Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Reflexiones sobre: «Dolor neuropático y crónico de nueva aparición en supervivientes de COVID-19 grave: análisis secundario del ensayo PAIN-COVID» 对“严重2019冠状病毒病幸存者重新出现的慢性和神经疼痛：PAIN-COVID试验的二次分析”的思考

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redar.2025.501996

A. Alcántara Montero , P.J. Ibor Vidal

引用次数: 0

¡Historia complicada de una complicación citada! 一个复杂的故事，一个复杂的引用！

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501898

R. Magoon , V. Suresh

引用次数: 0

Las inyecciones de plasma rico en plaquetas mejoran los resultados funcionales en comparación con la radiofrecuencia pulsada mediante bloqueo del ganglio impar en el tratamiento de la coxigodinia 在弓形虫治疗中，富血小板等离子体注射通过阻断奇点，与脉冲射频相比，可改善功能结果

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501929

J. Pilco Inga , A. Fervienza Sánchez , J.J. Velázquez Fragoso , M. Fa-Binefa , I. Moya Molinas

Background and aim

Coccydynia is a painful condition commonly related to trauma or repetitive stress. While most cases respond to conservative management, a subset of patients requires minimally invasive interventions. Platelet-rich plasma (PRP) has recently emerged as a biological treatment alternative, promoting tissue repair. This study aimed to compare the clinical efficacy of PRP injections versus pulsed radiofrequency (PRF) at the ganglion impar in patients with coccydynia refractory to conservative treatment.

Materials and methods

A retrospective cohort study was conducted on 40 consecutive patients treated for coccydynia. 20 received PRP injections and 20 underwent PRF at the ganglion impar. Functional disability was measured by the Oswestry Disability Index (ODI) and pain intensity was assessed using the Visual Analogue Scale (VAS) at baseline and at six months. Statistical analysis included t-tests and multivariable regression models adjusted for baseline characteristics.

Results

Both groups showed improvement in pain and function. There were no significant differences in pre- or post-treatment VAS scores between the two groups. However, the mean change in ODI scores was significantly greater in the PRP group (−9.6 ± 4.2) compared to the PRF group (−5.4 ± 6.3), with a statistically significant difference in functional improvement (p = 0.018), and a clinically relevant improvement (≥ 30% reduction in ODI) was achieved in 85% of cases versus 45%, respectively (p = 0.02). The adjusted analysis confirmed the superiority of PRP after controlling for baseline differences.

Conclusions

PRP injections at the ganglion impar demonstrated superior improvement in functional outcomes compared to PRF in patients with refractory coccydynia. These findings support the use of PRP as a potentially more effective minimally invasive treatment, though prospective studies with longer follow-up are needed to confirm these results.

背景和目的尾骨痛是一种疼痛症状，通常与创伤或重复性压力有关。虽然大多数病例对保守治疗有反应，但一小部分患者需要微创干预。富血小板血浆（PRP）最近成为一种生物治疗替代方案，促进组织修复。本研究旨在比较PRP注射与脉冲射频（PRF）治疗难治性尾骨痛患者神经节损伤的临床疗效。材料与方法对40例连续治疗的尾骨痛患者进行回顾性队列研究。20例接受PRP注射，20例在神经节处接受PRF。在基线和6个月时，采用Oswestry残疾指数（ODI）测量功能残疾，使用视觉模拟量表（VAS）评估疼痛强度。统计分析包括t检验和多变量回归模型调整基线特征。结果两组患者疼痛和功能均有改善。两组治疗前和治疗后的VAS评分无显著差异。然而，与PRF组（- 5.4±6.3）相比，PRP组ODI评分的平均变化（- 9.6±4.2）显著大于PRF组（- 5.4±6.3），在功能改善方面具有统计学意义（p = 0.018）， 85%的病例实现了临床相关的改善（ODI降低≥30%），而45%的病例分别达到了（p = 0.02）。在控制基线差异后，校正分析证实了PRP的优越性。结论与PRF相比，在神经节处注射sprp对难治性尾骨痛患者的功能预后有更大的改善。这些发现支持使用PRP作为一种潜在的更有效的微创治疗，尽管需要更长时间随访的前瞻性研究来证实这些结果。

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引用次数: 0

Retos de la anestesiología: estenosis subglótica severa 麻醉学挑战：严重舌下狭窄

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501842

L. Gómez-López, R. Bergé Ramos, A. Vallejo Tarrat, J. Doménech de la Lastra

引用次数: 0

Síndrome coronario agudo debido a compresión coronaria por gran aneurisma del seno de Valsalva 瓦尔萨尔瓦大胸动脉瘤冠状动脉压迫引起的急性冠状动脉综合征

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501876

B. Segura-Méndez, R. Bernal-Esteban, N. Arce-Ramos, Y. Carrascal

引用次数: 0

Diagnóstico de síndrome de embolia grasa paradójica tras artroplastia de cadera cementada 髋关节置换术后矛盾型脂肪栓塞综合征的诊断

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501841

S. Maia , A. Carneiro , M. Vargas , B. Xavier , S. Caramelo

The diagnosis of cerebral fat embolism syndrome (FES) is not linear. In this case report, a 79-year-old woman underwent urgent cemented hip arthroplasty 24 hours after a femoral neck fracture. Immediately after the procedure she had a brief episode of altered state of consciousness. After four hours, she presented with multiple neurological symptoms which led to the activation of the stroke alert system. New and diverse neurological deficits appeared during the day. She had two brain CT scan done, which were normal. Transthoracic echocardiogram showed an exuberant patent foramen ovale. Electroencephalogram showed nonconvulsive status epilepticus, which was promptly treated. Brain MRI showed findings compatible with cerebral FES. After initial exclusion of an acute ischemic stroke, conditions that lead to multiple embolic strokes in different vascular territories had to be considered due to the diverse neurological deficits present. The hypothesis of embolization was also supported by the sudden onset of the illness. Even though FES is an exclusion diagnosis, fat microembolism have distinct radiographic features on the brain MRI, which were found on this patient. Perioperative neurological deficits are not uncommon, particularly in the older population. Accurate diagnosis and appropriate management are crucial to ensuring favourable outcomes and preventing long-term sequelae.

脑脂肪栓塞综合征（FES）的诊断不是线性的。在这个病例报告中，一位79岁的女性在股骨颈骨折24小时后接受了紧急骨水泥髋关节置换术。手术后，她立即出现了短暂的意识状态改变。四小时后，她出现了多种神经系统症状，导致中风警报系统被激活。白天出现了新的和不同的神经功能缺陷。她做了两次脑部CT扫描，正常。经胸超声心动图显示卵圆孔未闭。脑电图显示非惊厥性癫痫持续状态，并及时治疗。脑MRI显示与脑FES相符。在初步排除急性缺血性中风后，由于存在不同的神经功能缺陷，必须考虑导致不同血管区域的多发性栓塞性中风的情况。栓塞的假设也被疾病的突然发作所支持。尽管FES是一种排除性诊断，但脂肪微栓塞在脑MRI上具有明显的影像学特征，这是在该患者身上发现的。围手术期神经功能缺损并不罕见，特别是在老年人中。准确的诊断和适当的管理对于确保良好的结果和预防长期后遗症至关重要。

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引用次数: 0

Reversión del bloqueo del nervio frénico con solución salina tras bloqueo interescalénico: reporte de un caso 用盐溶液逆转神经间阻滞：一个案例报告

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501851

A.M. Castro-Alemán, J.A. Estupiñán-Tibaduiza, R.P. Altamirano-Muñoz, J.C. Altuve-Quiroz

Brachial plexus block at the interscalene level is a regional anesthetic technique widely used to provide analgesia in shoulder and upper extremity surgery; However, it is associated with a high incidence of phrenic nerve block with diaphragmatic paralysis which has clinical implications in patients with underlying respiratory disease, showing respiratory difficulty symptoms. As consequence, it has been contraindicated in certain population groups. Once diaphragmatic paralysis and respiratory symptoms are established, management is supportive and expectant. In recent years, the administration or “washing” with normal saline solution has been described with the same approach, to reverse the phrenic nerve block and thus the respiratory symptoms. We present the first case of successful reversal of phrenic nerve block with saline in Latin America.

斜角肌间水平臂丛阻滞是一种广泛应用于肩部和上肢手术的区域麻醉技术；然而，膈神经阻滞伴膈肌麻痹的高发与膈神经阻滞相关，膈肌麻痹对有潜在呼吸系统疾病的患者有临床意义，表现为呼吸困难症状。因此，它在某些人群中是禁忌的。一旦确定膈肌麻痹和呼吸道症状，治疗是支持和期待的。近年来，用生理盐水给药或“冲洗”也采用了同样的方法，以逆转膈神经阻滞，从而缓解呼吸道症状。我们提出的第一例成功逆转膈神经阻滞与生理盐水在拉丁美洲。

引用次数: 0

Bloqueo ecoguiado SFO de punción única (SP-SFO): dispersión de la tinción en cadáveres 单刺SFO （SP-SFO）生态导向阻滞：将染料分散在尸体上

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501951

S. Diwan , V. Sathe , A. Sabnis , P. Mane , A. Gupta

Background

The terminal nerves of the lumbar plexus, the femoral and obturator nerves, and the sciatic nerve are situated in different fascial planes on the medial side of the thigh. Attempts have been made to approach these nerves using a single puncture from the anterior and medial aspect of the thigh. The previously described SOFT block requires multiple transducer positions, needle redirections, and punctures. We attempted a novel single-puncture, single-position approach to all 3 nerves in different fascial planes in 6 soft embalmed cadavers that provided a total of 12 specimens.

Methods

Six fresh human cadavers left at room temperature for a minimum of 6 hours were positioned supine, and an ultrasound-guided single puncture technique was used to target branches of the sciatic, femoral, and obturator nerves (SP-SFO) and inject 0.1% methylene blue dye. Cross-sections were obtained with a band saw in all cadavers at the level of the SP-SFO injections to observe the spread of the dye in various planes.

Results

Cadaver cross-sections showed the spread of the dye in all respective planes. The dye infiltrated the femoral and obturator nerves, while in 4 specimens it reached the sciatic nerve and the paraneural tissue.

Conclusion

This single puncture for branches of the sciatic, femoral, and obturator nerves block (SP-FSO block) can be used to successfully target all these nerves.

腰丛末梢神经、股神经和闭孔神经、坐骨神经分布在大腿内侧不同的筋膜平面上。已经尝试通过从大腿前部和内侧穿刺来接近这些神经。先前描述的SOFT块需要多个换能器位置，针重定向和穿刺。我们尝试了一种新颖的单穿刺、单位置入路，在不同的筋膜平面上所有3条神经，在6具软防腐尸体上提供了总共12个标本。方法6具室温下放置至少6小时的新鲜人尸体平卧，超声引导下单针穿刺坐骨神经、股神经和闭孔神经（SP-SFO）分支，注射0.1%亚甲基蓝染料。在所有尸体的SP-SFO注射水平上用带锯获得横截面，观察染料在各个平面上的扩散。结果扫描切片显示染料在各平面上的扩散情况。染色浸润股神经和闭孔神经，4例到达坐骨神经和神经旁组织。结论单次穿刺坐骨、股、闭孔神经分支阻滞（SP-FSO阻滞）可成功靶向所有神经。

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引用次数: 0

Sopesar los riesgos: impacto del índice de masa corporal en las complicaciones postoperatorias en la cirugía cardíaca 权衡风险：体重指数对心脏手术术后并发症的影响

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501952

A.A. Pupiales-Dávila , R. Gopar-Nieto , G. Rojas-Velasco , D. Manzur-Sandoval

Introduction

Body mass index (BMI) is a key determinant of cardiovascular risk and may significantly impact postoperative outcomes. This study aimed to evaluate the relationship between BMI and early postoperative complications in patients undergoing cardiac surgery.

Methods

This retrospective study analyzed data from 555 patients who underwent cardiac surgery at the National Institute of Cardiology from June 2022 to December 2023. Patients were categorized into 4 BMI groups: underweight, normal weight, overweight, and obese. Data on demographics, surgical procedures, postoperative complications, and hemodynamic parameters were collected and analyzed.

Results

Preoperative comorbidities, including chronic heart failure and fibrilación auricular, were more common among underweight patients. This group was also at higher risk of poscardiotomy low output syndrome (univariate OR 3.35, P=.03), and postoperative fibrilación auricular remained significant in multivariate analysis (OR 1.48, P=.01), and required increased vasopressor and inotropic support. Obese patients had a significantly increased risk of postoperative mediastinitis in both univariate (OR 2.47, P=.04) and multivariate analyses (OR 2.12, P=.03). In-hospital mortality was 14.3% in underweight vs. 6.1% in obese patients (P=.52).

Conclusions

This study highlights the significant impact of BMI on postoperative outcomes in cardiac surgery. Underweight patients exhibited higher rates of postoperative complications and mortality, likely due to underlying comorbidities and limited physiological reserves. While obesity is associated with increased cardiovascular risk, our findings suggest a potential obesity paradox in this cohort. Further research is needed to elucidate the underlying mechanisms and refine risk stratification models incorporating BMI and other relevant factors.

身体质量指数（BMI）是心血管风险的关键决定因素，并可能显著影响术后预后。本研究旨在评估心脏手术患者BMI与术后早期并发症的关系。方法本回顾性研究分析了2022年6月至2023年12月在美国国家心脏病研究所接受心脏手术的555例患者的数据。患者被分为4个BMI组：体重过轻、正常体重、超重和肥胖。收集和分析了人口统计学、外科手术、术后并发症和血流动力学参数的数据。结果体重过轻患者术前合并症包括慢性心力衰竭和fibrilación耳廓更为常见。该组发生心肌切开术后低输出综合征的风险也较高（单因素OR为3.35，P= 0.03），术后fibrilación耳廓在多因素分析中仍具有显著性（OR为1.48，P= 0.01），需要增加血管加压剂和肌力支持。在单因素分析（OR 2.47， P= 0.04）和多因素分析（OR 2.12， P= 0.03）中，肥胖患者术后发生纵隔炎的风险均显著增加。体重不足患者的住院死亡率为14.3%，肥胖患者为6.1% （P= 0.52）。结论本研究强调了BMI对心脏手术术后预后的重要影响。体重过轻的患者术后并发症和死亡率较高，可能是由于潜在的合并症和有限的生理储备。虽然肥胖与心血管风险增加有关，但我们的研究结果表明，这一队列中存在潜在的肥胖悖论。需要进一步的研究来阐明潜在的机制，并完善纳入BMI和其他相关因素的风险分层模型。

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引用次数: 0

Dolor posquirúrgico y clasificación CIE-11: entre el reconocimiento nosológico y los límites operativos 术后疼痛与ICE -11分类：在病理识别与手术界限之间

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redar.2025.501950

A. Alcántara Montero , A. Montes Pérez

引用次数: 0

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