Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Encuesta nacional sobre disfunción cognitiva perioperatoria 围手术期认知功能障碍全国调查

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2024.02.004

E.M. Aldana , N. Pérez de Arriba , J.L. Valverde , C. Aldecoa , N. Fábregas , J.L. Fernández-Candil , en representación del grupo de Trabajo de la Sección de Neurociencias

Background

Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population. The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity.

Material and methods

Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR.

Results

544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed.

Conclusions

Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.

背景围术期认知功能障碍（PCD）是一种非常普遍的临床综合征，原因是手术人群逐渐老龄化。我们的研究旨在评估接受调查的西班牙麻醉医师在这一问题上的临床实践。材料和方法由神经科学组进行前瞻性在线调查，并由 SEDAR 发布。54.4%的受访者从未对认知障碍进行过术前评估，仅有 7.5%的受访者经常进行术前评估。79.6%的受访者缺乏针对有 PCD 风险的患者的术中管理方案。在制定麻醉计划时，只有 23.3% 的受访者考虑到了患者的情况。在预防 PCD 方面，89% 的人认为有镇静或无镇静的区域麻醉优于全身麻醉。88.8%的人认为苯二氮卓类药物具有较高的 PCD 风险。71.7%的人认为麻醉深度监测可预防术后认知障碍。对术后谵妄进行常规评估的比例较低，仅为 14%。超过 80% 的人认为 PCD 诊断不足。有必要提高人们对检测 PCD 风险因素以及术后评估和诊断必要性的认识。因此，建议制定相关指南和方案，并实施继续教育计划，让麻醉医师成为负责围术期护理的多学科团队的重要成员。

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引用次数: 0

Sepsis debida a absceso hepático diagnosticada mediante ultrasonidos en la UCI 在重症监护室通过超声波诊断肝脓肿引起的败血症

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.04.003

引用次数: 0

Radiofrecuencia del nervio supraescapular como estrategia analgésica para el dolor crónico de hombro. Revisión sistemática y metaanálisis 肩胛上神经射频治疗作为慢性肩痛的镇痛策略。系统回顾和荟萃分析

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2024.03.004

Introduction

Chronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects.

Methods

We performed a systematic review of clinical trials retrieved from Medline, Embase and the cCentral databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I² test.

Results

We identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of −0.9 (95% CI: −1.1-0.33; P=.29; I² 88%; P<.001) and −1.17 (95% CI: −2.49-0.14; P=.08; I² 97%; P<.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI: −0.91-0.29; P=.31; I² 80%; P<.001) and −1.54 (95% CI: −3.26-0.19; P=.08; I² 98%; P<.001), respectively. No RFS-related adverse events were described.

Conclusion

The evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.

导言：慢性肩痛在普通人群中发病率很高。目前已有许多不同的镇痛策略，包括肩胛上神经射频治疗（RFS）；但是，这种方法的有效性仍不明确，也无法提出有力的建议。本系统性综述旨在分析最新的临床试验，评估应用于肩胛上神经的 RFS 技术在治疗慢性肩痛、术后功能和不良反应方面的有效性。我们纳入了将 RFS 与其他策略（包括安慰剂）进行比较的试验，这些试验的主要结果指标包括视觉模拟量表评定的疼痛、肩痛与残疾指数 (SPADI) 评定的功能以及不良反应的发生率。使用 Cochrane RoB2 工具分析了偏倚风险。使用随机效应模型对证据进行分析，并使用 I2 检验对异质性进行量化。结果我们确定了 3030 项试验，其中 8 项符合纳入标准（n = 408）。其中 7 项存在高偏倚风险。接受RFS治疗的患者在1个月和3个月时的疼痛强度较低，标准化平均差异（SMD）分别为-0.9（95% CI：-1.1-0.33；P=.29；I2 88%；P<；.001）和-1.17（95% CI：-2.49-0.14；P=.08；I2 97%；P<；.001）。接受RFS治疗的患者在1个月和3个月时的功能受损程度有所减轻，SMD分别为-0.31（95% CI：-0.91-0.29；P=.31；I2 80%；P<；.001）和-1.54（95% CI：-3.26-0.19；P=.08；I2 98%；P<；.001）。结论有证据表明，RFS可减轻疼痛并改善功能。然而，证据的确定性较低。

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引用次数: 0

¿Por qué mi máquina de anestesia detecta halotano tras la administración de broncodilatadores? Un dato curioso 为什么我的麻醉机在使用支气管扩张剂后检测到氟烷？一个奇怪的事实

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.05.007

引用次数: 0

Un dolor de bolsillo: prevalencia de dolor en los pacientes con implantación de sistemas de neuromodulación: estudio retrospectivo 袖珍疼痛：植入神经调控系统患者的疼痛发生率：一项回顾性研究。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2024.02.001

Introduction

Implantable pulse generator (IPG) is a neurostimulation therapy mediated by electrodes and surgically implanted in a subcutaneous “pocket” used for the control of numerous pathologies. This study examines both the prevalence of pain associated with IPG implantation (“pain pocket syndrome”) and its associated characteristics.

Materials and methods

56 patients with an IPG were included in the study. A health questionnaire was conducted to determine the presence of pain associated with the pocket and its neuropathic characteristics, as well as associated aesthetic concerns, location, situations that accentuate or alleviate pain, medications used for baseline and pocket pain control and other factors associated.

Results

Pain in the area of implantation of the IPG had a prevalence of 52.6% of patients (n = 27), in our sample, with a mean score on the visual analogic scale (VAS) of 4.9 points [3.9 - 5.8 points], with neuropathic characteristics in 53.3% (n = 16) of the patients with pain, with differences between the mean VAS score of the female (5.5 [4.3 - 5.8 points]) and males (3.5 points [2.1 - 4.9 points]) (P=.04).

Conclusion

Pocket pain is a condition with a higher prevalence than described in previous studies, being of a higher intensity in females, involving a moderate pain in the area of implantation of the neuromodulating therapy. This pain has neuropathic characteristics and could require a repositioning intervention. Hence, more studies in this field should be carried to detect and prevent this syndrome.

导言植入式脉冲发生器（IPG）是一种由电极介导的神经刺激疗法，通过手术植入皮下 "口袋"，用于控制多种病症。本研究探讨了与 IPG 植入相关的疼痛（"口袋疼痛综合征"）的发生率及其相关特征。研究人员进行了健康问卷调查，以确定是否存在与牙槽袋相关的疼痛及其神经病理性特征，以及相关的美学问题、位置、加重或减轻疼痛的情况、用于控制基线和牙槽袋疼痛的药物及其他相关因素。结果在我们的样本中，52.6%的患者（n = 27）在植入 IPG 的区域出现疼痛，视觉模拟量表（VAS）的平均得分为 4.9分[3.9 - 5.8分]，53.3%的疼痛患者（n = 16）具有神经病理性特征，女性（5.5分[4.3 - 5.8分]）和男性（3.5分[2.1 - 4.9分]）的平均VAS评分存在差异（P=.04）。04）。结论口袋痛是一种发病率高于以往研究的病症，女性发病率更高，神经调节疗法植入区域有中度疼痛。这种疼痛具有神经病理性特征，可能需要重新定位干预。因此，应在这一领域开展更多研究，以检测和预防这种综合征。

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引用次数: 0

Perforación traqueal tardía tras tiroidectomía total 甲状腺全切除术后的晚期气管穿孔

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.04.004

引用次数: 0

Oxigenación por membrana extracorpórea veno-arterial (ECMO VA) como parte de un abordaje multimodal para protección de la isquemia medular en la reparación quirúrgica de un aneurisma toracoabdominal 静脉-动脉体外膜氧合（VA ECMO）作为胸腹动脉瘤手术修复中保护脊髓缺血的多模式方法的一部分。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.11.010

F.E. Fernández-Suárez , J.M. López-González , C.M. Fernández-Vallina , V. Cueva-Carril , B.M. Jiménez Gómez , J. García-Menéndez

Spinal cord ischaemia leading to paraplegia or paraparesis is one of the most devastating complications of aortic surgery. The risk of ischaemia is particularly high in repairs involving both the thoracic and abdominal segments, because in these cases blood flow to the spinal arteries can be interrupted.

Multimodal protocols have now been developed to reduce the incidence of this complication, and include measures such as cerebrospinal fluid (CSF) drainage, avoidance of hypotension and anaemia, systemic hypothermia, neuromonitoring, maintaining distal perfusion during proximal clamping of the aorta, and reimplantation of intercostal or lumbar arteries, whenever feasible.

We describe a case in which, due to the special characteristics of the surgery, veno-arterial extracorporeal membrane oxygenation (VA ECMO) was used to maintain distal blood flow in the lumbar, inferior mesenteric, and hypogastric arteries during aortic clamping. This approach reduced the risk of spinal cord and visceral ischaemia, and also eliminated the need for thoracotomy because partial left bypass was not required.

脊髓缺血导致截瘫或瘫痪是主动脉手术最具破坏性的并发症之一。在涉及胸段和腹段的修复手术中，脊髓缺血的风险尤其高，因为在这些情况下，脊髓动脉的血流可能会中断。现在已经制定了多模式方案来降低这种并发症的发生率，其中包括脑脊液引流、避免低血压和贫血、全身低体温、神经监测、在近端夹闭主动脉时保持远端灌注，以及在可行的情况下重新植入肋间动脉或腰动脉等措施。我们描述了一个病例，在该病例中，由于手术的特殊性，在夹闭主动脉时使用了静脉-动脉体外膜氧合（VA ECMO）来维持腰动脉、肠系膜下动脉和胃下动脉的远端血流。这种方法降低了脊髓和内脏缺血的风险，而且由于不需要部分左侧旁路，因此也无需进行开胸手术。

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引用次数: 0

Monitorización del índice biespectral para sedación en colonoscopias electivas de pacientes adultos: ensayo controlado aleatorizado 双频谱指数监测用于成年患者择期结肠镜检查中的镇静剂：随机对照试验

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.12.003

Background

Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy.

Methods

We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and duration of colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction.

Results

Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; P = .02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI: 1.013-1.091; P = .0087) and in men (95% CI: 1.129-7.668; P = .0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups.

Conclusions

Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.

背景在手术室外进行镇静手术时，应对患者进行密切监测，但目前还不清楚哪种监测方式最好。我们研究了 BIS 监测与传统监测在结肠镜检查镇静过程中的有效性和安全性。方法我们对 180 名接受择期结肠镜检查的患者进行了双盲临床试验。患者被随机分为 1) BIS 组或 2) 对照组，对照组分别使用 BIS 监测仪或拉姆塞镇静评分法监测镇静情况。主要结果是两组中镇静引起的不良事件发生率。次要结果是发生不良事件的患者的特征、发生这些事件时结肠镜检查的持续时间、异丙酚和瑞芬太尼的用量以及患者的满意度。结果二元分析显示，BIS 组的心肺并发症较少（41.11% 对对照组的 57.78%；P = 0.02）。多变量分析发现，老年患者（95% CI：1.013-1.091；P = .0087）和男性患者（95% CI：1.129-7.668；P = .0272）发生不良事件的风险明显更高。这些事件都是在肝曲处观察到的。丙泊酚或瑞芬太尼的剂量、抢救药物的使用和患者满意度在组间没有观察到明显差异。虽然在镇静过程中常规使用 BIS 似乎没有必要，但临床医生应采取措施识别并发症风险较高的患者，这些患者可能会从这种监测中获益。

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引用次数: 0

Manejo anestésico de banding de la arteria pulmonar en un paciente adulto con ventrículo único y transposición de grandes arterias no corregida 单心室和大动脉转位未矫正的成年患者肺动脉束带术的麻醉管理

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2023.09.008

Pulmonary artery banding (PAB) is a procedure mainly performed during the neonatal period as an initial stage to definitive palliative reconstruction, a scenario in which the criteria for banding adjustment are well defined. However, the indication for BAP in the adult is extraordinarily rare, even more in patients with single ventricle and unrepaired transposition of the great arteries (TGA), and there are no established criteria for banding adjustment. Due to the small number of these procedures,

there is

limited experience in their anesthetic management and complications.

We describe a case of a 29-year-old patient diagnosed with a cyanotic congenital heart disease of double-inlet left ventricle with TGA and unrepaired mitral stenosis, who underwent to a hybrid procedure of PAB and enlargement of the communication between the two atria.

肺动脉束带术（PAB）主要是在新生儿期进行的一种手术，是最终姑息性重建的初始阶段，在这种情况下，束带调整的标准是非常明确的。然而，在成人中进行 BAP 的适应症极为罕见，在单心室和未修复的大动脉转位（TGA）患者中更是如此，而且也没有既定的束带调整标准。我们描述了一例 29 岁患者的病例，该患者被诊断为紫绀型先天性心脏病，左心室双入口，伴有 TGA 和未修复的二尖瓣狭窄，接受了 PAB 和扩大两个心房之间沟通的混合手术。

引用次数: 0

Estrategia de manejo del dolor agudo posoperatorio en las Unidades de Cirugía Mayor Ambulatoria de España. Proyecto Directorio de Unidades de Cirugía Mayor Ambulatoria 2.0 西班牙大型门诊手术室的术后急性疼痛管理策略。主要门诊手术室目录项目 2.0

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2024.02.005

Introduction

Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain.

Methods

A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country.

Results

We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs.

Conclusions

The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.

导言：充分治疗术后急性疼痛是非卧床手术的质量要求之一，而术后急性疼痛处理不佳与延迟出院、非计划入院和出院后延迟入院有关。本研究的目的是了解西班牙非住院手术室（ASU）术后疼痛管理的组织策略。研究方法通过对我国不同非住院手术室术后急性疼痛管理的相关方面进行电子调查，开展了一项横断面多中心研究。结果我们招募了 133 个非住院手术室，其中 85 个回答了有关术后疼痛管理的问题。在回答问题的 ASU 中，80% 制定了具体的疼痛管理方案，37.6% 提供了有关镇痛计划的术前信息。88.2% 的 ASU 在设施内进行术后疼痛评估，只有 56.5% 的 ASU 在家中进行评估。所有 ASU 都使用多模式镇痛方案，但 68.2% 的 ASU 报告使用阿片类药物治疗中度至重度疼痛。结论 DUCMA 的研究强调，在我国，日间手术中的疼痛治疗仍是一项挑战，而且并不总是与国家指导方针一致。研究结果表明，有必要制定相关策略，以改善日间手术的临床实践并统一疼痛管理。

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引用次数: 0

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