Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Fósforo inorgánico como factor predictivo del síndrome de bajo gasto cardiaco postoperatorio en la cirugía por cardiopatía congénita 无机磷作为先天性心脏病手术中术后低成本心脏综合征的预测因素

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501654

M.A. Murillo-Pozo , A.M. Vázquez-Florido , A. Ortiz-Alvarez , V. Modesto i Alapont , A. González-Calle , E. Sánchez-Valderrábanos

Background and objective

Low cardiac output syndrome (LCOS) is the most common complication after cardiac surgery in children with congenital heart disease (CHD). The aim of this study was to assess the predictive value of serum inorganic phosphorus (SIPL) as an indicator of LCOS in the postoperative period.

Materials and methods

From June 2018 to December 2019, a single-center prospective study was conducted in patients with CHD undergoing surgery who required extracorporeal circulation (ECC). In the postoperative period, patients were divided into group 1 with LCOS and group 2 without LCOS. Blood samples were extracted in pre and postoperative periods. Serial measurements of SIPL, NT-proBNP, troponin T and creatinine were collected and compared between both groups. Multivariate analyses were conducted to identify the risk factors of SBGC.

Results

A total of 97 patients were included, with 31 in group 1 and 66 in group 2. There was an increment of SIPL which peaked at the 8-hour postsurgery (5.3 mg/dL, 4.6-5.8). Postoperative median SIPL in the group 1 were significantly higher than in the group 2. All consecutive SIPL measurements also were significantly higher in group 1. Changes in SIPL over time approached statistical significance (P < .001). Logistic regression analyses indicated that ECC (OR: 1.01; 95% CI: 0,9-1.01), SIPL (OR: 1.02; 95% CI: 1-1.04), NT-ProBNP (OR: 1; 95% CI; 1-1.0) were the independent risk factors of LCOS.

Conclusions

The increase in SIPL was more pronounced in LCOS group 1. SIPL emerged as a new predictive risk factors of LCOS.

背景与目的低心输出量综合征（LCOS）是先天性心脏病（CHD）患儿心脏手术后最常见的并发症。本研究的目的是评估血清无机磷（SIPL）作为LCOS术后指标的预测价值。材料与方法2018年6月至2019年12月，在需要体外循环（ECC）的冠心病手术患者中进行了一项单中心前瞻性研究。术后将患者分为有LCOS的1组和无LCOS的2组。分别于术前和术后抽取血样。收集并比较两组间SIPL、NT-proBNP、肌钙蛋白T和肌酐的连续测量结果。进行多因素分析以确定SBGC的危险因素。结果共纳入97例患者，其中1组31例，2组66例。SIPL在术后8小时达到峰值（5.3 mg/dL, 4.6 ~ 5.8）。组1术后中位SIPL明显高于组2。1组所有连续SIPL测量值也显著升高。SIPL随时间的变化接近统计学意义(P <；措施)。Logistic回归分析表明，ECC (OR: 1.01；95% ci: 0,9-1.01)，单一(or: 1.02；95% CI: 1-1.04), NT-ProBNP (OR: 1；95%可信区间;1 ~ 1.0)为LCOS的独立危险因素。结论LCOS 1组SIPL升高更为明显。SIPL作为LCOS新的预测危险因素出现。

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引用次数: 0

Manejo anestésico perioperatorio y desenlaces posquirúrgicos de pacientes tratados con radiocirugía robótica CyberKnife® CyberKnife®机器人放射手术治疗患者的术后和术后麻醉管理

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501652

D. Gallego González , S. Ramírez Pulgarín , K. Marisancén Carrasquilla , Y.A. Colina Vargas , C. Vera Marín , L.F. Botero Posada

Background and objective

The CyberKnife® is a robotic stereotactic radiosurgery system designed for non-invasive treatment of tumor lesions. Some of these procedures are performed under sedation or general anesthesia, depending on the patient and the lesion being treated. The objective of this study is to describe the anesthetic management and postoperative outcomes of patients treated with CyberKnife® radiosurgery at a reference center for neurosurgery in the city of Medellín, Colombia.

Methods

A descriptive, retrospective study was conducted on patients treated with CyberKnife® under sedation or general anesthesia between 2012 and 2022.

Results

75 patients were included, 56% of whom were female, with a median age of 59 years, primarily operated on for uveal melanomas (40%) and other tumor pathologies of the central nervous system; most frequently scheduled for a total of 5 radiosurgery sessions (66,7%), on an outpatient basis in 96% of cases. The main anesthetic technique used was balanced general anesthesia (76%) with sevoflurane, propofol, lidocaine, fentanyl. Neuromuscular relaxation was used in 58,7% of patients. Airway management was performed with a laryngeal mask in most cases (64%). The main minor side effects or complications identified were postoperative headache (22,7%), followed by intraoperative hypotension (18,7%) and bradycardia (16%). No major complications associated with anesthetic management were reported.

Conclusions

Balanced general anesthesia with neuromuscular relaxation was the main anesthetic technique used for CyberKnife® radiosurgery. Despite the logistical difficulties in this type of procedure, no major complications during the perioperative period were found.

背景和目的CyberKnife®是一种机器人立体定向放射外科系统，专为非侵入性治疗肿瘤病变而设计。其中一些手术是在镇静或全身麻醉下进行的，这取决于患者和正在治疗的病变。本研究的目的是描述在哥伦比亚Medellín市神经外科参考中心接受射波刀放射手术治疗的患者的麻醉管理和术后结果。方法对2012年至2022年在镇静或全身麻醉下使用射波刀的患者进行描述性、回顾性研究。结果纳入75例患者，56%为女性，中位年龄59岁，主要手术治疗葡萄膜黑色素瘤（40%）及其他中枢神经系统肿瘤病理；最常见的安排是总共5次放射手术（66.7%），96%的病例是门诊。主要麻醉方式为七氟醚、异丙酚、利多卡因、芬太尼平衡全麻（76%）。58.7%的患者使用神经肌肉松弛术。大多数病例（64%）使用喉罩进行气道管理。确定的主要轻微副作用或并发症是术后头痛（22.7%），其次是术中低血压（18.7%）和心动过缓（16%）。无与麻醉管理相关的主要并发症报道。结论平衡全身麻醉配合神经肌肉松弛是射波刀放射外科手术的主要麻醉技术。尽管在这种类型的程序后勤困难，围手术期没有发现重大并发症。

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引用次数: 0

Patient Blood Management: una visión conceptual y de análisis desde el liderazgo en España 患者血液管理：来自西班牙领导的概念性和分析观点

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501650

E. Méndez-Arias , A. Abad-Motos , M. Barquero-López , R. Delestal-Aldaria , Á.M. Muñoz de Solano Palacios , A. Pajares , S. Aguilar López , I. Fornet , M. Quintana-Díaz , G. Yanes , M.J. Colomina

The evolution of blood saving programs to Patient Blood Management (PBM) represents a broader and more comprehensive approach to optimize the use of the patient's own blood, thus improving clinical outcomes and minimizing the risks associated with allogeneic blood transfusion with a holistic view of socio-economic sustainability.

Implementing the strategies of the three PBM pillars in any hospital center involves a transversal change throughout the organization in which it can be very useful to apply the strategy defined by Kotter at the business level for change management.

The support of renowned institutions such as the World Health Organization and the European Commission demonstrates the importance and urgency of implementing PBM programs, setting guidelines at an international level and supporting the adoption of effective strategies in the management of blood transfusion at a national and institutional level.

In Spain, we need to have health managers at both the Hospital Management level and the Regional Health Services and/or Ministry of Health that provide the necessary resources for its proper implementation in the health system from primary care to hospital care and also the resources for the timely evaluation of the results.

从血液保存项目到患者血液管理（PBM）的发展代表了一种更广泛、更全面的方法来优化患者自身血液的使用，从而改善临床结果，并将与异体输血相关的风险降至最低，同时具有社会经济可持续性的整体观点。在任何医院中心实施三个PBM支柱的战略都涉及到整个组织的横向变革，在这种情况下，将Kotter在业务层面定义的战略应用于变革管理非常有用。世界卫生组织和欧洲委员会等知名机构的支持表明了实施PBM计划的重要性和紧迫性，在国际层面制定指导方针，并支持在国家和机构层面采用有效的输血管理战略。在西班牙，我们需要在医院管理层面和地区卫生服务和/或卫生部都有卫生管理人员，为在卫生系统中从初级保健到医院护理的适当实施提供必要的资源，并为及时评估结果提供资源。

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引用次数: 0

Anemia perioperatoria: protocolos y directrices para facilitar el adecuado abordaje 围产期贫血：促进适当治疗的方案和准则

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501725

S. Aragón Álvarez , E. Bisbe Vives

引用次数: 0

Manejo anestésico en gestantes con displasia esquelética y talla baja. A propósito de un caso 骨骼发育不良和身材矮小孕妇的麻醉管理。病例报告

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.03.005

Á. Barranco de Santiago, A. Alandes-Gallego, I. García-Rojas, B. Tena, M. Magaldi

Skeletal dysplasias and short stature are a heterogeneous group of pathologies in which achondroplasia is the most common presentation. The presence of bone deformities leads to thoracic and airway changes that can complicate ventilation and airway management. Most individuals with skeletal dysplasia present spinal abnormalities that increase the difficulty of administering neuraxial anaesthesia. In pregnant patients, physiological and anatomical changes further complicate obstetric and anaesthesia management.

We report the case of a patient with skeletal dysplasia and short stature who was admitted to our hospital in week 34.3 of her pregnancy due to labour and respiratory difficulties. It was decided to perform an emergency caesarean section due to the disproportionate size of the foetal head with respect to the pelvis. We also review the different anaesthesia techniques described in the literature, and discuss their potential advantages and difficulties.

骨骼发育不良和身材矮小是一组异质性的病理，其中软骨发育不全是最常见的表现。骨畸形的存在导致胸腔和气道改变，使通气和气道管理复杂化。大多数患有骨骼发育不良的个体存在脊柱异常，这增加了给予轴向麻醉的难度。在妊娠患者中，生理和解剖的变化进一步使产科和麻醉管理复杂化。我们报告一例患有骨骼发育不良和身材矮小的患者，在怀孕第34.3周因分娩和呼吸困难而入院。由于胎儿头部与骨盆不成比例，决定进行紧急剖腹产手术。我们还回顾了文献中描述的不同麻醉技术，并讨论了它们潜在的优势和困难。

引用次数: 0

POCUS gástrico, una herramienta emergente en la valoración del ayuno perioperatorio: revisión narrativa POCUS胃，评估围手术期禁食的新兴工具：叙述综述

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501655

C. Juliá-Romero, C. Palau-Martí, A. Tejedor-Bosqued

Pulmonary aspiration during anesthetic induction is a serious adverse event that can lead to catastrophic consequences for the patient, including death. To date, the assessment of preoperative fasting has been evaluated with the history using the times recommended by clinical guidelines. This assessment is not objective since the presence or absence of gastric contents cannot be assured. The implementation of bedside gastric ultrasound in a complementary manner prior to anesthetic induction is an objective, simple and rapid tool that helps stratify risk in decision-making. The objective of this review is to summarize the existing literature on gastric POCUS in the assessment of preoperative fasting relevant to anesthetic practice. To this end, a bibliographic review has been carried out in the main databases Pubmed and Embase from 2014 to 2024.

麻醉诱导过程中的肺误吸是一种严重的不良事件，可导致患者灾难性的后果，包括死亡。到目前为止，术前禁食的评估都是根据临床指南推荐的时间来评估的。这种评估是不客观的，因为胃内容物的存在或不存在不能保证。在麻醉诱导前辅以床边胃超声是一种客观、简单、快速的工具，有助于在决策时对风险进行分层。本综述的目的是总结现有的关于胃POCUS在评估术前禁食与麻醉实践相关的文献。为此，对2014 - 2024年主要数据库Pubmed和Embase进行了文献综述。

引用次数: 0

Gestión de la sangre del paciente: ¡ahora o nunca! 病人血液管理：机不可失！

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2025.501752

C. Jericó , J.A. García Erce

引用次数: 0

Manejo transfusional perioperatorio en craneotomías: encuesta nacional, un punto de partida para valorar la mejora asistencial 颅切开术术后输血管理：全国调查，评估护理改善情况的起点

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501661

P. Hurtado , M. Garcia-Orellana , A. Martinez-Simon , G. Pujol-Fontrodona , E. Méndez , P. Doménech-Asensi , A. Pajares , A. López-Gómez , L. Valencia , M.J. Colomina , J. Fernández-Candil , Grupo de trabajo de Neurociencias y Hemostasia, Medicina Transfusional y Fluidoterapia de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR)

Objective

To assess the perioperative management of haemostasis and transfusion practices in adult patients undergoing craniotomies.

Method

Online questionnaire addressed to Spanish anaesthesiologists and promoted by the Neurosciences and Haemostasis, Transfusion Medicine and Fluid Therapy Sections of SEDAR. The questionnaire was sent by email and social media, and was active between June and October 2022.

Results

We obtained 155 responses from 67 centres; 59.4% perform >100 craniotomies per year. 61.7% were regularly involved in neuroanaesthesiology. Only 21.9% of respondents had pre-anaesthesia assessment performed by a member of that section, and in most of them (83.0%) the assessment was performed ≤3 weeks in advance. Of the respondents with Patient Blood Management programmes, 58.2% had no specific protocols for craniotomies. 90.3% reported that haemoconcentrates are systematically reserved. A lower platelet limit of 100,000/mcL is considered acceptable by 76.8%. 99.4% of respondents discontinued antiplatelet medication based on half-life. Only 23.9% respondents routinely discontinued non-steroidal anti-inflammatory drugs. The transfusion threshold for haemoglobin during surgical bleeding was <10g/dl in 18.7%, <9g/dl in 38.1%, <8g/dl in 38.7% and <7 g/dl in 4.5%.

Conclusions

Preoperative anaemia screening and treatment programmes are not implemented and blood product reserves are systematised in patients scheduled for craniotomy. Anti-aggregation therapy is discontinued according to the half-life of the drug without checking platelet functionality.

目的探讨成人开颅手术患者围手术期止血输液的处理方法。方法在线问卷调查西班牙麻醉师和促进神经科学和止血，输血医学和液体治疗部门的SEDAR。该调查问卷通过电子邮件和社交媒体发送，于2022年6月至10月期间进行。结果我们获得了来自67个中心的155份回复；每年进行100例开颅手术的占59.4%。61.7%定期接受神经麻醉学检查。只有21.9%的应答者有麻醉前评估由该科的成员进行，其中大多数（83.0%）的评估是在≤3周前进行的。在有患者血液管理方案的应答者中，58.2%没有开颅手术的具体方案。90.3%的人报告有系统地保留血浓缩物。76.8%的人认为血小板下限为100,000/mcL是可以接受的。99.4%的应答者根据半衰期停用抗血小板药物。只有23.9%的受访者常规停用非甾体抗炎药。手术出血时血红蛋白输血阈值为10g/dl（18.7%）、9g/dl（38.1%）、8g/dl（38.7%）和7g /dl（4.5%）。结论开颅患者术前贫血筛查和治疗方案未落实，血液制品储备未系统化。在不检查血小板功能的情况下，根据药物的半衰期停止抗聚集治疗。

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引用次数: 0

Vía aérea difícil por fibromas esclerosantes múltiples en paciente con síndrome de Cowden 一名考登综合征患者因多发性硬化性纤维瘤导致呼吸道困难

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.03.002

G. Ballout, R. Berge Ramos, L. Gómez-López, M. López-Baamonde

引用次数: 0

Neumoencéfalo tras técnica espinal-epidural combinada: informe de caso 脊髓-硬膜外联合技术后的气脑：病例报告

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.03.008

I. Martins de Carvalho, P. Costa Antunes, A. Nunes Miranda, J. Marques Vinagre

Pneumocephalus refers to the presence of air within the intracranial cavity, and albeit its occurrence following neuraxial techniques is rare, it is commonly associated with a loss of resistance to air technique.

This case report describes a parturient who underwent neuraxial analgesia for pain management during labour. Epidural space identification with loss of resistance to saline technique was used and she went on to develop a symptomatic pneumocephalus.

The pneumocephalus had an atypical presentation without immediate headache but with a sudden change in consciousness, likely due to an increase in intracranial pressure following migration of air into the intracranial cavity through the ventricular system.

Although in most cases it is benign, asymptomatic, and self-limiting, early diagnosis is helpful as treatment with supplemental oxygen can speed recovery. In this case, due to its atypical and sudden presentation, supportive treatment was essential for the prognosis of both mother and baby.

气颅是指颅内腔内存在空气，尽管其在轴向穿刺技术后很少发生，但通常与空气穿刺技术阻力丧失有关。本病例报告描述了一个在分娩过程中接受神经轴镇痛治疗的产妇。硬膜外腔识别与生理盐水技术的阻力丧失，她继续发展为症状性脑气。气颅有一个不典型的表现，没有立即头痛，但意识突然改变，可能是由于空气通过脑室系统迁移到颅内腔后颅内压增加。虽然在大多数情况下，它是良性的，无症状的，自限性的，早期诊断是有帮助的，因为补充氧气治疗可以加速恢复。在本病例中，由于其非典型和突然的表现，支持性治疗对于母亲和婴儿的预后都是必不可少的。

引用次数: 0

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