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Superior vena cava syndrome in the postoperative setting of a type A aortic dissection A 型主动脉夹层术后出现上腔静脉综合征。
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.02.019
M.I. Alonso-Paniagua , M.J. Cóbreces-García
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引用次数: 0
Glomus tumor causing chronic finger pain: ischemia test is a reliable clinical sign for the diagnosis. Case report and review of literature 导致慢性手指疼痛的结节肿瘤:缺血试验是可靠的临床诊断标志。病例报告和文献综述。
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2024.02.021
A. Ojeda Niño , C.L. Nebreda Clavo , C. Batista Barreiros , R. Vallejo Salamanca

Glomus tumors are a rare, benign neoplasm arising from the neuroarterial structure known as the glomus body, which is a specialized arteriovenous shunt involved in temperature regulation. They account for less than 2% of soft tissue tumors and between 1% and 4.5% of tumors in the hand.. Despite their first descriptions appearing almost 100 years ago, late and missed diagnoses are common, leading to significant suffering. The classic diagnostic triad includes spontaneous pain, a sensation of pressure and tenderness, and cold hypersensitivity. Magnetic resonance imaging remains the most useful imaging modality. The abolition of pain after inflating a blood pressure cuff above the systolic blood pressure level (ischemia test) is highly diagnostic.Therefore, we suggest the routine use of this simple test in cases of upper limb pain of unclear etiology . Surgical excision is the treatment of choice and is curative.

绒毛膜瘤是一种罕见的良性肿瘤,产生于称为绒毛膜体的神经动脉结构,这是一种参与温度调节的特殊动静脉分流。它们在软组织肿瘤中所占的比例不到 2%,在手部肿瘤中所占的比例在 1% 到 4.5% 之间。尽管近 100 年前就有人对其进行了首次描述,但晚期诊断和漏诊仍很常见,这导致了可怕的痛苦。经典的诊断三联征包括自发性疼痛、压痛和触痛以及冷过敏。磁共振成像仍然是最有用的成像方式。将血压袖带充气至高于收缩压水平后疼痛消失(缺血试验)具有很高的诊断价值,因此我们建议在病因不明的上肢疼痛病例中常规使用这种简单的试验。手术切除是首选的治疗方法,而且可以治愈。
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引用次数: 0
Preoperative pregabalin prevents succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials 术前服用普瑞巴林可预防琥珀胆碱诱发的筋膜痉挛和肌痛:随机试验荟萃分析
Pub Date : 2024-04-01 DOI: 10.1016/j.redare.2022.12.002
P.A. Vélez , V. Lara-Erazo , A.F. Caballero-Lozada , A. Botero , G. Lozada , A.F. Velásquez , L.M. Villegas , A. Zorrilla-Vaca

Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction; however, its use is associated with fasciculation and myalgia. We performed a systematic review and meta-analysis of randomized controlled clinical trials comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included with a total of 481 patients - 241 in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR = 0.69, 95% CI 0.56−0.84, P < .001), which remained statistically significant for pregabalin (RR = 0.71, 95% CI 0.54−0.93, P = .013) and gabapentin (RR = 0.61, 95% CI 0.45−0.82, P = .001) separately. There was no difference in fasciculations between the groups (RR = 0.92, 95% CI 0.82–1.03, P = .148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24 h of surgery.

琥珀胆碱是用于快速序列诱导的金标准神经肌肉阻滞剂,但其使用与筋膜炎和肌痛有关。我们对随机对照临床试验进行了系统回顾和荟萃分析,比较了加巴喷丁类药物和安慰剂在预防筋束收缩和琥珀胆碱诱发肌痛方面的效果。六项随机临床研究共纳入了 481 名患者,其中干预组 241 人,安慰剂组 240 人。加巴喷丁类药物降低了琥珀酰胆碱引起的肌痛的发生率(RR = 0.69,95% CI 0.56-0.84,P = 0.001),普瑞巴林(RR = 0.71,95% CI 0.54-0.93,P = 0.013)和加巴喷丁(RR = 0.61,95% CI 0.45-0.82,P = 0.001)分别降低了肌痛的发生率。两组间的筋膜炎没有差异(RR = 0.92,95% CI 0.82-1.03,P = .148)。术前使用加巴喷丁类药物可降低术后 24 小时内琥珀胆碱诱发肌痛的发生率。
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引用次数: 0
Filar cyst on lumbar sonography prior to neonatal spinal anaesthesia. 新生儿脊髓麻醉前腰椎超声波检查发现的丝状囊肿。
Pub Date : 2024-03-02 DOI: 10.1016/j.redare.2024.03.004
R Eizaga Rebollar, A Alonso Ojembarrena
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引用次数: 0
Massive hemothorax diagnosed by ultrasound in patient on ECMO 使用 ECMO 的患者通过超声波诊断出大血胸。
Pub Date : 2024-03-01 DOI: 10.1016/j.redare.2024.03.003
L. Segovia García de Marina , P. Torrella Llauger , M. Sosa Garay , I. Talavera Blanco
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引用次数: 0
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。
{"title":"Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study","authors":"P. Martín-Serrano ,&nbsp;E. Alday-Muñoz ,&nbsp;A. Planas-Roca ,&nbsp;E. Martín-Pérez","doi":"10.1016/j.redare.2024.03.005","DOIUrl":"10.1016/j.redare.2024.03.005","url":null,"abstract":"<div><h3>Background and objectives</h3><p>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.</p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061666","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
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。
{"title":"Acute pulmonary oedema secondary to intravascular absorption syndrome during hysteroscopy: A case report","authors":"F.M. Colás Borrás ,&nbsp;C. Subirá Alsina ,&nbsp;E. Tria Galera ,&nbsp;M.C. de la Torre Terrón ,&nbsp;I. Martínez De Lagrán Zurbano","doi":"10.1016/j.redare.2023.04.001","DOIUrl":"10.1016/j.redare.2023.04.001","url":null,"abstract":"<div><p><span><span>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 </span>fluid overload<span>, 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 </span></span>intensive care unit.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10587621","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
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Revista espanola de anestesiologia y reanimacion
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