Pub Date : 2024-06-01DOI: 10.1016/j.redare.2024.04.006
I. Abramovich , I. Crisan , D. Sobreira Fernandes , S. De Hert , A. Lukic , G. Norte , B. Matias , M. Majić , J. Berger-Estilita
Background
Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe.
Methods
Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives.
Results
Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK.
Conclusion
This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.
{"title":"Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care","authors":"I. Abramovich , I. Crisan , D. Sobreira Fernandes , S. De Hert , A. Lukic , G. Norte , B. Matias , M. Majić , J. Berger-Estilita","doi":"10.1016/j.redare.2024.04.006","DOIUrl":"10.1016/j.redare.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe.</p></div><div><h3>Methods</h3><p>Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives.</p></div><div><h3>Results</h3><p>Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK.</p></div><div><h3>Conclusion</h3><p>This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759883","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}
Pub Date : 2024-06-01DOI: 10.1016/j.redare.2024.03.007
S. Cabezudo Ballesteros , P. Sanabria Carretero, F. Reinoso Barbero
Electrical impedance tomography (EIT) is a new method of monitoring non-invasive mechanical ventilation, at the bedside and useful in critically ill patients. It allows lung monitoring of ventilation and perfusion, obtaining images that provide information on lung function. It is based on the physical principle of impedanciometry or the body's ability to conduct an electrical current. Various studies have shown its usefulness both in adults and in pediatrics in respiratory distress syndrome, pneumonia and atelectasis in addition to pulmonary thromboembolism and pulmonary hypertension by also providing information on pulmonary perfusion, and may be very useful in perioperative medicine; especially in pediatrics avoiding repetitive imaging tests with ionizing radiation.
{"title":"Review of electrical impedance tomography in the pediatric patient","authors":"S. Cabezudo Ballesteros , P. Sanabria Carretero, F. Reinoso Barbero","doi":"10.1016/j.redare.2024.03.007","DOIUrl":"10.1016/j.redare.2024.03.007","url":null,"abstract":"<div><p>Electrical impedance tomography (EIT) is a new method of monitoring non-invasive mechanical ventilation, at the bedside and useful in critically ill patients. It allows lung monitoring of ventilation and perfusion, obtaining images that provide information on lung function. It is based on the physical principle of impedanciometry or the body's ability to conduct an electrical current. Various studies have shown its usefulness both in adults and in pediatrics in respiratory distress syndrome, pneumonia and atelectasis in addition to pulmonary thromboembolism and pulmonary hypertension by also providing information on pulmonary perfusion, and may be very useful in perioperative medicine; especially in pediatrics avoiding repetitive imaging tests with ionizing radiation.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066410","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}
Pub Date : 2024-06-01DOI: 10.1016/j.redare.2024.04.005
A. Placenti, F. Fratebianchi
Mean airway pressure (MAP) is the mean pressure generated in the airway during a single breath (inspiration + expiration), and is displayed on most anaesthesia and intensive care ventilators. This parameter, however, is not usually monitored during mechanical ventilation because it is poorly understood and usually only used in research. One of the main determinants of MAP is PEEP. This is because in respiratory cycles with an I:E ratio of 1:2, expiration is twice as long as inspiration. Although MAP can be used as a surrogate for mean alveolar pressure, these parameters differ considerably in some situations. Recently, MAP has been shown to be a useful prognostic factor for respiratory morbidity and mortality in mechanically ventilated patients of various ages. Low MAP has been associated with a lower incidence of 90-day mortality, shorter ICU stay, and shorter mechanical ventilation time. MAP also affects haemodynamics: there is evidence of a causal relationship between high MAP and low perfusion index, both of which are associated with poor prognosis in mechanically ventilated patients. Elevated MAP values have also been associated with high central venous pressure and lactate, which are indicative of ventilator-associated right ventricular failure and tissue hypoperfusion, respectively. MAP, therefore, is an important parameter to measure in clinical practice. The aim of this review has been to identify the determinants of MAP, the pros and cons of using MAP instead of traditional protective ventilation parameters, and the evidence that supports the use of MAP in clinical practice.
{"title":"Mean airway pressure as a parameter of lung-protective and heart-protective ventilation","authors":"A. Placenti, F. Fratebianchi","doi":"10.1016/j.redare.2024.04.005","DOIUrl":"10.1016/j.redare.2024.04.005","url":null,"abstract":"<div><p>Mean airway pressure (MAP) is the mean pressure generated in the airway during a single breath (inspiration + expiration), and is displayed on most anaesthesia and intensive care ventilators. This parameter, however, is not usually monitored during mechanical ventilation because it is poorly understood and usually only used in research. One of the main determinants of MAP is PEEP. This is because in respiratory cycles with an I:E ratio of 1:2, expiration is twice as long as inspiration. Although MAP can be used as a surrogate for mean alveolar pressure, these parameters differ considerably in some situations. Recently, MAP has been shown to be a useful prognostic factor for respiratory morbidity and mortality in mechanically ventilated patients of various ages. Low MAP has been associated with a lower incidence of 90-day mortality, shorter ICU stay, and shorter mechanical ventilation time. MAP also affects haemodynamics: there is evidence of a causal relationship between high MAP and low perfusion index, both of which are associated with poor prognosis in mechanically ventilated patients. Elevated MAP values have also been associated with high central venous pressure and lactate, which are indicative of ventilator-associated right ventricular failure and tissue hypoperfusion, respectively. MAP, therefore, is an important parameter to measure in clinical practice. The aim of this review has been to identify the determinants of MAP, the pros and cons of using MAP instead of traditional protective ventilation parameters, and the evidence that supports the use of MAP in clinical practice.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767097","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}
Pub Date : 2024-06-01DOI: 10.1016/j.redare.2024.04.007
G. Laguna , F. Suárez-Sipmann , G. Tusman , J. Ripollés , O. Díaz-Cambronero , R. Pujol , E. Rivas , I. Garutti , R. Mellado , J. Vallverdú , A. Jacas , A. Fervienza , R. Marrero , J. Librero , J. Villar , C. Ferrando
Background
Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse.
Methods
Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH2O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis.
Discussion
The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.
{"title":"Rationale and study design for an Individualized PeriopeRative Open lung VEntilatory approach in Emergency Abdominal Laparotomy/scopy: study protocol for a prospective international randomized controlled trial","authors":"G. Laguna , F. Suárez-Sipmann , G. Tusman , J. Ripollés , O. Díaz-Cambronero , R. Pujol , E. Rivas , I. Garutti , R. Mellado , J. Vallverdú , A. Jacas , A. Fervienza , R. Marrero , J. Librero , J. Villar , C. Ferrando","doi":"10.1016/j.redare.2024.04.007","DOIUrl":"10.1016/j.redare.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse.</p></div><div><h3>Methods</h3><p>Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH<sub>2</sub>O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis.</p></div><div><h3>Discussion</h3><p>The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759331","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}
Pub Date : 2024-06-01DOI: 10.1016/j.redare.2024.02.018
J. Llau García, J. Moreno Pachón, E. Mateo Rodríguez, J. De Andrés Ibáñez
{"title":"Intracardiac mass","authors":"J. Llau García, J. Moreno Pachón, E. Mateo Rodríguez, J. De Andrés Ibáñez","doi":"10.1016/j.redare.2024.02.018","DOIUrl":"10.1016/j.redare.2024.02.018","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998754","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}
Pub Date : 2024-05-31DOI: 10.1016/j.redare.2024.05.006
L Madrid-Vázquez, R Casans-Francés, M A Gómez-Ríos, M L Cabrera-Sucre, P P Granacher, L E Muñoz-Alameda
Purpose: To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters.
Methods: This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values.
Results: We recruited 400 patients. Cormack-Lehanne patients≥III had higher age, BMI, cervical circumference, Mallampati class membership≥III, and bite test≥II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the "Classic Model" achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models.
Conclusions: The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development.
{"title":"Machine learning models based on ultrasound and physical examination for airway assessment.","authors":"L Madrid-Vázquez, R Casans-Francés, M A Gómez-Ríos, M L Cabrera-Sucre, P P Granacher, L E Muñoz-Alameda","doi":"10.1016/j.redare.2024.05.006","DOIUrl":"10.1016/j.redare.2024.05.006","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters.</p><p><strong>Methods: </strong>This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values.</p><p><strong>Results: </strong>We recruited 400 patients. Cormack-Lehanne patients≥III had higher age, BMI, cervical circumference, Mallampati class membership≥III, and bite test≥II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the \"Classic Model\" achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models.</p><p><strong>Conclusions: </strong>The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development.</p><p><strong>Clinical registry: </strong>ClinicalTrials.gov: NCT04816435.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201344","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}
Pub Date : 2024-05-29DOI: 10.1016/j.redare.2024.05.005
A Soto Sánchez, O Cano Valderrama, I Vilela Ferrer, N Díaz Jiménez, M Hernández Barroso, P L Bravo García, G Hernández Hernández, J J Balanzá
Introduction: Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation.
Methods: The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected.
Results: Not avaliable until the end of the study.
Conclusions: The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.
简介痔疮是最常见的肛肠疾病,发病率占成年人的 44%。最有效的治疗方法是手术,但术后疼痛率也最高,在最初的 24-48 小时内,中度至重度疼痛率为 30-40%。因此,必须采取措施改善这种情况,例如使用局麻药进行阴部神经阻滞。然而,阴部神经的多变性有时会导致阻滞效果不佳,因此需要寻求神经定位方法来提高成功率。本研究的主要目的是比较在解剖学参考和神经刺激引导下进行阴股神经阻滞的痔切除术患者术后即刻(24 小时)的疼痛情况:本项目拟在常规临床实践条件下进行单中心、三盲、随机临床疗效试验。西班牙一家三级医院将纳入 18 岁以上的痔疮患者,他们都是药物治疗难治性痔疮、无症状的 III-IV 级和 II 级痔疮患者,这些患者对保守治疗无效,而且是主要门诊手术的手术补助对象。将收集人口统计学变量、痔疮病理学变量、手术细节、术前口头数字疼痛量表和手术并发症:结论:阴部神经阻滞引导下的痔疮治疗效果显著:尽管神经刺激器的使用尚未得到充分研究,但在解剖标志引导下进行的阴部神经阻滞已被证明有助于控制痔切除术后的疼痛,我们相信它可能会改善手术效果。
{"title":"Protocol of a clinical trial on the effectiveness of pudendal nerve block with and without neurostimulation in reducing posthemorroidectomy pain.","authors":"A Soto Sánchez, O Cano Valderrama, I Vilela Ferrer, N Díaz Jiménez, M Hernández Barroso, P L Bravo García, G Hernández Hernández, J J Balanzá","doi":"10.1016/j.redare.2024.05.005","DOIUrl":"10.1016/j.redare.2024.05.005","url":null,"abstract":"<p><strong>Introduction: </strong>Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation.</p><p><strong>Methods: </strong>The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected.</p><p><strong>Results: </strong>Not avaliable until the end of the study.</p><p><strong>Conclusions: </strong>The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184977","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}
Pub Date : 2024-05-25DOI: 10.1016/j.redare.2024.05.003
A Alegre Cortés, A Bilbao Ares, A Pola Jiménez, Y Abaurrea Díaz, S Fernández Alonso, M Salvador Bravo
The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.
{"title":"Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge.","authors":"A Alegre Cortés, A Bilbao Ares, A Pola Jiménez, Y Abaurrea Díaz, S Fernández Alonso, M Salvador Bravo","doi":"10.1016/j.redare.2024.05.003","DOIUrl":"10.1016/j.redare.2024.05.003","url":null,"abstract":"<p><p>The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157678","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}
Pub Date : 2024-05-25DOI: 10.1016/j.redare.2024.05.004
C A Sanchis Veryser, J M Esparza Miñana, J V Català Ripoll
Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain. The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.
至少从 Google Scholar、Clinical Trials、PubMed 和 Cochrane 数据库收集的信息来看,对药用大麻治疗急性术后疼痛疗效的怀疑是有道理的。尽管大麻素在治疗各种病症方面已显示出疗效,但在急性术后疼痛方面尚未显示出疗效。有关这一主题的研究成果不断涌现,确实在这方面带来了些许希望;然而,所采用的多种方法阻碍了得出明确结论的前景。考虑到这一问题的现状,本文不会对含有大麻素化合物的药物在急性术后疼痛治疗中的作用做出肯定或否定的表态。
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Pub Date : 2024-05-01DOI: 10.1016/j.redare.2024.02.007
U.A. López González , D. Bautista Rentero , M. Crespo Gómez , P. Cárcamo Ibarra , A.M. Míguez Santiyán
Background
Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it.
Objective
To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU.
Design
Retrospective longitudinal study.
Ambit
Intensive care unit of a tertiary hospital.
Patients
People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019.
Interventions
None. This is an observational study.
Variables of interest
Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays.
Results
Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients.
Conclusions
Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.
{"title":"Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital","authors":"U.A. López González , D. Bautista Rentero , M. Crespo Gómez , P. Cárcamo Ibarra , A.M. Míguez Santiyán","doi":"10.1016/j.redare.2024.02.007","DOIUrl":"10.1016/j.redare.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it.</p></div><div><h3>Objective</h3><p>To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU.</p></div><div><h3>Design</h3><p>Retrospective longitudinal study.</p></div><div><h3>Ambit</h3><p>Intensive care unit of a tertiary hospital.</p></div><div><h3>Patients</h3><p>People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019.</p></div><div><h3>Interventions</h3><p>None. This is an observational study.</p></div><div><h3>Variables of interest</h3><p>Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays.</p></div><div><h3>Results</h3><p>Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients.</p></div><div><h3>Conclusions</h3><p>Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718190","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}