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Disección coronaria espontánea en el servicio de reanimación. A propósito de un caso 在复苏服务中自发冠状动脉解剖。关于一个案例
Pub Date : 2021-07-19 DOI: 10.24875/raa.21000004
Jonatan Vargas-Caño, Haizea Montes-Hijosa, Raquel Crespo Sainz-Aja, Karmelo Intxaurraga-Fernández
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引用次数: 0
Relación entre la viscosidad sanguínea y la perfusión tisular 血液粘度与组织灌注的关系
Pub Date : 2020-10-08 DOI: 10.24875/raa.20000016
D. Cerutti, J. Fernández, I. Schein
Background: Hemorrhagic shock is one of the leading causes of death in the surgical and polytraumatized patient. The central goal: Of every reanimation maneuvers is to bring oxygen to the cells, requiring an adequate management of macro and micro hemodynamic variables. The blood viscosity, one of these variables, plays a very important role. Methods: An experimental study was carried out with 10 pigs which were randomly divided in two groups. Both groups were exanguinated to a 70% of their blood volume. In the first group, named Group H, the fluid reposition was made with HES, while in the second group, named Group S, was made with autologous blood. Hourly assessment of macro and micro hemodynamic variables, and plasmatic viscosity, was carried out for six hours. Results: The results obtained were individually analyzed. Lactate, central venous oxygen saturation and bases exces values were taken to measure tissue perfusion. These values were reflected in tables and figures, and were analyzed together with the viscosity of the swine blood. Conclusions: On the basis of the results of ours measurements we can infer that the tissue perfusion was better when the maintenance of plasmatic and, secondarily, blood viscosity values were prioritize over the hematocrit level. However more studies are needed to confirm this theory.
背景:失血性休克是外科和多发创伤患者死亡的主要原因之一。中心目标:每一次复苏操作都是为了给细胞提供氧气,这需要对宏观和微观血液动力学变量进行适当的管理。血液粘度,这些变量之一,起着非常重要的作用。方法:选用10头猪,随机分为2组进行试验研究。两组都被检查到70%的血容量。第一组(H组)采用HES置换液,第二组(S组)采用自体血置换液。每小时评估宏观和微观血流动力学变量和血浆粘度,持续6小时。结果:分别对所得结果进行分析。取乳酸、中心静脉血氧饱和度及基准值测量组织灌注。这些数值以表格和图表的形式反映出来,并与猪血的粘度一起进行分析。结论:根据我们的测量结果,我们可以推断,当血浆和血液粘度值的维持优先于红细胞压积水平时,组织灌注更好。然而,需要更多的研究来证实这一理论。
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引用次数: 0
Satisfacción de la recuperación anestésica postoperatoria por la escala de Iowa 爱荷华州术后麻醉恢复满意度量表
Pub Date : 2020-10-08 DOI: 10.24875/raa.20000041
I. Cordero-escobar, Aymé González-Torrero, G. Pérez-Martínez
Introduction: The quality of assistance is generally evaluated based on the results and has well-defined standards. Objective: To determine the degree of satisfaction recovery anesthetic, according to the Iowa Scale. Methods : A descrip-tive, cross-sectional study was conducted to assess the satisfaction of patients in the postoperative period after receiving an anesthetic procedure, electively. 791 patients were surveyed with the Iowa Scale. Results : The age group prevailed between 29 and 39 years (38%), the male sex (63%) and the physical state ASA II (63%). The most frequent surgical procedures were those of General Surgery (35%), the surgical time between 60-120 minutes in 48%. The most common anesthetic technique was general anesthesia 56%. There were no intraoperative complications in 85% and post-anesthe-sia were tremors in 27% of the total. The average score on the Iowa Scale according to patient satisfaction was 4.05 ± 0.75, 5.75 ± 1.25 and 7.15 ± 1.70 and its correlation with satisfaction was low, moderate and high respectively. Conclusions: incluían aspectos multidimensionales, ni incluían ningún tipo de proceso de exploración psicométrica y que la gran mayoría de los estudios relaciona-dos con la anestesia no utiliza herramientas validadas A high degree of satisfaction with the anesthetic recovery was observed, which was verified electively. The value of the Iowa Scale score, specifically measured the correlation between numerical value and the high degree of satisfaction of anesthetic recovery.
导言:援助的质量通常是根据结果来评估的,并且有明确的标准。目的:根据爱荷华量表测定恢复麻醉的满意度。方法:采用描述性横断面研究,对选择性接受麻醉手术后患者的术后满意度进行评估。采用爱荷华量表对791例患者进行调查。结果:年龄以29 ~ 39岁为主(38%),男性占63%,ASA II型占63%。最常见的外科手术是普通外科(35%),手术时间在60-120分钟之间的占48%。最常见的麻醉方式是全身麻醉,占56%。术中无并发症占85%,麻醉后震颤占27%。患者满意度的爱荷华量表平均得分为4.05±0.75、5.75±1.25和7.15±1.70,与满意度的相关程度分别为低、中、高。结论:incluían各方面多维度分析,incluían ningún过程分析,exploración psicomactrica y que la gran, mayoría麻醉过程分析,麻醉恢复满意程度高,麻醉恢复满意程度高,可选择性验证。爱荷华量表得分的数值,具体衡量数值与麻醉恢复的高满意度之间的相关性。
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引用次数: 1
Experiencia clínica con el uso de la mascarilla laríngea Ambu® AuraGain™ en situaciones avanzadas 有在高级情况下使用Ambu®AuraGain™喉部口罩的临床经验
Pub Date : 2019-11-19 DOI: 10.24875/raa.19000023
Elisa Díez-Castillo, Unai Ortega-Mera, Ó. González-Larrocha, María San-Juan-González, Luis F Ortega-Largo, Alba Fernández-Fernández-de Quincoces, S. López-Álvarez
Objective: Efficacy of the advanced use of the Ambu® AuraGainTM laryngeal mask airway (LMA) in a sample of 92 surgery patients. Method: Descriptive and prospective study. The inclusion criteria were classically named as advanced use of LMA: obesity, laparoscopic surgery, surgery of two or more hours and different positions from the supine position, excluding patients with risk of aspiration and/or limited oral opening (inter-incisor distance ≤ 3 cm). The degree of difficulty in device placement,
目的:探讨Ambu®AuraGainTM喉罩通气(LMA)在92例外科手术患者中的应用效果。方法:描述性和前瞻性研究。纳入标准被经典地命名为LMA的晚期使用:肥胖、腹腔镜手术、手术时间2小时及以上、与仰卧位不同的体位,排除有误吸风险和/或口腔开放受限(切牙间距离≤3cm)的患者。设备放置的困难程度,
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引用次数: 0
Hemólisis masiva intravascular y sepsis: Clostridium perfringens, un patógeno a tener en cuenta 血管内大量溶血和败血症:产气荚膜梭菌,一种需要考虑的病原体
Pub Date : 2019-11-19 DOI: 10.24875/raa.19000026
Alba Fernández-Fernández-de Quincoces, Iraira Ereño-Orbea, S. Telletxea-Benguría, Rubén Álvarez-Álvarez
We describe the case of a 68-year-old diabetic type 2 and hypercholesterolemic woman admitted to our hospital with a clinical frame consistent with acute cholecystitis. During the first hours of admission, an emergency cholecystectomy was performed without incidents, after which she begins with a hemodynamic deterioration, renal and clinical failure compatible with intravascular hemolysis and coagulopathy, of fatal evolution. The patient died 48 h after admission, despite the fact that empirical broad-spectrum antibiotic treatment and the support measures applied were started. Gram-positive bacilli were detected in blood cultures sensitive to the treatment established. Massive hemolysis is a condition caused by Clostridium perfringens, which can be associated with shock and multiple organ failure, as happened in this case. Although it is infrequent, a high index of suspicion and a rapid therapeutic action is very important, since it has a mortality of 70-100%.
我们描述了一个68岁的2型糖尿病和高胆固醇血症妇女入院的临床框架与急性胆囊炎一致。在入院的最初几个小时内,进行了紧急胆囊切除术,没有发生任何事故,之后她开始出现血流动力学恶化、肾脏和临床衰竭,并伴有血管内溶血和凝血病,发展为致命的。患者入院后48 h死亡,尽管开始了经验性广谱抗生素治疗和应用的支持措施。在对所建立的治疗敏感的血液培养中检测到革兰氏阳性杆菌。大量溶血是由产气荚膜梭菌引起的一种疾病,可能与休克和多器官衰竭有关,正如本例所发生的那样。虽然不常见,但高度的怀疑和迅速的治疗行动是非常重要的,因为它的死亡率为70-100%。
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引用次数: 0
Controversias sobre el uso de bloqueadores neuromusculares en el síndrome de insuficiencia respiratoria aguda 神经肌肉阻滞剂在急性呼吸衰竭综合征中的应用争议
Pub Date : 2019-11-19 DOI: 10.24875/raa.19000030
I. Cordero-escobar, Caridad de Dios-Soler-Morejón
Neuromuscular blockers are drugs that are used as a complement to general anesthesia. To update review of the literature on the use of neuromuscular blockers in acute respiratory failure syndrome. The possibility of use in this context has opened a vast field of research. Its prolonged administration has been associated with complications and despite the controversies about its use, in recent years it has been observed that it can be considered an adjuvant drug for the treatment of this syndrome. It is necessary to increase the scientific evidence to guarantee a high safety profile of these drugs as adjuvants in the treatment of acute respiratory failure syndrome before their systematic use can be recommended. In light of current knowledge and the controversy of the subject, the indication of these drugs should be individualized in the critical patient in general and in that with acute respiratory distress syndrome in particular.
神经肌肉阻滞剂是用于全身麻醉的补充药物。对神经肌肉阻滞剂在急性呼吸衰竭综合征中的应用进行文献综述。在这种情况下使用的可能性开辟了一个广阔的研究领域。它的长期使用与并发症有关,尽管对其使用存在争议,但近年来已经观察到它可以被视为治疗该综合征的辅助药物。在推荐系统使用这些药物之前,有必要增加科学证据,以保证这些药物作为辅助治疗急性呼吸衰竭综合征的高度安全性。鉴于目前的知识和该主题的争议,这些药物的适应症应个体化的危重患者,特别是急性呼吸窘迫综合征。
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引用次数: 0
Cuantificación del consumo de gases anestésicos y medicinales después de la implementación de anestesia general a bajo flujo 低流量全身麻醉后麻醉和药用气体消耗量的量化
Pub Date : 2019-11-19 DOI: 10.24875/raa.19000031
M. Ramos, Franco Fratebianchi, J. Lafourcade, Bruno Santoro, María J. Laiño, D. Guardabassi
objetivos: Relevar el consumo de gases anestésicos y medicinales y compararlo de acuerdo a si se utilizó o no anestesia a bajo flujo, asimismo, estimar el consumo de oxígeno si las anestesias generales se hubieran realizado con estaciones de trabajo con concertina. Material y métodos: Se obtuvieron los datos de consumo en diferentes cirugías, comparándose estos con el mismo período del año anterior, momento en el que no se realizaba anestesia a bajo flujo. También se estimó cómo hubiese aumentado el consumo de oxígeno si las mismas cirugías relevadas se hubieran efectuado con una máquina de anestesia con tecnología de concertina. Resultados: La recolección de datos incluyó 59 anestesias generales. La cantidad de anestesias por frasco de sevoflurano aumentó de 12.1 a 18.7 después de la implementación parcial de la técnica de bajo flujo. Se estimó un ahorro de 45,633 l de oxígeno al utilizar pistón. Discusión: La precisión en el aporte de gas fresco y el análisis de gases espirados parece reducir el consumo de agente anestésico. Se halló que la eficiencia en el uso de sevoflurano no es óptima, y que la utilización sistemática de la técnica de bajo flujo aportaría beneficios para el paciente, el medio ambiente, la salud del personal de quirófano y la economía institucional.
目的:记录麻醉和医用气体的消耗,并根据是否使用低流量麻醉进行比较,并估计在手风琴工作站进行全身麻醉时的耗氧量。材料和方法:收集不同手术的消耗数据,并与去年同期进行比较,当时没有进行低流量麻醉。我们还估计,如果使用手风琴技术的麻醉机进行同样的手术,氧气消耗会增加多少。结果:数据收集包括59例全身麻醉。在部分实施低流量技术后,每瓶七氟醚的麻醉量从12.1增加到18.7。据估计,使用活塞节省了45,633升氧气。然而,在大多数情况下,这是不可能的。研究发现,七氟醚的使用效率不是最佳的,系统地使用低通量技术将为患者、环境、手术室工作人员的健康和机构经济带来好处。
{"title":"Cuantificación del consumo de gases anestésicos y medicinales después de la implementación de anestesia general a bajo flujo","authors":"M. Ramos, Franco Fratebianchi, J. Lafourcade, Bruno Santoro, María J. Laiño, D. Guardabassi","doi":"10.24875/raa.19000031","DOIUrl":"https://doi.org/10.24875/raa.19000031","url":null,"abstract":"objetivos: Relevar el consumo de gases anestésicos y medicinales y compararlo de acuerdo a si se utilizó o no anestesia a bajo flujo, asimismo, estimar el consumo de oxígeno si las anestesias generales se hubieran realizado con estaciones de trabajo con concertina. Material y métodos: Se obtuvieron los datos de consumo en diferentes cirugías, comparándose estos con el mismo período del año anterior, momento en el que no se realizaba anestesia a bajo flujo. También se estimó cómo hubiese aumentado el consumo de oxígeno si las mismas cirugías relevadas se hubieran efectuado con una máquina de anestesia con tecnología de concertina. Resultados: La recolección de datos incluyó 59 anestesias generales. La cantidad de anestesias por frasco de sevoflurano aumentó de 12.1 a 18.7 después de la implementación parcial de la técnica de bajo flujo. Se estimó un ahorro de 45,633 l de oxígeno al utilizar pistón. Discusión: La precisión en el aporte de gas fresco y el análisis de gases espirados parece reducir el consumo de agente anestésico. Se halló que la eficiencia en el uso de sevoflurano no es óptima, y que la utilización sistemática de la técnica de bajo flujo aportaría beneficios para el paciente, el medio ambiente, la salud del personal de quirófano y la economía institucional.","PeriodicalId":351025,"journal":{"name":"Revista Argentina de Anestesiologia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133178682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Black esophagus: Necrosis aguda esofágica en paciente con shock hemorrágico 黑食管:出血性休克患者急性食管坏死
Pub Date : 2019-03-14 DOI: 10.24875/RAA.18000012
E. Chicote-Álvarez, María J. Domínguez-Artiga, M. González-Martínez, Álvaro Terán-Lantarón
Acute esophageal necrosis (black esophagus) is an infrequent condition associated with tissue hypoperfusion. The etiology is multifactorial. The treatment consists of treating the triggering situation and keeping the patient nil-per-os. It can present complications such as perforation or esophageal stenosis. It is usually reversible by improving the triggering pathology.
急性食管坏死(黑色食管)是一种罕见的与组织灌注不足相关的疾病。病因是多因素的。治疗包括处理触发情况和保持病人零/ 0。它可以引起并发症,如穿孔或食管狭窄。它通常是可逆的,通过改善触发病理。
{"title":"Black esophagus: Necrosis aguda esofágica en paciente con shock hemorrágico","authors":"E. Chicote-Álvarez, María J. Domínguez-Artiga, M. González-Martínez, Álvaro Terán-Lantarón","doi":"10.24875/RAA.18000012","DOIUrl":"https://doi.org/10.24875/RAA.18000012","url":null,"abstract":"Acute esophageal necrosis (black esophagus) is an infrequent condition associated with tissue hypoperfusion. The etiology is multifactorial. The treatment consists of treating the triggering situation and keeping the patient nil-per-os. It can present complications such as perforation or esophageal stenosis. It is usually reversible by improving the triggering pathology.","PeriodicalId":351025,"journal":{"name":"Revista Argentina de Anestesiologia","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122914324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Manejo anestésico de paciente con enfermedad de Moyamoya sometido a encefaloduroarteriomiosinangiosis 脑硬动脉肌酐血管病变Moyamoya病患者的麻醉处理
Pub Date : 2019-03-14 DOI: 10.24875/RAA.18000008
Ana María Pérez-Muñoz, A. Martínez-Saniger, M. Echevarría-Moreno, I. Jiménez-López
Moyamoya’s disease is an unusual vascular entity with important physiopathological implications. Vascular stenosis in main cerebral arteries causes a loss in self-regulation, with high risk of hypoxia. It generates neovascularization too, that implies a high probability of rupture and intracerebral hemorrhage. One of the most extended therapy is the encephalo-dural–arterial synangiosis. This treatment consists of implanting superficial temporal artery in the cortical region affects. The most appropriate anesthetic technique as well as the strategies to optimize cerebral perfusion are still under discussion. In this article we present our experience with a patient undergoing this procedure under total intravenous anesthesia, with preservation of neurological status after extubation.
烟雾病是一种罕见的血管病,具有重要的生理病理意义。脑主动脉狭窄导致自我调节能力丧失,缺氧风险高。它也会产生新生血管,这意味着破裂和脑出血的可能性很高。最广泛的治疗方法之一是脑-硬膜动脉合并症。这种治疗包括在皮层区植入颞浅动脉。最合适的麻醉技术以及优化脑灌注的策略仍在讨论中。在这篇文章中,我们介绍了我们在全静脉麻醉下进行该手术的患者的经验,拔管后保留了神经系统状态。
{"title":"Manejo anestésico de paciente con enfermedad de Moyamoya sometido a encefaloduroarteriomiosinangiosis","authors":"Ana María Pérez-Muñoz, A. Martínez-Saniger, M. Echevarría-Moreno, I. Jiménez-López","doi":"10.24875/RAA.18000008","DOIUrl":"https://doi.org/10.24875/RAA.18000008","url":null,"abstract":"Moyamoya’s disease is an unusual vascular entity with important physiopathological implications. Vascular stenosis in main cerebral arteries causes a loss in self-regulation, with high risk of hypoxia. It generates neovascularization too, that implies a high probability of rupture and intracerebral hemorrhage. One of the most extended therapy is the encephalo-dural–arterial synangiosis. This treatment consists of implanting superficial temporal artery in the cortical region affects. The most appropriate anesthetic technique as well as the strategies to optimize cerebral perfusion are still under discussion. In this article we present our experience with a patient undergoing this procedure under total intravenous anesthesia, with preservation of neurological status after extubation.","PeriodicalId":351025,"journal":{"name":"Revista Argentina de Anestesiologia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129846327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sangrado tardío por déficit de factor XIII tras citorreducción y quimioterapia intraoperatoria hipertérmica 细胞还原和术中高热化疗后因子XIII缺乏导致晚期出血
Pub Date : 2019-03-14 DOI: 10.24875/RAA.18000017
I. Hernández, L. Soriano, E. Terradillos, P. Piñeiro, Wenceslao Vasquez, P. Duque
{"title":"Sangrado tardío por déficit de factor XIII tras citorreducción y quimioterapia intraoperatoria hipertérmica","authors":"I. Hernández, L. Soriano, E. Terradillos, P. Piñeiro, Wenceslao Vasquez, P. Duque","doi":"10.24875/RAA.18000017","DOIUrl":"https://doi.org/10.24875/RAA.18000017","url":null,"abstract":"","PeriodicalId":351025,"journal":{"name":"Revista Argentina de Anestesiologia","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131102790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Revista Argentina de Anestesiologia
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