Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Brote de policondritis recurrente con afectación grave del árbol traqueobronquial en una mujer embarazada con preeclampsia y criterios de gravedad. Manejo anestésico 一名先兆子痫孕妇爆发严重累及气管支气管树的复发性多软骨炎及严重程度标准。麻醉处理

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-12-01 DOI: 10.1016/j.redar.2023.05.012

E. Sarrió Badenes , M. Durá Aranda , L. Molero Sala , P. Martín Serrano

引用次数: 0

Encuesta Nacional sobre la Práctica Clínica en Analgesia Obstétrica en España 关于西班牙产科镇痛临床实践的全国调查

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-12-01 DOI: 10.1016/j.redar.2024.07.001

L. Hernández González , N. Brogly , S. Manrique Muñoz , C. Suárez Castaño , G. Yerga Pozo , M. Raynard Ortiz , E. Guasch Arévalo

Introduction

A national survey was conducted among maternity hospitals nationwide to understand the variability in clinical practice for obstetric analgesia and to reach a consensus on optimal care in the future in Spain.

Materials and methods

Spanish experts in obstetric anesthesiology designed a survey on the practice of obstetric analgesia during childbirth, following a Delphi process. The survey was sent to 195 Spanish maternity hospitals between April and September 2022 using Google Forms. A descriptive study of the results was performed.

Results

Responses were obtained from 108 centers (55.4%), of which 88 (83.8%) were public hospitals. The most commonly used technique was epidural analgesia in 97 (92.4%) centers. Nine (8.6%) centers used the combined spinal-epidural (CSE) technique, 5 (4.8%) used spinal analgesia, and 3 (2.9%) used dural puncture epidural (DPE) analgesia. The most commonly used local anesthetic was levobupivacaine 0.1-0.25% in 82 (78.1%) centers. Fentanyl or sufentanil were added to the local anesthetic in 96 (91.4%) centers. Epidural maintenance was performed with continuous epidural infusion (CEI) + patient-controlled epidural analgesia (PCEA) or programmed intermittent epidural bolus (PIEB) + PCEA in 64 (60.9%) and 33 (30.5%) centers, respectively. Fifteen (14.3%) centers lacked alternative techniques to epidural analgesia and 25 (23.8%) did not follow obstetric analgesia protocols.

Conclusion

Despite the variability in clinical practice for obstetric analgesia in Spain, the vast majority of centers follow recommendations in this field. There is room for improvement, which should be considered a fundamental strategy for progressing towards excellence.

在全国妇产医院中进行了一项全国性调查，以了解产科镇痛临床实践的可变性，并就西班牙未来的最佳护理达成共识。材料和方法西班牙产科麻醉学专家设计了一项关于分娩期间产科镇痛实践的调查，遵循德尔菲过程。该调查于2022年4月至9月期间使用谷歌表格向西班牙195家妇产医院发送。对结果进行了描述性研究。结果共获得108个中心（55.4%）的反馈，其中公立医院88个（83.8%）。97个中心（92.4%）最常用的方法是硬膜外镇痛。9个中心（8.6%）采用脊髓-硬膜外联合（CSE）技术，5个中心（4.8%）采用脊髓镇痛，3个中心（2.9%）采用硬膜穿刺硬膜外（DPE）镇痛。82个中心（78.1%）最常用的局麻药为左布比卡因0.1 ~ 0.25%。96个中心（91.4%）在局麻药中添加芬太尼或舒芬太尼。在64个中心（60.9%）和33个中心（30.5%）分别采用连续硬膜外输液(CEI) +患者自控硬膜外镇痛（PCEA）或计划性间歇硬膜外灌注(PIEB) + PCEA进行硬膜外维持。15个（14.3%）中心缺乏硬膜外镇痛的替代技术，25个（23.8%）中心没有遵循产科镇痛方案。结论：尽管西班牙产科镇痛的临床实践存在差异，但绝大多数中心都遵循这一领域的建议。还有改进的余地，这应该被视为迈向卓越的基本战略。

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引用次数: 0

Pruebas de hemostasia preoperatorias: una revisión narrativa de las guías existentes 术前止血试验：对现有指南的叙述审查

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-12-01 DOI: 10.1016/j.redar.2024.06.002

J.L. Jover Pinillos , R. Ferrandis Comes , D. Zamudio Penko , M. Bermúdez López , M. Basora Macaya , Maria J. Colomina

Introduction

Hemostasis tests are traditionally requested for all patients requiring any surgical act or invasive diagnostic-therapeutic procedure to prevent hemorrhagic complications. The aim of this study is to assess the necessity of requesting standard pre-procedure hemostasis tests.

Material and methods

A narrative literature review was conducted using the PubMed database. Search terms included «Hemostasis» or «Blood coagulation» in combination with «Preoperative care», «Preoperative period», or «Preoperative procedure». Additionally, a targeted search was performed to find recommendations from international societies related to the topic.

Results

A total of 233 articles were found, 17 were pre-selected, and after full-text evaluation, 14 relevant articles were identified. The targeted search yielded an additional 12 articles. The request for tests should be individualized according to the clinical history. Standardized screening questionnaires for hemostasis disorders are useful and complement the aforementioned approach. Factors such as age, ASA classification, bleeding potential-complexity of the procedure, and anesthetic technique may influence their request.

Discussion

The incidence of hemostasis disorders in the general population is very low, and these can mostly be detected through clinical history. Thus, it is the clinical history that should guide the need for laboratory test requests.

Conclusions

Preoperative hemostasis tests should not be indiscriminately requested for all patients needing an intervention or invasive diagnostic-therapeutic procedure, but rather when there are doubts about their hemostatic competence or as advised by the nature of the procedure they are undergoing.

invasivo. e hemostasia preoperat a cialquier der a la pregunta de que si es preceptivo solicitar pruebas de hemostasia preoperat

止血试验传统上要求所有患者需要任何手术或侵入性诊断治疗程序，以防止出血并发症。本研究的目的是评估要求标准的术前止血试验的必要性。材料与方法使用PubMed数据库进行叙述性文献综述。搜索词包括«止血»或«凝血»结合«术前护理»，«术前周期»，或«术前程序»。此外，还进行了有针对性的搜索，以查找与该主题相关的国际学会的建议。结果共检索到文献233篇，其中预选文献17篇，经全文评审，鉴定出相关文献14篇。目标搜索还产生了另外12篇文章。检查要求应根据临床病史进行个体化。止血障碍的标准化筛选问卷是有用的，并补充了上述方法。年龄、ASA分类、潜在出血、手术复杂性和麻醉技术等因素可能影响他们的要求。在一般人群中，止血障碍的发生率很低，大多可以通过临床病史检测出来。因此，临床病史应指导实验室检查要求的需要。结论对于所有需要介入治疗或侵入性诊断治疗的患者，不应不分青红皂白地要求进行手术后止血试验，而应在对其止血能力有怀疑或根据其正在进行的侵入性手术的性质建议进行止血试验时进行。术前止血术是一种特殊的止血术，在术前止血术是一种特殊的止血术

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引用次数: 0

Recomendaciones del Grupo de Trabajo de la Consulta de Preanestesia Digitalizada 数字化麻醉前咨询工作组的建议

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-12-01 DOI: 10.1016/j.redar.2024.03.007

A. Aroca Tanarro , R. Casans Francés , M.Á. Gómez-Ríos , E. Mendez Arias , M. Otero Pérez , L. Quecedo Gutierrez , V. Rojas Pernia , A. Abad Gurumeta

The main objectives of the pre-anaesthesia consultation are to establish the patient's anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies, e-Health, has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit.

The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.

麻醉前咨询的主要目标是确定患者的麻醉和手术风险，评估和优化其健康状况，向患者提供信息和术前建议，并履行法律规定的官僚义务。信息技术和电子保健的结合最大限度地提高了麻醉前评估的效率，并为患者提供了额外的好处。SEDAR工作队制定了一个数字框架，作为传统麻醉前评估过程的替代方案，并提出了一系列政策和技术建议，以便在医院麻醉科纳入不同类型的麻醉前远程咨询服务。我们还提出了一个评估工具，其中包括若干质量指标，以此为基础，在医疗保健方面进行持续改进。

引用次数: 0

Intubación transorbitaria en una paciente con vía aérea difícil por cirugía previa 为一名因既往手术导致气道困难的患者实施经眶插管术

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-12-01 DOI: 10.1016/j.redar.2023.05.011

M.E. Navio Poussivert, A. Martinez-Garcia, M.I. de la Rosa Jimenez

引用次数: 0

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

¿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

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

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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