Revista espanola de anestesiologia y reanimacion最新文献

Background: Preoperative anaemia is a common finding in patients undergoing gastrectomy, and is frequently targeted in optimisation strategies. However, its independent association with postoperative complications remains unclear, and the prognostic value of redefining diagnostic thresholds has not been formally assessed.

Methods: This prospective substudy of the POWER 4 cohort included 742 patients undergoing elective gastrectomy for cancer. Anaemia was defined by WHO sex-specific thresholds (Hb <13 g/dL in men, <12 g/dL in women) and a universal threshold of <13 g/dL. Four subcohorts were analysed: A1 (WHO, full cohort), A2 (universal, full), B1 (WHO, untreated), B2 (universal, untreated). Multivariable logistic regression was used to assess associations with postoperative complications. Discrimination was evaluated using AUC, AIC/BIC, and Net Reclassification Improvement (NRI). Generalised additive models (GAMs) were used to explore continuous relationships between haemoglobin and risk.

Results: Anaemia prevalence was 38.0% with WHO thresholds and 52.4% with the universal threshold. In full-cohort models, anaemia was not independently associated with complications (A1 OR 0.92 [95% CI 0.60-1.41]; A2 OR 0.89 [0.59-1.36]). Model performance was similar (AUC 0.686). In untreated patients (n = 584), discrimination improved (B1 AUC 0.750; B2 AUC 0.743), but anaemia remained non-significant. NRI modestly favoured the universal threshold (A1/A2: 0.048; B1/B2: 0.072), with most reclassification occuring in intermediate risk groups. GAMs showed a smooth monotonic relationship without a clear inflection point.

Conclusion: Anaemia was not independently associated with postoperative complications. Redefining thresholds altered prevalence but did not improve prediction. Haemoglobin may be better used as part of an integrated perioperative risk assessment rather than a binary stratifier.

Background: Preanesthesia consultation can be an effective tool for reducing anxiety scores in patients scheduled for elective surgery. Anxiety can cause perioperative complications.

Objective: was to determine the impact of preanesthesia consultation on anxiety scores.

Patients and methods: A single-center, observational study was carried out, with a descriptive, cross-sectional design and primary source. The anxiety score assessed using the APAIS scale (Amsterdam Preoperative Anxiety and Information Scale) was evaluated in adult participants before and after the pre-anesthetic consultation during the period December 2024 to April 2025. Statistical analysis was performed using the Wilcoxon, McNemar and chi-square tests. A P value < 0.05 was considered significant.

Results: A total of 190 participants were interviewed, of whom 180 were ultimately analyzed; 76.7% were women, and the mean age was 41.6 years. The most frequent procedures were general surgery and gynecological procedures. 86.7% had previously received anaesthesia. The prevalence of pre-consultation anxiety was 68.3%, decreasing to 47.2% after the consultation (p = 0.001). All interviewees between the ages of 18 and 25 reported anxiety before the pre-anaesthesia consultation (p = 0.031). The anesthetic technique that generated the greatest fear was general anaesthesia (42.8%), with the most frequently reported cause being fear of death (15.6%).

Conclusion: Preoperative anxiety is highly prevalent, and preanesthetic consultation could be an effective intervention to significantly reduce it.

Pain in neonates, if not adequately treated, can lead to long-term neurological and behavioural consequences. Among the most frequent causes are intrapartum fractures. Although rare, rib fractures represent a diagnostic and therapeutic challenge. This article presents the case of a 36-week neonate with a left rib fracture who exhibited symptoms such as inconsolable crying, feeding refusal, and oxygen desaturation. An ultrasound-guided erector spinae plane block (ESPB) was performed, resulting in significant clinical improvement without complications. Although ESPB has been widely used in adults and older children for the management of thoracic pain, its application in neonates is scarcely documented. This technique offers advantages over other regional analgesic methods, as it is associated with fewer adverse effects and provides direct analgesia to the thoracic nerves. Its use is suggested as a safe and effective alternative, particularly in non-surgical settings.

Advanced airway management in pediatric anesthesia has undergone substantial development with the incorporation of emerging technologies and strategies tailored to the unique anatomy and physiology of children. This review provides a critical appraisal of the clinical utility of tools such as videolaryngoscopy, high-flow nasal cannula oxygen therapy, and supraglottic devices, as well as specific techniques including the Bailey maneuver, fiberoptic-assisted intubation, and one-lung ventilation. Relevant studies published up to March 2025 were identified through searches in PubMed, Embase, Scopus, and Web of Science. Current evidence supports the use of these resources to enhance safety and effectiveness in complex scenarios, underscoring the importance of individualized device selection and specialized training. The integration of these strategies into tailored protocols represents a key step toward optimizing airway management in pediatric patients.

Objectives: In patients with cervical spine injury, glottic visualization is difficult in the head-neutral position. The role of external laryngeal manoeuvres, such as backward-upward-rightward pressure (BURP) and jaw thrust in intubation outcomes remains unclear. We compared the effects of jaw thrust and BURP on the quality of glottic view with the head in a neutral position during C-MAC videolaryngoscopy.

Methods: In this self-controlled study, glottic view was assessed in 120 adult patients using a C-MAC videolaryngoscope with no manoeuvre, BURP, or jaw thrust. After induction, endotracheal intubation was performed according to Grupo allocation. Screenshots of the best glottic view were taken each time to assess the percentage of glottic opening (POGO) score, modified Cormack-Lehane (MCL) grade, and glottic opening area en píxeles cuadrados. Intubation times, ease of intubation, haemodynamics, and complications were also recorded.

Results: POGO scores (mean[DE]) were significantly higher with BURP (72.7[19.9]) and jaw thrust (60[26.3]) manoeuvres compared to no manoeuvre (25[26.9];P < 0.0001). Glottic opening area en píxeles cuadrados (P < 0.001) and MCL grades (P = 0.043) were considerably higher after the application of laryngeal manoeuvres. There were no significant differences in the duration of laryngoscopy and intubation times between Grupos; however, intubation was significantly easier with BURP (P = 0.021) and jaw thrust (P = 0.032).

Conclusion: External manoeuvres, such as BURP and jaw thrust, should improve glottic view during C-MAC videolaryngoscopy in patients with the head in a neutral position.

Background: In 2010, the World Health Organization (WHO) called for global implementation of Patient Blood Management (PBM) programs to optimize transfusion practices and reduce variability in blood utilization. This study examines the evolution of red cell, platelet, and plasma consumption in Iberia (Spain and Portugal), comparing trends within the region and with European benchmarks like the United Kingdom, Germany, and Italy.

Methods: National transfusion activity reports from Spain, Portugal, the United Kingdom (2011-2023) were analyzed. Key metrics included transfusion rates per 1,000 inhabitants for red cells, platelets, and fresh frozen plasma. Statistical analyses were performed using Kruskal-Wallis tests and ANOVA to identify differences between countries and over time.

Results: From 2011 to 2023, red cell transfusion rates decreased by 30% in the UK, 6% in Spain, and 15% in Portugal. Germany showed a modest decline, while Italy maintained stable rates exceeding 40 units per 1,000 inhabitants. Platelet and plasma consumption exhibited distinct patterns, with Portugal showing a steeper decline compared to Spain, and the UK maintaining the lowest overall rates. Platelet consume is clearly increasing.

Conclusions: The analysis reveals significant differences in blood component utilization across Iberia and Europe, reflecting varying levels of PBM adoption. Despite WHO and Council of Europe recommendations, Iberian countries lag behind the UK in reducing red cell transfusion rates. These findings underscore the need for uniform PBM implementation to harmonize practices and optimize resource use, not only Red Cell Concentrates. The creation of the Iberian task-force (section of the Ibero-American PBM Society (SIAPBM) could be an opportunity to create the necessary awareness in our countries and become a meeting point between America and Europe.