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Usefulness of the spectral density matrix in the dosing of halogenated hypnotics 光谱密度矩阵在卤代催眠药剂量中的用途。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.03.002
E. Sandín-López, A. Fernández-López, B. Fernández-Torres
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引用次数: 0
Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery 在接受腹腔镜结肠手术的患者中使用肺泡扩张操作的术中效果。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.03.006
R. Mato-Búa, A. Prado-Rodríguez, D. López-López, P. Rama-Maceiras, N. Molins-Gauna, F. Álvarez-Refojo

Introduction

Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact.

Methods

Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min.

Results

Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3−117.8) mmHg before to 60.7 (29.6−91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1–39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5−53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied.

Conclusion

In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.

导言:在全身麻醉下接受腹腔镜腹部手术的患者中,肺部偏流很常见,这会增加围手术期呼吸系统并发症的风险。肺泡募集操作(ARM)可用于打开有肺偏流的肺实质,但其益处的持续时间尚未明确确定。本研究的目的是确定腹腔镜结肠手术中肺泡扩张术的有效性、反应持续时间及其对血流动力学的影响:研究纳入了 25 名接受腹腔镜结肠手术的患者。麻醉诱导和腹腔积气手术开始后,进行 ARM,然后确定最佳 PEEP。在操作前和随后的 90 分钟内定期分析呼吸力学和气体交换变量以及血流动力学参数:结果:三名患者因手术原因被排除在外。肺泡动脉血氧梯度从操作前的 94.3 (62.3-117.8) mmHg 降至操作后的 60.7 (29.6-91.0) mmHg(P < .05)。这一差异在 90 分钟的研究过程中一直保持不变。呼吸系统的动态顺应性从操作前的 31.3 ml/cmH2O(26.1-39.2)升至操作后的 46.1 ml/cmH2O(37.5-53.5)(P < .05)。这一差异保持了 60 分钟。研究中未发现任何血流动力学变量发生重大变化:结论:对于接受腹腔镜结肠手术的患者,术中进行 ARM 可改善呼吸系统的力学和氧合,而不会对血流动力学造成影响。这些操作的益处可持续至少一小时。
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引用次数: 0
Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study 使用胸腔积液含量预测大腹部手术后的体液平衡和术后肺部并发症:一项观察性研究。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.03.005
P. Martín-Serrano , E. Alday-Muñoz , A. Planas-Roca , E. Martín-Pérez

Background and objectives

The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyse the association between the variation in TFC values (TFCd0%) at 24 h postoperatively, postoperative fluid balance, and postoperative pulmonary complications.

Material and methods

Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and fluid balance.

Results

50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3–37.5] and was correlated at r = 0.44 with the postoperative balance of 677 ml [IQR: 125.5−1,412]. Increased TFC was related to a higher risk of atelectasis (OR = 1.24) and pulmonary congestion (OR = 1.3).

Conclusions

TFCd0% measured 24 h after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.

背景和目的:体液过多的有害影响经常表现在肺部。胸腔积液含量(TFC)是 STARLINGTM 生物反应监测仪提供的一个变量,代表胸腔积液的总量。目的是分析术后 24 小时内 TFC 值(TFCd0%)的变化、术后体液平衡和术后肺部并发症之间的关联:前瞻性分析观察研究。研究对象包括在一家三级教学医院接受腹部大手术的患者。在手术过程中和术后 24 小时内,使用 STARLINGTM 监测器对患者进行监测。STARLINGTM 测量 TFC 及其在围手术期不同阶段的变化。进行了连续肺部超声检查,并记录了术后肺部并发症。采用 Logistic 回归预测肺不张和肺充血的发生率。计算皮尔逊相关系数以验证 TFC 与体液平衡之间的关联:对 50 名患者进行了分析。术后第一天早上测量的 TFCd0% 中位数增加了 27.1% [IQR:20.3-37.5],与术后 677 毫升 [IQR:125.5-1,412] 的体液平衡相关,r = 0.44。TFC增加与发生肺不张(OR = 1.24)和肺充血(OR = 1.3)的风险较高有关:结论:术后 24 小时测量的 TFCd0% 与术后体液平衡呈中度相关性。结论:术后 24 小时测量的 TFCd0% 与术后体液平衡呈中度相关性,其增加是出现术后肺部并发症的风险因素。
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引用次数: 0
Left side clot in transit in double-lung transplantation diagnosticated by transesophageal echocardiography: what’s next? 经食道超声心动图诊断双肺移植术中左侧血栓形成:下一步是什么?
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2023.12.001
D. Perez-Ajami , P. Carmona García , I. Zarragoikoetxea Jauregui , G. Sales Badía , P. Argente Navarro

A 61-year-old man with no predisposition to thrombosis underwent sequential double lung transplantation without extracorporeal membrane oxygenation (ECMO) support due to terminal stage COPD. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography study was performed to check the pulmonary venous anastomosis. The study showed a large, heterogeneous, dense, hyperechoic free-floating mass in the left atrium compatible with a clot in transit from the pulmonary circulation. The surgical team were notified of this finding so that they could reopen the anastomosis and remove the clot to prevent a major complication. There were no clinical manifestations when the patient was awakened.

一名无血栓形成倾向的 61 岁男子因慢性阻塞性肺疾病晚期接受了顺序双肺移植手术,但未接受体外膜氧合(ECMO)支持。植入双肺并再灌注后,进行了全面的经食道超声心动图检查,以检查肺静脉吻合情况。检查结果显示,左心房内有一个巨大、异质、致密、高回声的游离漂浮肿块,与肺循环中的血栓相吻合。他们将这一发现通知了手术团队,以便重新打开吻合口并取出血块,防止出现重大并发症。患者苏醒后没有任何临床表现。
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引用次数: 0
Acute pulmonary oedema secondary to intravascular absorption syndrome during hysteroscopy: A case report 宫腔镜手术中血管内吸收综合征继发急性肺水肿:病例报告
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2023.04.001
F.M. Colás Borrás , C. Subirá Alsina , E. Tria Galera , M.C. de la Torre Terrón , I. Martínez De Lagrán Zurbano

Hysteroscopy is an exploratory endoscopic technique that studies the interior of the uterine cavity and the endocervical canal. Various fluids, such as physiological saline, are used to optimise visualisation of the internal structures during this procedure. A rare complication of hysteroscopy is fluid overload, which can be associated with intravascular absorption syndrome, usually after lengthy procedures or tissue dissection. There are no data on the incidence and prevalence of this syndrome, and few cases involving physiological saline solution have been reported. We present a case of hysteroscopic myomectomy complicated by vascular absorption syndrome, which gave rise to acute pulmonary oedema that required admission to the intensive care unit.

宫腔镜检查是一种探索性内窥镜技术,用于研究子宫腔内部和宫颈内口。在此过程中,会使用生理盐水等各种液体来优化内部结构的可视化。宫腔镜检查的一个罕见并发症是液体超负荷,这可能与血管内吸收综合征有关,通常发生在冗长的手术或组织解剖之后。目前还没有关于这种综合征的发生率和流行率的数据,涉及生理盐水的病例报道也很少。我们介绍了一例宫腔镜子宫肌瘤切除术并发血管吸收综合征的病例,该病例导致急性肺水肿,需要入住重症监护室。
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引用次数: 0
Airway guidelines: Addressing the gaps 气道指南:缩小差距。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.01.008
J.A. Law , G. Kovacs
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引用次数: 0
Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I 西班牙麻醉、复苏和疼痛治疗学会 (SEDAR)、西班牙急诊和急救医学学会 (SEMES) 和西班牙耳鼻咽喉头颈外科学会 (SEORL-CCC) 困难气道处理指南。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.02.001
M.Á. Gómez-Ríos , J.A. Sastre , X. Onrubia-Fuertes , T. López , A. Abad-Gurumeta , R. Casans-Francés , D. Gómez-Ríos , J.C. Garzón , V. Martínez-Pons , M. Casalderrey-Rivas , M.Á. Fernández-Vaquero , E. Martínez-Hurtado , R. Martín-Larrauri , L. Reviriego-Agudo , U. Gutierrez-Couto , J. García-Fernández , A. Serrano-Moraza , L.J. Rodríguez Martín , C. Camacho Leis , S. Espinosa Ramírez , P. Charco-Mora

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

西班牙麻醉、复苏和疼痛治疗学会 (SEDAR)、西班牙急诊医学学会 (SEMES) 和西班牙耳鼻咽喉头颈外科学会 (SEORL-CCC) 的气道管理分会推出了《成人患者困难气道综合管理指南》。其原则侧重于人的因素、危急情况下决策的认知过程,以及优化策略应用的进展,以保持充分的肺泡氧合,从而提高安全性和护理质量。该文件提供了以证据为基础的建议、理论教育工具和实施工具,主要是认知辅助工具,适用于麻醉学、危重症护理、急诊和院前医学领域的气道管理。为此,我们按照 PRISMA-R 指南进行了广泛的文献检索,并采用 GRADE 方法进行了分析。根据 GRADE 方法制定了建议。对于证据质量较低的部分,则通过德尔菲问卷调查达成共识,根据专家意见提出建议。
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引用次数: 0
Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II 西班牙麻醉、复苏和疼痛治疗学会 (SEDAR)、西班牙急诊和急救医学学会 (SEMES) 和西班牙耳鼻咽喉头颈外科学会 (SEORL-CCC) 困难气道处理指南。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.02.002
M.Á. Gómez-Ríos , J.A. Sastre , X. Onrubia-Fuertes , T. López , A. Abad-Gurumeta , R. Casans-Francés , D. Gómez-Ríos , J.C. Garzón , V. Martínez-Pons , M. Casalderrey-Rivas , M.Á. Fernández-Vaquero , E. Martínez-Hurtado , R. Martín-Larrauri , L. Reviriego-Agudo , U. Gutierrez-Couto , J. García-Fernández , A. Serrano-Moraza , L.J. Rodríguez Martín , C. Camacho Leis , S. Espinosa Ramírez , P. Charco-Mora

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

西班牙麻醉、复苏和疼痛治疗学会 (SEDAR)、西班牙急诊医学学会 (SEMES) 和西班牙耳鼻咽喉头颈外科学会 (SEORL-CCC) 的气道管理分会推出了《成人患者困难气道综合管理指南》。其原则侧重于人的因素、危急情况下决策的认知过程,以及优化策略应用的进展,以保持充分的肺泡氧合,从而提高安全性和护理质量。该文件提供了以证据为基础的建议、理论教育工具和实施工具,主要是认知辅助工具,适用于麻醉学、危重症护理、急诊和院前医学领域的气道管理。为此,我们按照 PRISMA-R 指南进行了广泛的文献检索,并采用 GRADE 方法进行了分析。根据 GRADE 方法制定了建议。对于证据质量较低的部分,则通过德尔菲问卷调查达成共识,根据专家意见提出建议。
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引用次数: 0
Negative-Pressure Pulmonary Edema (NPPE) 负压肺水肿(NPPE)。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.03.001
B. Estero Serrano de la Cruz, D. Jarast Olivari, P. Ramos Curado, M. Echevarría Moreno
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引用次数: 0
Adding intrathecal midazolam to local anesthetics improves sensory and motor block and reduces pain score without increasing side effects in lower limb surgeries: A meta-analysis and systematic review 在局麻药中加入鞘内咪达唑仑可改善下肢手术中的感觉和运动阻滞并降低疼痛评分,同时不会增加副作用:荟萃分析和系统综述。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2023.12.006
A.U. Huda , M.Z. Mughal

This meta-analysis was done to investigate the role of intrathecal midazolam in lower limb surgeries regarding prolongation of spinal block, postoperative pain control and associated side effects. The included studies reported onset and duration of sensory and motor block, time to first request analgesia, 24 h opioid consumption, postoperative pain control, and associated side effects following use of intrathecal midazolam for lower limb surgeries. This review was performed following the PRISMA guidelines and using the online databases, Medline, Science Direct, Google scholar and Cochrane library. We registered this review with the PROSPERO database (ID-CRD42022346361) in August 2022. A total of 10 randomised controlled trials were included in this meta-analysis.

Our results showed patients receiving 1 mg intrathecal midazolam showed significantly faster onset of sensory block [P = .001 (CI: −0.98, −0.31)]. Duration of sensory and motor block were also significantly prolonged in intrathecal midazolam group [P < .00001 (CI: 18.08, 39.12), P = .002 (CI: 0.45, 2). Intrathecal midazolam also increased the time to first request analgesia [P = .0003, (CI: 1.22, 4.14)]. Pain scores at 4 and 12 h postoperatively were significantly lower in patients receiving intrathecal midazolam [P = .00001 (CI: −1.20, −0.47) and P = .05 (CI: −0.52, −0.01) respectively]. In conclusion, the addition of intrathecal midazolam to local anesthetics in lower limb surgeries results in early onset of sensory and motor block. It also increases the duration of sensory and motor block. The time to first request analgesia is increased. VAS pain scores at 4 and 12 h postoperatively were also lower without any increased side effects.

这项荟萃分析旨在研究鞘内咪达唑仑在下肢手术中延长脊髓阻滞时间、术后疼痛控制和相关副作用方面的作用。纳入的研究报告了下肢手术中使用鞘内咪达唑仑后的感觉和运动阻滞起始时间和持续时间、首次要求镇痛的时间、24 小时阿片类药物消耗量、术后疼痛控制以及相关副作用。本综述遵循 PRISMA 指南,并使用了 Medline、Science Direct、Google scholar 和 Cochrane 图书馆等在线数据库。我们于 2022 年 8 月在 PROSPERO 数据库(ID-CRD42022346361)中注册了本综述。本次荟萃分析共纳入了 10 项随机对照试验。结果显示,接受 1 毫克鞘内咪达唑仑治疗的患者感觉阻滞起始时间明显更快[P = 0.001 (CI: -0.98, -0.31)]。鞘内咪达唑仑组患者的感觉和运动阻滞持续时间也明显延长 [P = 0.001 (CI: -0.98, -0.31)]。
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引用次数: 0
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Revista espanola de anestesiologia y reanimacion
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