cambios combinados en la SaO2 el IC sólo explican los cambios en la SVO2 durante la ventilación selectiva y después de ésta y más probable que reflejan cambios en la SAO2 que en la IC. Conclusiones. En las condiciones del estudio, la monitorización continua con SVO2 es un método fiable que indica primariamente la oxigenación y secundariamente el GC, en especial durante la ventilación unipulmonar, y refleja el balance aporte/demanda de oxígeno de los tejidos perfundidos. Pero dada su falta de especificidad, ante un descenso brusco de sus valores, se realizarán determinaciones hemodinámicas y gasimétricas para diagnosticar la causa de la alteración de dicho balance aporte/demanda

[Effect of propofol on oxygenation and the pulmonary short-circuit during single-lung ventilation]. / Efecto del propofol sobre la oxigenación y el cortocircuito pulmonar durante la ventilación a un solo pulmón.

OBJECTIVES: To determine the effect of propofol on pulmonary short circuit or shunt (Qs/Qt). PATIENTS AND METHODS: Nine patients undergoing scheduled thoracic surgery with single lung ventilation were studied. All patients were anesthesized with 2 mg/kg propofol followed by a continuous infusion of 4-6 mg/kg/h; fentanyl 0.3 mg followed by bolus as needed; and relaxed with atracurium 0.5 mg/kg followed by bolus of 0.1-0.2 mg/kg as needed. The ratio Qs/Qt was calculated with an FiO2 of 1 and patients in lateral decubitus. RESULTS: During double-lung ventilation Qs/Qt was 17.4 +/- 5.4% and PO2 was 430 +/- 16 mmHg, while shunt increased to 27.8 +/- 8.4% and PO2 decreased to 258 +/- 127 mmHg during single-lung ventilation. Change was significant in both cases. CONCLUSIONS: Continuous infusion of propofol produces a significant increase of Qs/Qt and a significant decrease of PaO2 during single-lung ventilation for thoracic surgery.

[Comparison of oxygen saturations in mixed venous and central blood during thoracic anesthesia with selective single-lung ventilation]. / Comparición de las saturaciones de oxígeno en sangre venosa mixta y central durante la anestesia torácica con ventilación selectiva unipulmonar.

OBJECTIVES: To establish the ratio of oxygen saturation in mixed venous to that of central venous blood in patients undergoing thoracic surgery, in order to rationalize use of the pulmonary arterial catheter. MATERIAL AND METHODS: We compared simultaneous spectrophotometric in vivo measurements for SvO2 [Abbott Oximetrix 3/SvO2 (O)] and in vitro analysis of blood taken from the distal opening of the catheter (co-oximeter/SvO2 [CO]), with in vitro analysis of central venous blood from the superior vena cava (co-oximetry/SvcO2 [CO]) for 23 patients scheduled for lung resection by thoracotomy in lateral decubitus with single lung ventilation and the same type of monitoring and anesthesia. Measurements were taken 15 min after induction (M1), after 15 minutes in lateral decubitus (M2), 5 minutes after pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6) and after 5 min supine (M7). RESULTS: SvO2(O) was higher than SvcO2 (CO) at M1, M3, M6 and M7 and the mean difference between the two concentrations was always less than 0.9%. SvcO2 (CO) was always higher than SvO2 (CO) (M1 to M7) and the mean difference was less than 1.3%. Simple linear correlation was significant (p < 0.001) for each of the measurements as well as for the whole sample. Both bias (0.2 and 0.7%) and its standard deviation (2.7 and 2.5%) between the two techniques were small and the differences between all measurements were less than 5% in 97 and 95.6%. CONCLUSION: For thoracic anesthesia in patients who are not good candidates for catheterization of the pulmonary artery, continuous measurement of SvO2 may be substituted for that of SvcO2 in order to monitor the balance of supply/demand.

[Comparative analysis of the criteria for surveillance and monitoring in anesthesia, resuscitation and pain therapy. Recommendation of the Sociedad Española de Anestesia y Reanimación]. / Análisis comparativo de los criterios de vigilancia y monitorización en anestesia, reanimación y terapia del dolor. Recomendaciones de la SEDAR.

INTRODUCTION: One part of morbidity and mortality associated with anesthesia is due to accidents. It is thought that an additional monitoring can prevent and avoid most of anesthetic accidents. OBJECTIVES: In order to improve patient's safety and quality of anesthesia, Harvard University hospital approved in 1985 the rules for intraoperative monitoring. These were adopted by the American Society of Anesthesiologists (ASA) in 1986. In line with this procedure, professional associations of several countries pronounced their own rules. SEDAR did it in 1989. The purpose of this study was to compare spanish rules with those of America (Harvard and ASA), Australia, England and France. RESULTS: Comparative analysis revealed that the spanish norms are more extensive since they include not only the intraoperative anesthetic activities, but also those related to recovery, pain, and obstetric anesthesia. However, it has some deficiencies such as the lack of a periodical revision, and of an adaptative period and assistance to the anesthesiologist provided by auxiliary personnel. Successful points were the recognition that pulse oximetry is essential, the preoperative verification of all material, and, more importantly, is the only one that considers essential capnography in the assessment of ventilation and pulse oximetry during regional anesthesia and postoperative phase. CONCLUSION: Spanish norm is comparable to that of the other countries considered in this study. It shows important successful points and at the same time some significant deficiencies.

Cardiovascular and respiratory complications after elective supratentorial craniotomy.

The cardiovascular and respiratory complications and their treatment during the immediate postoperative period in the intensive care unit (ICU) are analyzed in 145 consecutive cases of supratentorial craniotomy. In this series, 87.5% of the patients remained in the unit less than 48 hours. In all, 67 cardiovascular disorders were observed in 49 subjects (33.7%). Supraventricular tachycardia, arterial hypotension and hypertension were, in order of frequency, the most common hemodynamic alterations. Fifty percent of the arterial hypertensions were treated with vasodilators. The etiological cause of hypotension was hypovolemia in 66.6% of the cases. Extubation was not performed in the operating room in 17.93% of the subjects, and seven patients in which it was had to be reintubated. The stay in the ICU was longer for those intubated (3.03 +/- 0.77 days). Mortality was 2.06%.