[Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department]. / Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias.

OBJECTIVE: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). METHODS: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). RESULTS: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. CONCLUSIONS: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

[Adjuvant methadone or fentanyl in spinal anesthesia with bupivacaine: a randomized, double-blind, placebo-controlled trial]. / Metadona frente a fentanilo como adyuvante en anestesia subaracnoidea con bupivacaína. Estudio doble ciego, controlado con placebo, comparativo, aleatorizado.

OBJECTIVE: To compare the effect of combining spinal bupivacaine with either of 2 lipophilic opioids (fentanyl or methadone), testing the hypothesis that methadone would give longer-lasting analgesia. METHODS: Randomized, double-blind, placebo-controlled trial enrolling 69 women undergoing vaginal hysterectomy under spinal anesthesia (13 mg of 0.5% bupivacaine). The patients were randomized to 3 groups for use of different adjuvants: normal saline (placebo), 15 µg [DOSAGE ERROR CORRECTED] of fentanyl, or 3 mg of methadone. The main outcome was duration of analgesic effect measured as time elapsing until need for the first analgesic dose. The characteristics of the spinal blocks and adverse events were secondary outcome variables. RESULTS: Methadone significantly prolonged the duration of analgesia in comparison with the other adjuvants; with methadone, the effect was 1.9 times longer than in the placebo group and 1.5 times longer than in the fentanyl group. Duration of the sensory-motor block was significantly shorter in the methadone group (mean difference, 30 minutes). No differences in the incidences of adverse events were observed between the 2 opioid groups. No signs or symptoms suggestive of direct neurologic toxic effects were observed. CONCLUSIONS: The addition of methadone to bupivacaine significantly prolonged the postoperative analgesic effect of spinal anesthesia and shortened sensory-motor block duration, enhancing patient comfort after surgery.

[Subarachnoid anesthesia in the repair of urinary stress incontinence using a Burch-type colposuspension by means of extraperitoneal laparoscopy]. / Anestesia subaracnoidea en la reparación de la incontinencia urinaria al esfuerzo mediante la colposuspensión tipo Burch por laparoscopia extraperitoneal.

UNLABELLED: Extraperitoneal laparoscopy does not lead to increased intra-abdominal pressure, meaning that the mainly respiratory physiological changes that develop derive from CO2 absorption from the extraperitoneal cavity that is created. Therefore, subarachnoid anesthesia might possibly be appropriate for this type of procedure. OBJECTIVE: To assess the efficacy of subarachnoid anesthesia for correcting urinary incontinence by extraperitoneal Burch laparoscopic colposuspension. PATIENTS AND METHODS: Six consecutive patients undergoing extraperitoneal Burch laparoscopic colposuspension under intradural anesthesia. A lateral decubitus puncture was made and 12 mg of 0.5% hyperbaric bupivacaine was infused with 20 micrograms of fentanyl. We monitored hemodynamic variables, end-tidal CO2 and respiratory frequency. Complications occurring during surgery and recovery were recorded. RESULTS: Four patients presented intraperitoneal CO2 leaks upon insufflation of the extraperitoneal cavity, with dyspnea and chest-shoulder pain in addition to anxiety and agitation, such that general anesthesia had to be provided. Subcutaneous emphysema was observed to the cervical zone after surgery but discharge was not delayed. The study was halted in view of the results obtained. CONCLUSION: Subarachnoid anesthesia was not effective for extraperitoneal Burch laparoscopic colposuspension because of the impossibility of alleviating discomfort from intraperitoneal leakage and subcutaneous emphysema that can develop during the procedure.

[Isobaric 2% lidocaine in continuous subarachnoid anesthesia using microcatheters]. / Lidocaína isobárica al 2% en anestesia subaracnoidea continua con microcatéteres.

The objective in the study of the clinical effect of isobaric 2% lidocaine for continuous spinal anesthesia with a microcatheter technique. Nine consecutive patients undergoing lower abdominal surgery under spinal anesthesia were enrolled. We inserted 27 G catheters through 22 G Sprotte (Intralong) needles to administer 20 mg of isobaric 2% lidocaine followed by successive doses of 10 mg until the required level of anesthesia was reached. Repeated injections of 10 mg were given during surgery whenever the level of anesthesia fell as much as one metamere, possibly permitting pain to appear. We recorded hemodynamic variables, level of anesthesia and motor block, as well as complications during and after surgery. The technique was used with nine patients, for whom the mean presurgical dose was 32.3 +/- 9.2 mg and the mean total dose was 51.3 +/- 25.3 mg. However, the protocol for administering the local anesthetic was suspended in three patients due to difficulty in maintaining the achieved level of anesthesia, as repeated injections were required, with consequent patient discomfort. In these patients relatively high levels of blockade were required and surgery lasted longer than one hour. The protocol followed with isobaric 2% lidocaine was not effective for continuous spinal anesthesia with microcatheters because of difficulty of maintaining level of anesthesia.

[Effectiveness of isobaric 0.5% bupivacaine and 5% lidocaine in continuous subarachnoid anesthesia with microcatheters]. / Eficacia de la bupivacaína al 0,5% y lidocaína al 5% isobaras en anestesia subaracnoidea continua con microcatéteres.

OBJECTIVES: To study the clinical effect of two isobaric local anesthetics infused through microcatheters for continuous subarachnoid anesthesia. MATERIAL AND METHODS: Patients undergoing surgery under continuous subarachnoid anesthesia were enrolled prospectively over 12 months. Twenty-seven-gage catheters were inserted through 22 G Sprotte (Intralong) needles. The two isobaric anesthetics (0.5% bupivacaine and 5% lidocaine) were studied in two successive six-month periods. One milliliter of local anesthetic was administered, followed by incremental doses of 0.5 ml until the required anesthetic level was reached. Hemodynamic variables were recorded, as were levels of anesthetic and motor blockade and complications developing during the surgical and postoperative periods. RESULTS: Thirty-one patients were anesthetized with isobaric 0.5% bupivacaine and 40 with isobaric 5% lidocaine. A high blockade was observed in three patients in the bupivacaine group and in 15 in the bupivacaine group (p < 0.05). The highest anesthetic level reached was T4. Hypotension occurred in one patient in the bupivacaine group and in 10 in the lidocaine group (p < 0.05). Blockade was difficult to increase to the appropriate level in 11 lidocaine patients and in one bupivacaine patient, whereas blockade of distal roots was difficult in 13 bupivacaine patients and in 7 lidocaine patients (p < 0.005). The total doses infused were 11.0 +/- 3.0 mg of 0.5% bupivacaine and 95.6 +/- 24.6 mg of 5% lidocaine. CONCLUSIONS: Isobaric 0.5% bupivacaine provides a more predictable anesthetic blockade with greater hemodynamic stability and a lower rate of difficulty in raising the level of blockade than does 5% lidocaine when administered through microcatheters for continuous subarachnoid anesthesia.

[Single metastasis of renal adenocarcinoma in contralateral adrenal gland]. / Metástasis única de adenocarcinoma renal en suprarrenal contralateral.

Presentation of a 63-year old female patient with single metastasis in right suprarenal gland from a simultaneous contralateral renal adenocarcinoma. The approach used was left nephrectomy and right suprarenalectomy. Two years after surgery, the patient is alive and shows no evidence of relapse. The extreme rarity of this finding is emphasized, and clinical, diagnostic, therapeutic and prognostic aspects are commented after reviewing the relevant literature.

[Thrombosis of intrathoracic veins. A complication of venous catheterization for temporary hemodialysis]. / Trombosis de las venas intratorácicas. Una complicación de la cateterización venosa para hemodiálisis temporal.

Venous thrombosis of large vessels is a common complication, generally asymptomatic, that may occur during central venous catheterization for temporal hemodialysis. We report 2 cases of intrathoracic venous thrombosis which were suspected because of the difficulties occurring during catheterization of a new venous approach during dialysis. Both cases were diagnosed by angiography.

[Comparison of intramuscular and intranasal premedication with midazolam in children]. / Comparación de la premedicación con midazolam por vía intramuscular o intranasal en niños.

The study involved 40 children ASA I to II type who were randomly divided into two groups of 20 patients with comparable age and sex profile. Premedication consisting of 0.2 mg/kg of midazolam (Dormicum, Roche) and 0.015 mg/kg of atropine was administered 30 to 40 min before surgical intervention by intramuscular way in one group and by intranasal in the other one. In the operating room a peripheral vein was cannulated and general anesthesia was induced with thiopental sodium and succinylcholine. Arterial blood oxygen saturation, heart rate, arterial blood pressure and respiratory rate were measured at baseline, beginning of sedation (closing eyes), and arrival at the operating room. The time at the onset of sedation, the degree of sedation at the operating room, and the reaction to the venopuncture were also measured. In both groups of patients heart rate and systolic arterial blood pressure measured at the arrival to the operating room were significantly higher than those recorded at baseline and at the onset of sedation. Diastolic blood pressure in patients with intranasal premedication increased on arrival to the operating room with respect to the sedation values. Arterial oxygen saturation significantly decreased from the baseline values in both groups at the onset of sedation and on arrival at the operating room. There were no significant changes in respiratory rate. None of the alterations had clinical consequences. There were no significant differences in the onset of sedation (12.42 +/- 4.07 min in the intramuscular group and 15.26 +/- 7.99 min in the intranasal administration), degree of sedation and response to venopunction in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of anesthesia with thiopental or etomidate in short duration operations]. / Comparación de la anestesia con tiopental o etomidato en intervenciones de corta duración.

Forty ASA I-II women who were scheduled for uterine curettage were randomly allotted to two groups of 20 patients each. Both groups were age- and weight- matched. They were pre-treated with atropine (0.01 mg/kg) and diazepam (0.1 mg/kg). Anesthesia was induced with 2.5% thiopental (5 mg/kg) or 0.1% etomidate (0.3 mg/kg) and was maintained with N2/O2 at 50% and isoflurane at 1% adding supplementation doses of inducer (20% of initial dose) when required. Quality of induction and maintenance of anesthesia, cardiovascular effects, secondary effects and quality and rapidity of awakening were evaluated. Etomidate patients presented a higher number of secondary effects and pain on injection of the drug (p less than 0.05) and occurrence of excitatory motions (p less than 0.01) attained statistical significance. Evaluation of anesthesia quality was significantly higher with thiopental (p less than 0.05). There were no differences with respect to the remaining studied variables. We conclude that etomidate when used as unique agent in anesthesia induction has no advantages over thiopental in healthy patients undergoing short duration operations.

[Variations in the internal pressure of the pneumatic cuffs of endotracheal tubes according to their contents and the anesthetic mixtures used. Experimental study]. / Variaciones de la presión interna de los neumotaponamientos de los tubos endotraqueales según su contenido y las mezclas anestésicas utilizadas. Estudio experimental.

With the purpose of measuring pressure changes in the pneumatic cuffs of endotracheal tubes when the composition of the mixture of gases used for ventilation had to change for the same content, we designed a model of artificial respiration that consisted of a tube with a low pressure pneumatic cuff measuring 8.5 mm in inner diameter introduced in a replica of a human trachea, adjusted to two anesthetic bags. The cuff valve was connected to a pressure transducer by a three-ended stopcock and, after aspiration of its content, it was inflated with air, saline or nitrous oxide and oxygen at 60% up to a basal pressure of 20 mmHg. The tube was connected to a respirator adjusted to inflate 10 l/min at a rate of 15 insufflations/min of: oxygen 100% for 5 minutes, then nitrous oxide and oxygen at 60% for 30 minutes and oxygen 100% again for 15 minutes. When inflating the pneumatic cuff with air and ventilating with nitrous oxide and oxygen at 60%, its pressure reached a maximum mean value of 58 mmHg (190% with respect to base values). When insufflating with saline and ventilating in the same conditions, pressure reached a maximum mean value of 33 mmHg (65% with respect to base values). When the pneumatic cuff was inflated with nitrous oxide and oxygen at 60%, important changes in pressure were observed when the characteristics of the inspired gases were modified. We conclude that some method for monitoring pneumatic cuff pressure should be systematized.