Revista espanola de anestesiologia y reanimacion最新文献

Background: Chronic post-thoracic surgery pain (CPTSP) is a common complication that affects a patient's quality of life. Thoracotomy is associated with a high risk of chronic pain. Video-assisted thoracoscopy surgery (VATS) is a less traumatic option, but its role in the development of CPTSP is unclear. Regardless of the approach, there is evidence that demographic, psychosocial, or clinical factors also contribute to pain. The primary objective of this study is to determine the incidence of CPTSP in our hospital. The secondary objective is to identify possible risk factors related to CPTSP.

Method: Retrospective, single-centre observational study. The medical records of patients that underwent thoracic surgery between January 2016 and January 2020 were reviewed. The diagnosis of CPTSP was made by reviewing the postoperative visits 6 months after surgery. We analysed the relationship between CPTSP and a series of variables, and then constructed a multivariate binary logistic regression model with a significance level of p < 0.05.

Results: A total of 259 patients were analysed, 46.7% underwent VATS and 53.3% underwent thoracotomy. The overall incidence of CPTSP was 12%; 4.1% in VATS and 18.8% in thoracotomies. The multivariate model revealed that acute postoperative pain severe and a greater number of chest tubes were risk factors for CPTSP.

Conclusion: The incidence of CPTSP was 12% in our hospital. Patients with higher acute postoperative pain severe and several chest tubes were more likely to develop CPTSP.

Background: Despite advancements in anaesthesiology and regional anaesthesia, the three-dimensional spread of local anaesthetics is still poorly understood. This study investigates the pericapsular spread of radiopaque contrast after ultrasound-guided genicular nerve block in cadaveric knees using CT reconstruction. The aim is to assess the reproducibility, accuracy, and variability of this technique in order to improve safety and effectiveness.

Methods: We used a four-stage methodology that involved performing genicular nerve block on cadaveric knees, acquiring data using high-resolution ultrasound and helical CT imaging, performing segmentation and surface reconstruction of the CT images, and analysing the data quantitively to determine the spread of the infiltrate in each genicular nerve region. Coefficients of variation were calculated to estimate the spread and reproducibility of each genicular nerve block.

Results: Our results revealed significant variability in spread in all genicular nerve blocks, particularly around the recurrent genicular nerve. Despite this variability, the spread-particularly along the medial-lateral and anterior-posterior axes-showed moderate consistency. Furthermore, the regions covered by 80% of the spread closely matched the pericapsular distribution of the genicular nerves of the knee.

Conclusions: Notable variability in spread was observed in genicular nerve blocks, particularly around the recurrent genicular nerve. However, the spread showed moderate consistency and aligns closely with the pericapsular nerve distribution of the knee. Future studies should combine quantitative analysis with anatomical dissection to further investigate the involvement of the deep peroneal motor branch.

Anaesthesia for kidney transplant in a patient with severe mitral regurgitation is a real challenge given the need for judicious haemodynamic management to avoid pulmonary oedema and maximise reperfusion of the transplanted organ. This is the first experience described in the literature of continuous spinal anaesthesia in a patient with chronic severe mitral regurgitation undergoing cadaver donor kidney transplant. Transthoracic echocardiography monitoring was used during the procedure to avoid aggravating the patient's mitral regurgitation. Intraoperatively, 17.5 ml/kg of crystalloids were administered and no vasopressors were required. Continuous spinal anaesthesia preserved haemodynamics and graft perfusion during the procedure.

Introduction: Standard tracheal intubation performed in the operating room is based on direct laryngoscopy using a standard Macintosh laryngoscope. Several authors recommend the universal use of a video laryngoscope as the first option for all intubations, regardless of whether the patient has predictors of a difficult airway or not. We hypothesize that using the McGrath video laryngoscope as the first intubation option increases the frequency of patients with easy intubation, and decreases intubation-related complications.

Methods and analysis: The VIDEOLAR-SURGERY trial is a prospective, multicentre, open-label, interventional, before-after study. In the pre-implementation period (non-interventional phase, 6-9 months [2600 intubations]), 35 anaesthesiologists from 8 hospitals perform all tracheal intubations for an elective or urgent surgical procedure using the standard Macintosh direct laryngoscope as the first intubation option. During the implementation period (2 months), each anaesthesiologist is given a McGrath Mac video laryngoscope and trained in its use. During the post-implementation period (interventional-phase, 6-9 months [2600 intubations]), the 35 anaesthesiologists perform all tracheal intubations using a McGrath Mac video laryngoscope as the first intubation option. The main objective of this study is to evaluate whether the use of a McGrath Mac video laryngoscope as the first intubation option increases the percentage of patients with easy intubation compared with the standard Macintosh laryngoscope.

Ethics and dissemination: The study protocol was approved on 2 May 2023 by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2023-177), and was registered on the Clinicaltrials.gov clinical trials registry under No. NCT NCT05850260. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If video laryngoscopy improves easy intubation compared with Macintosh direct laryngoscopy in all operating room intubations, its use may well become standard practice, thereby decreasing the risks of intubation-related complications.

Introduction and objectives: The occurrence of a difficult airway during intubation is a critical event in anaesthesia. Despite the usefulness of clinical predictors, difficult intubation frequently arises unexpectedly. The aim of this study was to determine the utility of airway ultrasound in detecting these patients.

Materials and methods: This was a case-control study. The patients in the case group were identified from the registry of patients with reports of difficult laryngoscopy (Cormack III and IV). The controls were selected from among patients classed as Cormack I who underwent surgery under general anaesthesia. Fifty patients (25 cases and 25 controls) participated in the study. All patients underwent ultrasound to obtain 3 measurements: distance from the skin to the hyoid bone, distance from the skin to the epiglottis, and distance from the skin to the vocal cords.

Results: A skin-to-hyoid bone distance greater than 9.8 mm (50% of the sample) generated an odds ratio of 5.46 (p = 0.005); a skin-to-epiglottis distance greater than 21.3 mm (50% of the sample) generated an odds ratio of 6.62 (p = 0.002). There was no significant difference in the skin-to-vocal cords distance.

Conclusions: Ultrasound has proven to be a useful tool for predicting difficult laryngoscopy. Despite the low sensitivity of clinical predictors, they appear to improve the detection of patients with difficult laryngoscopy when integrated into predictive models alongside ultrasound values.

Introduction and objectives: Anaesthesia during surgery for moyamoya disease (MMD) has different effects on cerebral physiology. Both sevoflurane and propofol have cerebral protective effects, albeit with different mechanisms. We used near infrared spectroscopy (NIRS) to observe the effect of sevoflurane and propofol on rSO₂ in paediatric patients undergoing MMD surgery.

Materials and methods: We included paediatric patients ASA grade I aged between 1 and 18 years undergoing surgery for MMD over a period of 1 year (from 1 April 2018 to 1 April 2019). Patients were randomized to 2 groups: Group S (sevoflurane) and Group P (propofol). NIRS values were recorded at 5 time points: T1 (baseline) T2 (after preoxygenation), T3 (after induction), T4 (end of surgery), T5 (after extubation). One-way ANOVA was used for intra-group comparisons and two-way repeated measures ANOVA with Bonferroni correction were used for inter-group comparisons. P value <0.05 was considered significant.

Results: A total of 20 patients were included in the study. The average age was 10.5 ± 4.3 years. The mean baseline rSO₂ was 78.35 ± 10.58 and 77.95 ± 8.81 in the right and left hemispheres, respectively. In both groups, rSO₂ values increased between baseline and anaesthesia induction and fell slightly at the end of surgery. The inter-group analysis showed no statistically significant change between rSO₂ values.

Conclusion: Both sevoflurane and propofol maintain adequate rSO₂ levels in children undergoing surgery for MMD.

Clinical trial registration number: CTRI/2018/04/013229 registered on 12.04.2018.

Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) of unknown etiology, more prevalent in obese women of childbearing age. The management of IIH during pregnancy represents a multidisciplinary challenge, as medical treatment is contentious due to the foetal teratogenic risk, and the technically challenging placement of a ventriculoperitoneal shunt is hindered by the presence of the pregnant uterus. The goal of anaesthetic management during childbirth is to maintain hemodynamic stability, cerebral perfusion pressure, and cerebral tissue oxygenation, while avoiding abrupt fluctuations in intracranial pressure. The choice of anaesthetic technique is complex and depends on the assessment of risks and benefits associated with each technique, involving a decision between neuraxial anaesthesia and general anaesthesia. We present the case of a pregnant woman with rapidly progressing IIH, approached in a multidisciplinary manner, whose anaesthetic management was technically challenging, resulting in a favourable outcome without subsequent complications.