Revista espanola de anestesiologia y reanimacion最新文献_第7页

Airway management in thoracic surgery in a patient with right tracheal supernumerary bronchus 1例右气管多余支气管胸外科患者的气道管理。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501771

S. Moreno-Jurico , M. Roger , M. Ubré , G. Martínez-Pallí

引用次数: 0

The effect of structured proctoring and hypotension prediction index teaching on incidence and duration of intraoperative hypotension in patients undergoing major abdominal surgery: A comparative study of two monitoring systems 结构化监测及低血压预测指标教学对腹部大手术患者术中低血压发生率及持续时间的影响：两种监测系统的比较研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501803

J. Ripollés-Melchor , P. Fernández-Valdés-Bango , D. García-López , M. Olvera-García , J.L. Tomé-Roca , C.A. Vargas-Berenjeno , A. Ruiz-Escobar , A.B. Adell-Pérez , L. Carrasco-Sánchez , A. Abad-Gurumeta , J.V. Lorente , A.V. Espinosa , I. Jiménez-López , M.A. Valbuena-Bueno , M.I. Monge-García

Introduction

Intraoperative hypotension (IOH) is a commonly observed phenomenon during major abdominal surgery. The severity and duration of IOH have been identified as crucial factors in the development of these complications.

Methods

The study compares two groups of adult patients undergoing major abdominal surgery: one group received standard hemodynamic management using the Edwards Flotrac device, while the second group received hypotension prediction index duration, and severity of intraoperative hypotension in high-risk patients (HPI)-guided hemodynamic management, with anesthesiologists trained via a structured proctoring program. We retrospective analized prospectively gathered anonymized data from 6 Spanish centers during 2021−2022. The primary outcome measure was the time-weighted average of mean arterial pressure < 65 mmHg (MAP) during surgery (TWA MAP 65 mmHg). The secondary outcome measures included incidence of hypotensive episodes, total time with hypotension, and percentage of time spent in hypotension during surgery.

Results

A total of 607 patients were analyzed, 270 in the pre-proctoring group vs 337 in the post-proctoring group. The median TWA MAP 65 mmHg was 0.09 mm Hg (interquartile range (IQR), 0.00−0.31 mm Hg) post-proctoring group vs 0.37 mmHg (IQR, 0.08–1.01 mm Hg) in the pre-proctoring group, for a median difference of 0.19 mmHg (95% CI, 0.13−0.27 mmHg; P < .001), whereas the median TWA MAP < 55 mmHg was 0.00 mmHg (IQR, 0.00−0.01 mmHg) post-proctoring group vs 0.00 mmHg (IQR, 0.00−0.07 mm Hg) in the pre-proctoring group, 0 mmHg (95% CI, 0.0−0.02 mm Hg; P < .001).

Conclusions

A structured program in hemodynamic training based on the intraoperative use of the hemodynamic prediction index decreases the incidence.

术中低血压（IOH）是腹部大手术中常见的现象。IOH的严重程度和持续时间已被确定为这些并发症发生的关键因素。方法：研究比较两组接受腹部大手术的成年患者：一组使用Edwards Flotrac装置接受标准的血流动力学管理，而第二组接受低血压预测指数持续时间和高危患者术中低血压严重程度（HPI）指导的血流动力学管理，麻醉医师通过结构化的监护计划进行培训。我们回顾性分析了2021-2022年期间从6个西班牙中心收集的匿名数据。主要结局指标是手术期间平均动脉压< 65 mmHg （MAP）的时间加权平均值（TWA MAP 65 mmHg）。次要结局指标包括低血压发作的发生率、低血压总时间和手术期间低血压时间的百分比。结果：共分析607例患者，监护前组270例，监护后组337例。监护后组TWA MAP 65 mmHg中位数为0.09 mmHg（四分位数间距（IQR）， 0.00-0.31 mmHg），而监护前组为0.37 mmHg (IQR, 0.08-1.01 mmHg)，中位数差异为0.19 mmHg (95% CI, 0.13-0.27 mmHg；结论：基于术中血流动力学预测指标的结构化血流动力学训练方案可降低发生率。

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引用次数: 0

Anaesthesia evaluation and perioperative strategies in liver disease patients with cardiohepatic syndrome 肝病合并心肝综合征患者的麻醉评价及围手术期策略。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501735

Á. 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.

由于肝脏和心脏功能障碍之间复杂的相互作用，心肝综合征（CHS）给围术期管理带来了巨大挑战。心肝综合征与心肾综合征类似，包括肝脏和心血管病变相互加重的各种情况。慢性肝病、肝硬化或心力衰竭患者的围手术期发病率和死亡率通常会增加，因此有必要采取量身定制的麻醉策略。对 CHS 病理生理学的全面了解至关重要，因为它可以为风险评估提供信息并指导围术期管理。常用的风险分层工具有 Child-Pugh 评分和 MELD 评分，但它们在全面反映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，从而改善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，避免使用经肝脏代谢的药物。雷米芬太尼（Remifentanil）、阿曲库铵（Atracurium）和艾司洛尔（Esmolol）等药物的肝脏代谢作用最小，是首选药物。特利加压素和血管加压素等以脾脏循环为靶点的血管加压素可改善这些患者的血液动力学。在增强术后恢复（ERAS）框架内，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，其中包括全面的风险评估和个性化的麻醉策略。这种方法可以减少这类高危人群的围手术期并发症和死亡率，从而改善预后。

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引用次数: 0

A comparative study of optic nerve sheath diameter and Lung Ultrasound score in healthy and preeclampsia parturients 健康与子痫前期产妇视神经鞘直径及肺超声评分的比较研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.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 <0.05 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 < 0.0001) and [5 (1–12) vs 0 (0–1.5); p value <0.0001], 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 < 0.0001). Women with severe preeclampsia had a higher LUSS as compared to the mild preclamptics 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.

CTRI registration

CTRI/2019/12/022243 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=37940&EncHid=&userName=). IEC: LHMC/IEC/Thesis/2019/116 dated 29/10/2019.

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：在这项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。结果：子痫前期产妇的平均ONSD和LUSS高于正常产妇（5.06±0.46 vs 4.24±0.38 mm）（p = 4.65 mm）， LUSS预测子痫前期的敏感性分别为77.14%和68.57%，特异性分别为91.43%和85.71%，AUC分别为0.907和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。Ctri报名：Ctri /2019/12/022243 （https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=37940&EncHid=&userName=）。IEC: LHMC/IEC/Thesis/2019/116日期为2019年10月29日。

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引用次数: 0

Preliminary study: Changes in systolic volume index during Nuss surgery 初步研究：Nuss手术中收缩容积指数的变化。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501726

B. Cabeza Martín, M. García-Navlet, A. Melone, M. Arellano Pulido, E. Sanjuan, M. Hervías

Introduction

The surgical correction of the pectus excavatum (PE) is justified by the progressive cardiopulmonary involvement. There are few studies that analyze the hemodynamic changes during the intraoperative period.

Objectives

To describe the stroke volume index (SVI) changes during the intraoperative with the Nuss technique, through the monitoring of the invasive blood pressure curve (IAP).

Material and methods

A prospective observational study of pediatric patients undergoing Nuss surgery by right video-assisted thoracoscopy (VATS). By analyzing the IAP curve using the FloTrac monitor (Edwars®), the following dynamic parameters were evaluated: stroke volume index (SVI), cardiac index (CI), stroke volume variation (SVV). The dates were collected on 3 occasions: baseline, before bar placement (after preload optimization in search of the target IVS) and after bar placement.

Results

Were included 6 patients aged 14–16 years, 5/6 males. Five of six had cardiac MRI with decreased FEVD (33%–44%), 1/6 with FEVD 53%. At baseline, IVS and CI were decreased, 19−29 ml/lat/m² and 1.1−1.9 L/min/m². Two-Three overloads of volume were performed to reach target IVS (25−35 ml/lat/m²), with an increase of 0%–75%. After the placement of the bar, the IVS was increased by 8%–42% (35−40 ml/lat/m²) with respect to the target IVS, with normalization of the CI (2.5−3.5 L/min/m²).

Conclusions

PE produces compression of the VD, with descent of the IVS. After the placement of the Nuss bar, through the analysis of the IAP, we can objectifield an increase in the IVS and normalization of the CI.

介绍：手术矫正漏斗胸（PE）是合理的进行性心肺累及。对术中血流动力学变化进行分析的研究较少。目的：通过监测有创血压曲线（IAP），描述Nuss技术术中脑卒中容积指数（SVI）的变化。材料与方法：采用右胸腔镜（VATS）对小儿Nuss手术患者进行前瞻性观察研究。通过使用FloTrac监护仪（Edwars®）分析IAP曲线，评估以下动态参数：脑卒中容积指数（SVI）、心脏指数（CI）、脑卒中容积变化（SVV）。数据在3种情况下收集：基线，在bar放置之前（在搜索目标IVS的预加载优化之后）和bar放置之后。结果：纳入6例患者，年龄14 ~ 16岁，男性5/6。5 /6的心脏MRI显示FEVD下降（33-44%），1/6的心脏MRI显示FEVD下降53%。基线时IVS和CI降低，分别为19 ~ 29 ml/lat/m2和1.1 ~ 1.9 L/min/m2。为达到目标IVS (25-35 ml/lat/m2)，进行2 -3次超载，增加0-75%。放置棒后，IVS相对于目标IVS增加8%-42% (35-40 ml/lat/m2)， CI正常化（2.5-3.5 L/min/m2）。结论：PE使VD受压，IVS下降。放置Nuss条后，通过对IAP的分析，我们可以客观地看到IVS的增加和CI的正常化。

{"title":"Preliminary study: Changes in systolic volume index during Nuss surgery","authors":"B. Cabeza Martín, M. García-Navlet, A. Melone, M. Arellano Pulido, E. Sanjuan, M. Hervías","doi":"10.1016/j.redare.2025.501726","DOIUrl":"10.1016/j.redare.2025.501726","url":null,"abstract":"<div><h3>Introduction</h3><div>The surgical correction of the pectus excavatum (PE) is justified by the progressive cardiopulmonary involvement. There are few studies that analyze the hemodynamic changes during the intraoperative period.</div></div><div><h3>Objectives</h3><div>To describe the stroke volume index (SVI) changes during the intraoperative with the Nuss technique, through the monitoring of the invasive blood pressure curve (IAP).</div></div><div><h3>Material and methods</h3><div>A prospective observational study of pediatric patients undergoing Nuss surgery by right video-assisted thoracoscopy (VATS). By analyzing the IAP curve using the FloTrac monitor (Edwars®), the following dynamic parameters were evaluated: stroke volume index (SVI), cardiac index (CI), stroke volume variation (SVV). The dates were collected on 3 occasions: baseline, before bar placement (after preload optimization in search of the target IVS) and after bar placement.</div></div><div><h3>Results</h3><div>Were included 6 patients aged 14–16 years, 5/6 males. Five of six had cardiac MRI with decreased FEVD (33%–44%), 1/6 with FEVD 53%. At baseline, IVS and CI were decreased, 19−29 ml/lat/m<sup>2</sup> and 1.1−1.9 L/min/m<sup>2</sup>. Two-Three overloads of volume were performed to reach target IVS (25−35 ml/lat/m<sup>2</sup>), with an increase of 0%–75%. After the placement of the bar, the IVS was increased by 8%–42% (35−40 ml/lat/m<sup>2</sup>) with respect to the target IVS, with normalization of the CI (2.5−3.5 L/min/m<sup>2</sup>).</div></div><div><h3>Conclusions</h3><div>PE produces compression of the VD, with descent of the IVS. After the placement of the Nuss bar, through the analysis of the IAP, we can objectifield an increase in the IVS and normalization of the CI.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 8","pages":"Article 501726"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133396","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

Feasibility and acceptability of an app for monitoring acute postoperative pain in major outpatient surgery 应用程序监测门诊大手术术后急性疼痛的可行性和可接受性。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501854

S. Vitale, M.I. Fábregas Blanco, P. Ricós Bugeda, R. Torruella Turró, H. Fernández Fernández, E. Reñé de Antonio

Introduction

By allowing intensive monitoring of acute postoperative pain (APP), mHealth could be clinically useful in contexts with a high prevalence of moderate to severe APP.

Objective

The primary objective was to evaluate the feasibility and acceptability of an app for monitoring DAP. The secondary objectives were to describe DAP during the first week of the postoperative period, to analyse factors associated with it and to assess adherence and satisfaction with analgesic treatment.

Materials and methods

Observational and prospective study in patients undergoing surgery under major ambulatory surgery (MAS) regimen who reported the intensity of DAP for 7 days with an app. We determined the proportions that agreed to use it and who made trajectories of DAP ≥5 days, the pattern of use of the app and the results. Risk factors associated with DAP were analyzed. Satisfaction with DAP control and adherence to the analgesic regimen were assessed through surveys.

Results

53.4% of patients measured their DAP with the app. The main reason for exclusion was technological limitations (75.1%). An uninterrupted DAP trajectory of ≥5 days was traced in 74.4% of patients and a high prevalence of moderate to severe DAP was observed, as well as a high proportion of patients who adhered little or not at all and were little or not at all satisfied with the analgesic results obtained.

Conclusions

Monitoring DAP with the app used was feasible and accepted by patients. It provided clinically useful information by allowing DAP trajectories to be traced and detecting high proportions of patients with moderate to severe DAP, dissatisfied with the analgesic results obtained and non-compliant with analgesic guidelines.

导语：通过对急性术后疼痛（APP）进行强化监测，移动医疗在中重度APP高发的情况下具有临床应用价值。目的：主要目的是评估应用程序监测DAP的可行性和可接受性。次要目的是描述术后第一周的DAP，分析与之相关的因素，并评估镇痛治疗的依从性和满意度。材料和方法：观察性和前瞻性研究，在大门诊手术（MAS）方案下接受手术的患者中，使用app报告了7天的DAP强度。我们确定了同意使用该应用程序的比例，以及DAP≥5天的轨迹，应用程序的使用模式和结果。分析与DAP相关的危险因素。通过调查评估患者对DAP控制的满意度和对镇痛方案的依从性。结果：53.4%的患者使用app测量DAP，排除的主要原因是技术限制（75.1%）。74.4%的患者追踪到不间断的DAP轨迹≥5天，观察到中重度DAP的高患病率，以及高比例的患者很少或根本没有坚持，对所获得的镇痛效果很少或根本不满意。结论：应用app监测DAP是可行的，且为患者所接受。它提供了临床有用的信息，允许追踪DAP轨迹，并检测出中重度DAP患者的高比例，不满意获得的镇痛结果和不遵守镇痛指南。

{"title":"Feasibility and acceptability of an app for monitoring acute postoperative pain in major outpatient surgery","authors":"S. Vitale, M.I. Fábregas Blanco, P. Ricós Bugeda, R. Torruella Turró, H. Fernández Fernández, E. Reñé de Antonio","doi":"10.1016/j.redare.2025.501854","DOIUrl":"10.1016/j.redare.2025.501854","url":null,"abstract":"<div><h3>Introduction</h3><div>By allowing intensive monitoring of acute postoperative pain (APP), mHealth could be clinically useful in contexts with a high prevalence of moderate to severe APP.</div></div><div><h3>Objective</h3><div>The primary objective was to evaluate the feasibility and acceptability of an app for monitoring DAP. The secondary objectives were to describe DAP during the first week of the postoperative period, to analyse factors associated with it and to assess adherence and satisfaction with analgesic treatment.</div></div><div><h3>Materials and methods</h3><div>Observational and prospective study in patients undergoing surgery under major ambulatory surgery (MAS) regimen who reported the intensity of DAP for 7 days with an app. We determined the proportions that agreed to use it and who made trajectories of DAP ≥5 days, the pattern of use of the app and the results. Risk factors associated with DAP were analyzed. Satisfaction with DAP control and adherence to the analgesic regimen were assessed through surveys.</div></div><div><h3>Results</h3><div>53.4% of patients measured their DAP with the app. The main reason for exclusion was technological limitations (75.1%). An uninterrupted DAP trajectory of ≥5 days was traced in 74.4% of patients and a high prevalence of moderate to severe DAP was observed, as well as a high proportion of patients who adhered little or not at all and were little or not at all satisfied with the analgesic results obtained.</div></div><div><h3>Conclusions</h3><div>Monitoring DAP with the app used was feasible and accepted by patients. It provided clinically useful information by allowing DAP trajectories to be traced and detecting high proportions of patients with moderate to severe DAP, dissatisfied with the analgesic results obtained and non-compliant with analgesic guidelines.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 8","pages":"Article 501854"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145220","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

Anaesthesia management of anterior cervical discectomy and fusion 颈前路椎间盘切除术的麻醉管理及fusión。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.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 h 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

Paraparetic variant of Guillain-Barré syndrome after epidural anaesthesia 硬膜外麻醉后格林-巴勒综合征的麻痹变异体。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.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。我们报告了一位66岁的女性因卵巢肿瘤病理接受手术，作为术后神经轴麻醉的并发症，她出现了一种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

Ulnar artery Doppler indices, a novel emerging predictor of segmental ulnar sparing after supraclavicular block: A prospective observational study 尺动脉多普勒指数，一种新的预测锁骨上阻滞后尺节段性保留的预测指标：一项前瞻性观察研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501899

M. Adolf Helmy, M. Medhat Megalaa, H. Mohamed Mamdouh, I.A. Ismail, L. Magdy Milad

Background

Supraclavicular brachial plexus block offers several advantages over general anesthesia, yet segmental ulnar sparing is one of the procedure's key drawbacks. Many parameters were proposed to ascertain segmental ulnar sparing, including thermal imaging and perfusion index. However, none proved optimal; therefore, we aimed to evaluate ulnar artery Doppler indices as a potential predictor of segmental ulnar sparing.

Methods

This prospective observational study was conducted at a tertiary center. To obtain a study power of 90% and an alpha error of 0.05, a minimum sample size of 62 patients was required, with a minimum of 11 patients exhibiting segmental ulnar sparing. Adult patients who received supraclavicular brachial plexus block for hand surgery were included. Each dermatome was assessed in terms of motor and sensory function. An experienced operator performed Doppler examinations at baseline, 10-, 20-, and 30 min following block administration. The primary outcome was the accuracy of the change in PI (ΔPI) in predicting segmental ulnar sparing. Other outcomes included the change in resistive index (ΔRI) and the change in waveform morphology (ΔM) to predict segmental ulnar sparing.

Results

Of the 81 patients assessed for eligibility, 15 were excluded, leaving sixty-six in the final analysis. Eleven of the 66 individuals showed segmental ulnar sparing. ΔPI and ΔRI have been identified as accurate predictors of segmental ulnar sparing with best cut-off values of <8.8% and 12%, respectively. Additionally, ulnar artery Doppler morphological changes from triphasic pattern to a monophasic wave can rule out segmental ulnar sparing with a 100% negative predictive value.

Conclusion

In adult patients undergoing hand surgery using supraclavicular brachial plexus block, Changes of Doppler indices, namely ΔPI, ΔRI, and ΔM, showed good accuracy in predicting segmental ulna preservation. However, the generalizability of our findings is limited by being a single-center study with a relatively small sample size.

背景：锁骨上臂丛阻滞与全身麻醉相比有几个优点，但节段性尺骨保留是该手术的主要缺点之一。提出了许多参数来确定节段性尺骨保留，包括热成像和灌注指数。然而，没有一个被证明是最佳的；因此，我们旨在评估尺动脉多普勒指数作为节段性尺动脉保留的潜在预测指标。方法：本前瞻性观察研究在三级中心进行。为了获得90%的研究效能和0.05的α误差，至少需要62例患者的样本量，其中至少有11例患者表现出节段性尺骨保留。在手外科手术中接受锁骨上臂丛阻滞的成年患者也包括在内。根据运动和感觉功能评估每个皮节。一位经验丰富的操作员在阻滞给药后的基线、10分钟、20分钟和30分钟进行多普勒检查。主要结果是PI变化预测尺节段性保留的准确性（ΔPI）。其他结果包括电阻指数的变化（ΔRI）和波形形态的变化（ΔM），以预测节段性尺骨保留结果：在81例评估合格的患者中，15例被排除，剩下66例进入最终分析。66例患者中有11例尺节段性保留。ΔPI和ΔRI被确定为节段性尺骨保留的准确预测因子，最佳临界值分别< 8.8%和12%。此外，尺动脉多普勒形态学变化从三相模式到单相波可以排除节段性尺动脉保留，100%阴性预测值。结论：在锁骨上臂丛神经阻滞行手外科手术的成年患者中，多普勒指数ΔPI、ΔRI和ΔM的变化对预测节段尺骨保留有较好的准确性。然而，我们的研究结果的普遍性受到单中心研究和相对较小的样本量的限制。

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引用次数: 0

Perioperative management of patients on GLP-1 receptor agonist treatment: Risks and recommendations GLP-1受体激动剂治疗患者的围手术期管理：风险和建议。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501859

E. Simón Polo, I. Rubio Jiménez, N. Aguirre Ahedo, M. Sanjuán Fernández

引用次数: 0