Revista Espanola de Anestesiologia y Reanimacion最新文献_第8页

Utilidad de la ecografía de la vaina del nervio óptico durante la cirugía colorrectal laparoscópica 视神经鞘超声在腹腔镜结肠直肠手术中的应用

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.501672

L. Alcover Navarro , C.S. Romero García , E. Mateo Rodríguez , P. Granero Castro , J. de Andrés Ibáñez

Introduction

Abdominal laparoscopic surgery to treat colorectal cancer has been shown to be more effective than open surgery in terms of mobility, hospital stay, tumour recurrence and long-term survival. This surgical approach requires pneumoperitoneum and the Trendelenburg position (35-45°), both of which have a negative effect on the cardiovascular system and can even change the cerebrovascular physiology, leading to an increase in intracranial pressure (ICP). Ultrasound measurement of optic nerve sheath (ONS) diameter has shown excellent correlation with invasive ICP measurement.

Objective

To correlate the increase in ONS diameter with surgical time and time to emergence after anaesthesia. The incidence of visual disturbances (visual acuity) and/or neurological complications (agitation, cognitive dysfunction) in the immediate postoperative period was also evaluated.

Material and methods

Thirty consecutive patients undergoing laparoscopic surgery for rectal or sigmoid adenocarcinoma were recruited. Pre-, intra- and postoperative ONS measurements were obtained and the Snellen test for visual acuity, Mini Mental Test for cognitive function, and the Richmond Agitation and Sedation Scale (RASS) were administered.

Results

The ONS increased intraoperatively in both eyes compared to baseline. However, this was not correlated with total surgical time or time to emergence, and there was no statistically significant correlation between ONS and postoperative neurological or visual alterations.

腹部腹腔镜手术治疗结直肠癌已被证明在活动、住院时间、肿瘤复发和长期生存方面比开放手术更有效。该手术入路需要气腹和Trendelenburg体位（35-45°），这两种体位对心血管系统有负面影响，甚至可以改变脑血管生理，导致颅内压（ICP）升高。超声测量视神经鞘（ONS）直径与有创ICP测量有很好的相关性。目的探讨麻醉后脑管直径增加与手术时间及术后出现时间的关系。术后即刻视力障碍（视力）和/或神经系统并发症（躁动、认知功能障碍）的发生率也进行了评估。材料和方法本研究招募30例连续行腹腔镜直肠或乙状结肠腺癌手术的患者。进行术前、术中和术后ONS测量，并进行Snellen视力测试、认知功能迷你心理测试和Richmond躁动镇静量表（RASS）。结果术中双眼ONS较基线增高。然而，这与总手术时间或出现时间无关，并且ONS与术后神经或视觉改变之间没有统计学上的显著相关性。

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引用次数: 0

Manejo anestésico de un paciente con dispositivo de modulación de la contractilidad cardiaca 使用心脏收缩调节装置对病人进行麻醉处理

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.04.006

A. Álvarez Bartolomé , Á. Mingote Lladó , M. Casado Salcedo , J. García Fernández

The cardiac contractility modulation (CCM) device is an electrical therapy for the treatment of patients with moderate-severe heart failure (HF), which has been shown a small improvement in exercise tolerance and quality of life in these patients. The Guidelines about the management of implantable cardiac devices do not include any recommendations about CCM and only one article refers to the anesthetic management of these patients. We present a clinical case about the anesthetic management of a patient with this cardiac device. We believe that in the future it will be more common to find patients with similar devices in anesthesia practice.

心脏收缩调节（CCM）装置是一种用于治疗中重度心力衰竭（HF）患者的电疗法，已显示出这些患者的运动耐量和生活质量的小幅改善。关于植入式心脏装置管理的指南没有包括任何关于CCM的建议，只有一篇文章提到了这些患者的麻醉管理。我们提出了一个临床病例的麻醉管理的病人与这种心脏装置。我们相信，在未来的麻醉实践中，使用类似设备的患者将会越来越多。

引用次数: 0

Complicaciones asociadas al retraso en la cirugía de fractura de cadera por antiagregantes plaquetarios 与血小板抗粘连剂髋部骨折手术延迟有关的并发症

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.501674

V. Moratalla Sasu, N. Bakhshaliyeva, J. Fernández González, E. Alday Muñoz

Background and objectives

Hip fractures typically affect elderly individuals with multiple comorbidities. Early surgical intervention within the first 48 hours has been shown to improve outcomes. However, when on antiplatelet therapy, surgery is often delayed preventing bleeding complications. This study aims to compare the incidence of perioperative complications, the need for blood transfusions, and the length of hospital stay between two groups of patients: those with delayed surgery more than 72 hours due to antiplatelet use and those who had surgery within the first 48 hours.

Methods

A retrospective cohort study was conducted on 110 patients who underwent hip fracture surgery between December 2012 and April 2018. Patients who had a delay of more than 72 hours in the surgery were selected. A 1:1 randomized sampling was made to obtain a control group with surgery within the first 48 hours.

Results

The baseline clinical characteristics were similar between the two groups, except for a higher rate of ischemic heart disease, cerebrovascular accidents and use of antiplatelet medication in the delayed surgery group. The early surgery group had a higher rate of acute renal failure (14.6% vs. 1.8%). The rest of the postoperative complications were higher in the delayed group (5.5% vs. 20%). The hospital stay was longer in the delayed group (15.2 vs. 8.93 days), although this difference accounted for the preoperative stay.

Conclusion

This study found that delayed surgery was linked to a higher incidence of medical complications and a longer hospital stay due to the wait time for surgery.

背景和目的髋部骨折通常影响有多种合并症的老年人。在最初48小时内进行早期手术干预已被证明可以改善结果。然而，当进行抗血小板治疗时，手术往往被推迟，以防止出血并发症。本研究旨在比较两组患者的围手术期并发症发生率、输血需求和住院时间：因使用抗血小板药物而延迟手术超过72小时的患者和在最初48小时内手术的患者。方法对2012年12月至2018年4月110例髋部骨折患者进行回顾性队列研究。选择手术延迟超过72小时的患者。采用1:1随机抽样，获得48小时内手术的对照组。结果两组患者的基线临床特征相似，但延迟手术组的缺血性心脏病、脑血管意外发生率和抗血小板药物使用率较高。早期手术组的急性肾功能衰竭发生率较高（14.6%比1.8%）。延迟组术后其他并发症发生率较高（5.5% vs. 20%）。延迟组的住院时间更长（15.2天对8.93天），尽管这种差异可以解释术前的住院时间。本研究发现，延迟手术与较高的医疗并发症发生率和由于等待手术时间而延长的住院时间有关。

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引用次数: 0

Bloqueo del músculo erector de la espina para analgesia obstétrica en el déficit de Factor XI: a propósito de un caso 因因子XI缺乏症进行产科镇痛而阻断脊柱勃起肌：以一个病例为目的

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.03.010

P. Martín Serrano , A. Ferraz Pérez , C. Medina Hernández , V. Prieto Hidalgo

Factor XI (FXI) deficiency is a rare bleeding disorder characterized by a quantitative or qualitative deficiency of FXI. The symptoms are highly variable, and the severity and site of bleeding is unpredictable and does not necessarily correlate with FXI levels. FXI deficiency is classified by phenotype: bleeding or non-bleeding, depending on the clinical manifestations.

We present the case of a woman in her twenties diagnosed with FXI with a bleeding phenotype. The patient requested labour analgesia, but the haematology department contraindicated neuraxial techniques, given her history. An ultrasound-guided lumbar erector spinae plane block (ESPB) was performed, achieving pain relief after 45 minutes.

ESP block could be an alternative to consider when neuraxial analgesia is contraindicated in labour.

因子XI （FXI）缺乏是一种罕见的出血性疾病，其特征是FXI的定量或定性缺乏。症状是高度可变的，出血的严重程度和部位是不可预测的，并不一定与FXI水平相关。FXI缺乏症根据临床表现分为出血型或不出血型。我们提出的情况下，一名妇女在她的二十多岁诊断为FXI与出血表型。患者要求分娩镇痛，但血液科禁止轴向技术，考虑到她的病史。超声引导腰椎竖立者脊柱平面阻滞（ESPB）， 45分钟后疼痛缓解。当神经轴镇痛在分娩中是禁忌时，ESP阻滞可以作为一种选择。

引用次数: 0

¿Por qué ir a ciegas si se puede visualizar la vía aérea? 如果你能看到空中的路径，为什么要盲目呢？

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.501688

A.A.J. van Zundert , M.Á. Gómez-Ríos , T.C.R.V. van Zundert

Airway management is a critical aspect of anesthesiology, essential for ensuring patient safety during various medical interventions, including surgery, emergency care, and critical care settings. Despite advancements, difficult laryngoscopy and tracheal intubation remain significant challenges, particularly in emergency scenarios, posing risks of hypoxia, brain damage, and death. This article examines the efficacy of videolaryngoscopy (VLS) and video laryngeal mask airways (VLMA) in improving airway management outcomes compared to traditional techniques across diverse clinical environments.

We conducted a comprehensive review of literature and current practices, analyzing the advantages and limitations of VLS and VLMA. The paper highlights the importance of visualization in airway management and evaluates the effectiveness of these devices in various settings. VLS and VLMA offer several benefits over traditional direct laryngoscopy, including enhanced glottic visualization, higher first-attempt success rates, reduced rates of oxygen desaturation, and fewer adverse events. These devices provide a larger angle of view and allow for real-time monitoring, improving overall patient safety. Additionally, they serve as excellent educational tools for training anesthesiologists and other healthcare providers involved in airway management.

In emergency and critical care scenarios, the rapid and accurate placement of airway devices is crucial. VLS and VLMA facilitate quicker and more reliable intubation, reducing the likelihood of complications such as esophageal intubation or airway trauma. These technologies also allow for better teamwork and coordination as the airway view can be shared with the entire medical team.

The adoption of VLS and VLMA as standard practice in airway management can significantly enhance visualization and success rates, reducing the risk of complications. These devices should be integrated into routine clinical use to improve patient outcomes. Further research is warranted to optimize their application and explore advancements such as artificial intelligence in airway management.

气道管理是麻醉学的一个重要方面，对于确保各种医疗干预（包括手术、急诊和重症监护）期间的患者安全至关重要。尽管取得了进展，困难的喉镜检查和气管插管仍然是重大挑战，特别是在紧急情况下，造成缺氧、脑损伤和死亡的风险。本文研究了在不同的临床环境下，与传统技术相比，视频喉镜检查（VLS）和视频喉罩气道（VLMA）在改善气道管理结果方面的疗效。我们对文献和目前的实践进行了全面的回顾，分析了VLS和VLMA的优点和局限性。本文强调了可视化在气道管理中的重要性，并评估了这些设备在各种情况下的有效性。与传统的直接喉镜检查相比，VLS和VLMA有几个优点，包括增强声门可视化、更高的首次尝试成功率、降低氧饱和度和更少的不良事件。这些设备提供了更大的视角，并允许实时监控，提高了患者的整体安全。此外，它们还可以作为培训麻醉师和其他参与气道管理的医疗保健提供者的优秀教育工具。在紧急和重症监护情况下，快速准确地放置气道设备至关重要。VLS和VLMA促进更快和更可靠的插管，减少并发症的可能性，如食管插管或气道创伤。这些技术还允许更好的团队合作和协调，因为气道视图可以与整个医疗团队共享。采用VLS和VLMA作为气道管理的标准做法可以显著提高可视化和成功率，降低并发症的风险。这些设备应纳入常规临床使用，以改善患者的预后。需要进一步的研究来优化它们的应用，并探索人工智能在气道管理中的应用。

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引用次数: 0

Características clínicas e implicación pronóstica de la fibrilación auricular en el período postoperatorio de cirugía cardíaca con circulación extracorpórea 心脏外循环手术术后耳纤颤的临床特征和预后影响

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-04-01 DOI: 10.1016/j.redar.2024.501673

C.Y. Salinas-Ulloa , R. Gopar-Nieto , E. García-Cruz , G. Rojas-Velasco , D. Manzur-Sandoval

Introduction

Despite the latest innovations in surgical and cardiopulmonary bypass techniques, atrial fibrillation remains a common arrhythmia in patients undergoing heart surgery, and has been shown to increase the incidence of intra- and postoperative complications. For this reason, it is among the top 10 research topics in cardiovascular surgery.

Method

Observational, analytical, retrospective study carried out at the largest cardiovascular centre in Mexico. Adult patients (>18 years) with no history of atrial fibrillation who underwent heart surgery with cardiopulmonary bypas between 1 January 2022 and 31 December 2023 were included. Variables that have previously been correlated with postoperative atrial fibrillation (POAF) were evaluated.

Results

A total of 544 patients were included. The incidence of POAF was 11.9%. Overall in-hospital mortality was 5.9%. There was a significant difference in age between patients that developed postoperative atrial fibrillation and those that maintained sinus rhythm (62 vs 57 years; p = ≤ 0.01). Using a univariate logistic regression model, we found that POAF significantly predicts the occurrence of hospital-acquired pneumonia (OR: 3.12; 95% CI: 1.61-6.02; P≤0.01) and the requirement for renal replacement therapy (OR: 3.04; 95% CI: 1.34-6.86; P≤0.01).

Conclusions

Atrial fibrillation is a common arrhythmia in the postoperative period of heart surgery with cardiopulmonary bypass, and is a predictor of adverse outcomes. Prevention, early detection and treatment of POAF may have prognostic implications.

尽管外科手术和体外循环技术有了最新的创新，但心房颤动仍然是心脏手术患者常见的心律失常，并且已被证明会增加手术内和术后并发症的发生率。因此，它是心血管外科的十大研究课题之一。方法在墨西哥最大的心血管中心进行观察性、分析性、回顾性研究。纳入了在2022年1月1日至2023年12月31日期间接受心脏手术并进行心肺旁路手术的无房颤史的成年患者（18岁）。评估了先前与术后心房颤动（POAF）相关的变量。结果共纳入544例患者。POAF的发生率为11.9%。总体住院死亡率为5.9%。术后发生心房颤动的患者和维持窦性心律的患者在年龄上有显著差异(62岁vs 57岁；P =≤0.01)。采用单变量logistic回归模型，我们发现POAF显著预测医院获得性肺炎的发生(OR: 3.12；95% ci: 1.61-6.02；P≤0.01)和肾替代治疗需求(OR: 3.04；95% ci: 1.34-6.86；P≤0.01)。结论心房纤颤是体外循环心脏手术术后常见的心律失常，是不良预后的预测因素。预防、早期发现和治疗POAF可能具有预后意义。

{"title":"Características clínicas e implicación pronóstica de la fibrilación auricular en el período postoperatorio de cirugía cardíaca con circulación extracorpórea","authors":"C.Y. Salinas-Ulloa , R. Gopar-Nieto , E. García-Cruz , G. Rojas-Velasco , D. Manzur-Sandoval","doi":"10.1016/j.redar.2024.501673","DOIUrl":"10.1016/j.redar.2024.501673","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the latest innovations in surgical and cardiopulmonary bypass techniques, atrial fibrillation remains a common arrhythmia in patients undergoing heart surgery, and has been shown to increase the incidence of intra- and postoperative complications. For this reason, it is among the top 10 research topics in cardiovascular surgery.</div></div><div><h3>Method</h3><div>Observational, analytical, retrospective study carried out at the largest cardiovascular centre in Mexico. Adult patients (>18 years) with no history of atrial fibrillation who underwent heart surgery with cardiopulmonary bypas between 1 January 2022 and 31 December 2023 were included. Variables that have previously been correlated with postoperative atrial fibrillation (POAF) were evaluated.</div></div><div><h3>Results</h3><div>A total of 544 patients were included. The incidence of POAF was 11.9%. Overall in-hospital mortality was 5.9%. There was a significant difference in age between patients that developed postoperative atrial fibrillation and those that maintained sinus rhythm (62 vs 57 years; p = ≤ 0.01). Using a univariate logistic regression model, we found that POAF significantly predicts the occurrence of hospital-acquired pneumonia (OR: 3.12; 95% CI: 1.61-6.02; <em>P</em>≤0.01) and the requirement for renal replacement therapy (OR: 3.04; 95% CI: 1.34-6.86; <em>P</em>≤0.01).</div></div><div><h3>Conclusions</h3><div>Atrial fibrillation is a common arrhythmia in the postoperative period of heart surgery with cardiopulmonary bypass, and is a predictor of adverse outcomes. Prevention, early detection and treatment of POAF may have prognostic implications.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 4","pages":"Article 501673"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792764","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

Estudio comparativo del diámetro de la vaina del nervio óptico y la puntuación Lung Ultrasound en parturientas sanas y con preeclampsia 对患有先兆子痫的健康产妇的视神经鞘直径和肺超声评分比较研究

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-18 DOI: 10.1016/j.redar.2025.501773

A. Nagpal, M. Pandey, N. Kumar

Background

Complications of preeclampsia include cerebral and pulmonary edema which strongly correlate with optic nerve sheath diameter (ONSD) and lung ultrasound score (LUSS) respectively. This study was conducted to compare ONSD and LUSS in healthy and preeclamptic parturients.

Methods

In this prospective observational analytical study, 35 healthy pregnant women and preeclamptic women each underwent ultrasound assessment for ONSD and LUSS (12 region lung technique). Severity of preeclampsia was noted. ROC analysis was performed to obtain a cutoff value for both ONSD and LUSS to predict complications of preeclampsia. A p-value of < .05 was considered significant.

Results

Mean ONSD and LUSS were higher in preeclamptic compared to healthy parturients (5.06 ± 0.46 vs 4.24 ± 0.38 mm, P < .0001), and (5 [1-12] vs 0 [0-1.5]; p value < .0001, respectively). Mean ONSD in severe pre-eclampsia (5.36 ± 0.32 mm) was significantly higher as compared to mild pre-eclampsia (4.71 ± 0.35 mm; P < .0001). Women with severe preeclampsia had a higher LUSS as compared to the mild preeclamptics and healthy parturients. However, no difference in ONSD and LUSS between mild preeclamptics and healthy parturients was observed. A mean ONSD of > 4.65 mm and LUSS of > 2 could predict preeclampsia with a sensitivity of 77.14% and 68.57% and specificity of 91.43% and 85.71% with an AUC of 0.907 and 0.806 respectively.

Conclusion

Both ONSD and LUSS can be used to assess severity and complications of preeclampsia. Early detection can be used to treat, guide fluid therapy and monitor response to treatment.

背景子痫前期的并发症包括脑水肿和肺水肿，两者分别与视神经鞘直径（ONSD）和肺超声评分（LUSS）密切相关。本研究旨在比较健康和子痫前期产妇的ONSD和LUSS。方法在本前瞻性观察性分析研究中，35名健康孕妇和子痫前期妇女分别接受超声检查ONSD和LUSS（12区肺技术）。注意到子痫前期的严重程度。进行ROC分析以获得ONSD和LUSS预测子痫前期并发症的临界值。p值为0.05被认为是显著的。结果子痫前期产妇的ONSD和LUSS平均高于正常产妇（5.06±0.46 vs 4.24±0.38 mm, P = 0.0001），（5 [1-12] vs 0 [0-1.5], P = 0.0001）。重度子痫前期患者的平均ONSD（5.36±0.32 mm）明显高于轻度子痫前期患者（4.71±0.35 mm; P < 0.0001）。重度子痫前期孕妇的LUSS高于轻度子痫前期孕妇和健康孕妇。然而，轻度子痫前期和健康孕妇的ONSD和LUSS没有差异。平均ONSD为4.65 mm， LUSS为2，预测子痫前期的敏感性为77.14%、68.57%，特异性为91.43%、85.71%，AUC分别为0.907、0.806。结论ONSD和LUSS可用于评估子痫前期的严重程度和并发症。早期发现可用于治疗，指导液体治疗和监测对治疗的反应。

{"title":"Estudio comparativo del diámetro de la vaina del nervio óptico y la puntuación Lung Ultrasound en parturientas sanas y con preeclampsia","authors":"A. Nagpal, M. Pandey, N. Kumar","doi":"10.1016/j.redar.2025.501773","DOIUrl":"10.1016/j.redar.2025.501773","url":null,"abstract":"<div><h3>Background</h3><div>Complications of preeclampsia include cerebral and pulmonary edema which strongly correlate with optic nerve sheath diameter (ONSD) and lung ultrasound score (LUSS) respectively. This study was conducted to compare ONSD and LUSS in healthy and preeclamptic parturients.</div></div><div><h3>Methods</h3><div>In this prospective observational analytical study, 35 healthy pregnant women and preeclamptic women each underwent ultrasound assessment for ONSD and LUSS (12 region lung technique). Severity of preeclampsia was noted. ROC analysis was performed to obtain a cutoff value for both ONSD and LUSS to predict complications of preeclampsia. A p-value of <.05 was considered significant.</div></div><div><h3>Results</h3><div>Mean ONSD and LUSS were higher in preeclamptic compared to healthy parturients (5.06±0.46 vs 4.24±0.38mm, <em>P</em>         <.0001). Women with severe preeclampsia had a higher LUSS as compared to the mild preeclamptics and healthy parturients. However, no difference in ONSD and LUSS between mild preeclamptics and healthy parturients was observed. A mean ONSD of >4.65mm and LUSS of >2 could predict preeclampsia with a sensitivity of 77.14% and 68.57% and specificity of 91.43% and 85.71% with an AUC of 0.907 and 0.806 respectively.</div></div><div><h3>Conclusion</h3><div>Both ONSD and LUSS can be used to assess severity and complications of preeclampsia. Early detection can be used to treat, guide fluid therapy and monitor response to treatment.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 8","pages":"Article 501773"},"PeriodicalIF":0.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134781","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 la dislocación laríngea tras discectomía y fusión cervical anterior 椎间盘切除术和前宫颈融合后咽喉脱位的麻醉管理

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-17 DOI: 10.1016/j.redar.2025.501801

C. Beltrán Piles, B. Monleón, R. Badenes, D. Tabares, P. Capilla

Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure with positive outcomes, but it is not without potentially serious complications for the patient.

We present the case of a patient who underwent ACDF and was found to have a cervical swelling prior to extubation. After a joint evaluation with the otolaryngology team, a suspicion of laryngeal structure dislocation was raised. A manual repositioning was performed prior to neuromuscular relaxation, and the patient was transferred intubated to the Recovery Unit due to a high risk of upper airway obstruction secondary to edema.

After 24 hours of monitoring under scheduled corticosteroid treatment, a planned and safe extubation was carried out, witnessed by the otolaryngology team.

前路颈椎椎间盘切除术和融合术（ACDF）是一种常见的外科手术，具有积极的结果，但对患者来说并非没有潜在的严重并发症。我们提出的情况下，患者接受ACDF，并发现有一个宫颈肿胀之前拔管。在与耳鼻喉科小组联合评估后，怀疑喉结构脱位。在神经肌肉放松之前进行手动重新定位，由于患者继发于水肿的上气道阻塞的高风险，患者被转移到恢复病房。在预定的皮质类固醇治疗下监测24小时后，在耳鼻喉科小组的见证下进行了计划和安全的拔管。

引用次数: 0

Evaluación anestésica y estrategias perioperatorias en los pacientes con hepatopatía y síndrome cardiohepático 肝病和心肝综合征患者的麻醉评估和术后策略

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-10 DOI: 10.1016/j.redar.2025.501735

A. Espinosa , J. Ripolles Melchor , M. Jain , R. Navarro-Perez , Y.A. Shadad , A. Malvido , A. Abad Gurumeta , R. Alharbi

Cardiohepatic syndrome (CHS) presents a significant challenge in perioperative management due to the complex interaction between liver and heart dysfunction. CHS, analogous to cardiorenal syndrome, encompasses various conditions where hepatic and cardiovascular pathologies exacerbate one another. Patients with chronic liver disease, cirrhosis, or heart failure often exhibit increased perioperative morbidity and mortality, necessitating tailored anesthetic strategies. A comprehensive understanding of CHS pathophysiology is crucial, as it informs risk assessment and guides perioperative management. Risk stratification tools such as the Child-Pugh and MELD scores are commonly used, but they have limitations in fully capturing perioperative risks. The updated STS 2024 model includes liver-specific parameters, improving risk prediction in cardiac surgeries. Additionally, the VOCAL-Penn score addresses gaps in traditional risk models, providing a more accurate assessment for patients with advanced liver disease.

Perioperative management focuses on minimizing hemodynamic stress and avoiding drugs metabolized by the liver. Agents like Remifentanil, Atracurium, and Esmolol are preferred for their minimal hepatic metabolism. Vasopressors such as terlipressin and vasopressin, which target the splanchnic circulation, improve hemodynamics in these patients. Within the Enhanced Recovery After Surgery (ERAS) framework, optimizing nutrition and fluid management is essential for reducing perioperative complications. Effective management of patients with CHS requires a multidisciplinary approach that integrates comprehensive risk assessment and individualized anesthetic strategies. This approach improves outcomes by reducing perioperative complications and mortality in this high-risk population.

由于肝功能障碍和心功能障碍之间复杂的相互作用，肝功能障碍综合征（CHS）在围手术期治疗中提出了重大挑战。CHS与心肾综合征类似，包括肝脏和心血管疾病相互加剧的各种情况。慢性肝病、肝硬化或心力衰竭患者围手术期的发病率和死亡率往往会增加，因此需要有针对性的麻醉策略。全面了解CHS的病理生理是至关重要的，因为它可以为风险评估和围手术期管理提供指导。通常使用的风险分层工具如Child-Pugh和MELD评分，但它们在充分捕捉围手术期风险方面存在局限性。更新后的STS 2024模型包括肝脏特异性参数，提高了心脏手术的风险预测。此外，VOCAL-Penn评分弥补了传统风险模型的不足，为晚期肝病患者提供了更准确的评估。围手术期管理的重点是尽量减少血流动力学压力和避免肝脏代谢的药物。瑞芬太尼、阿曲库铵和艾司洛尔等药物因其肝脏代谢最低而被首选。血管加压素，如特利加压素和血管加压素，靶向内脏循环，改善这些患者的血液动力学。在增强术后恢复（ERAS）框架下，优化营养和液体管理对于减少围手术期并发症至关重要。对CHS患者的有效管理需要多学科方法，包括综合风险评估和个体化麻醉策略。这种方法通过减少高危人群的围手术期并发症和死亡率来改善预后。

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引用次数: 0

Variante paraparética del síndrome de Guillain-Barré tras anestesia epidural 硬膜外麻醉后Guillain- Barre综合征的副病理变异

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2025-03-06 DOI: 10.1016/j.redar.2025.501775

F. Garvayo Fernández, A. López Olid, M. Pascual Salas, A. Sánchez López, L.M. Jiménez Rodriguez, F.J. Redondo Calvo

Epidural procedures are widely used as an analgesic adjunct in various surgeries, allowing for a reduction in the use of opioids and the avoidance of their side effects. According to the third National Audit Project in the United Kingdom, the incidence of serious complications related to epidural puncture is very low. A case is presented of a 66-year-old woman who underwent surgery for ovarian oncological pathology and developed, as a complication of neuroaxial anaesthesia in the postoperative period, a sensory-motor disorder limited to the lower limbs, compatible with the paraparesis variant of Guillain-Barré syndrome.

硬膜外手术在各种手术中广泛用作镇痛辅助手段，可减少阿片类药物的使用并避免其副作用。根据英国第三次国家审计项目，硬膜外穿刺相关的严重并发症发生率非常低。一例66岁的女性因卵巢肿瘤病理接受手术，作为术后神经轴性麻醉的并发症，发展为局限于下肢的感觉运动障碍，与格林-巴-罗综合征的麻痹变型相一致。

引用次数: 0