Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center.

INTRODUCTION AND OBJECTIVES: Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience. METHODS: Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge. RESULTS: Percutaneous traction (PCT) was the most frequent procedure (n=280) in local (n=166) and systemic infections (n=114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure). CONCLUSIONS: Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse.

Rol del anestesiólogo: punto de vista de los pacientes / The anaesthetist's role from the patient's perspective

Introduction: Despite advances in anesthesiology over the past decades, patient knowledge regarding the specialty appears to be scant. Objective: To determine the degree of knowledge among patients about anaesthesiology and the role of anaesthetists, and to identify the demographic factors associated with greater knowledge about the specialty. Materials and method: Prospective study based on a survey questionnaire conducted in a Level III hospital in Spain, in which all the patients coming for preoperative assessment during a two-week period were interviewed. The survey included questions on different aspects of the specialty covering the preoperative and intraoperative contexts, as well as other areas of anaesthesiology. Results: Overall, 306 patients were included in the study Of the population interviewed, 80% believe that anaesthetists are specialized physicians. Many patients did not understand the role of the anaesthetist in the treatment of intraoperative medical conditions, the importance of the pre-anaesthesia visit, or the role of the anaesthetist outside the operating room. Conclusions: The results show that patient knowledge regarding anaesthesia and the role of the anaesthetist is scant, the level of education being the only variable that shows differences between the groups. We believe that anaesthetists and related scientific organizations must try to communicate more information about the speciality in order to help improve health education in the general population, and increase the knowledge about anaesthesiology.

Introducción: Pese a los avances de la anestesiología en las últimas décadas, el conocimiento por parte de los pacientes sobre la especialidad parece escaso. Objetivo: Determinar el grado de conocimiento que poseen los pacientes sobre la anestesiología y la función de los anestesiólogos, y establecer qué factores demográficos condicionan un mayor conocimiento de la especialidad. Material y método: Estudio prospectivo formado por una encuesta-cuestionario realizado en un hospital español de tercer nivel, en el que durante dos semanas se entrevistaron a todos los pacientes que acudieron a la consulta de valoración preoperatoria. El cuestionario incluía preguntas relacionadas con diversos aspectos de la especialidad, desde su vertiente preoperatoria, contextos intraoperatorios y otras áreas de la anestesiología. Resultados: El estudio pudo completarse en un total de 306 pacientes. El 80% de la población encuestada cree que los anestesiólogos eran médicos especializados. Muchos pacientes no entendieron el papel del anestesiólogo en el tratamiento de cuestiones médicas intraop-eratorias, la importancia de la valoración preanestésica o el papel de los anestesiólogos fuera del quirófano. El factor más relevante que condicionó una tasa mayor de respuestas correctas fue el nivel educativo del paciente. Conclusiones: Los resultados han mostrado que el conocimiento de los pacientes sobre anestesiología y el papel de los anestesiólogos es escaso, siendo el nivel educativo la única variable que muestra las diferencias entre los grupos. Creemos que los anestesiólogos y las organizaciones científicas relacionadas deben hacer un esfuerzo para proporcionar más información acerca de la especialidad, con el objetivo de mejorar la educación sanitaria de la población general y su conocimiento sobre la anestesiología.

Displasia cefaloesquelética (Síndrome de Taybi-Linder): Presentación de un caso y consideraciones anestésicas / Cephaloskeletal dysplasia (Taybi-Linder syndrome): Case report and anesthetic considerations

Introduction: Microcephalic osteodysplastic primordial dwarfism (or Taybi-Linder syndrome) is a rare disease characterized by bone and central nervous system malformations, in addition to intrauterine retardation. Case presentation: 20-year-old patient operated on for adhesiolysis and enteropexy due to bowel obstruction from post surgical adhesions. Conclusion: The anesthetic considerations in these patients include the potential airway impairment secondary to facial malformations and neurological complications, primarily seizures.

Introducción: El enanismo microcefálico osteodisplásico primario (o síndrome de Taybi- Linder) es una infrecuente enfermedad caracterizada por malformaciones óseas, del sistema nervioso central y crecimiento intrauterino retardado. Presentación del caso: Paciente de 20 años intervenida de adhesiolisis y pexia intestinal por un cuadro de obstrucción intestinal por bridas postquirúrgicas. Conclusión: Como consideraciones anestésicas de estos pacientes destacamos las posibles alteraciones de la vía aérea secundarias a las malformaciones faciales y las complicaciones neurológicas, principalmente crisis convulsivas.

Bloqueo de la vaina de los rectos ecoguiado para reparación de hernia umbilical en un paciente con síndrome de Wolff-Parkinson-White: reporte de un caso / Ultrasound-guided rectus sheath block for an umbilical hernia repair in a patient with Wolff-Parkinson-White syndrome: A case report

Perioperative management of patients with Wolff-Parkinson-White syndrome requires a special care by anaesthesiologists. Choosing the most suitable anaesthetic technique is very important. Both general anaesthesia and neuroaxial blockade may result in haemodynamic instability and arrhythmias development. Rectus sheath block is considered as a useful regional technique for umbilical surgery in patients at high-risk of cardiopulmonary complications.

El manejo perioperatorio de los pacientes con síndrome de Wolff-Parkinson-White requiere de un especial cuidado por parte de los anestesiólogos. Elegir la técnica anestésica más adecuada es de vital importancia. Tanto la anestesia general como el bloqueo del neuroeje puede resultar en inestabilidad hemodinámica y desarrollo de arritmias. El bloqueo de la vaina de los rectos se considera una técnica regional muy útil para la cirugía umbilical en los pacientes con riesgo de complicaciones cardiopulmonares.

Trombosis recurrente de la arteria hepática en tres trasplantes hepáticos sobre el mismo paciente: informe de caso / Recurrent hepatic artery thrombosis in three instances of liver transplant in a single patient: Case report

Introduction: Orthotopic liver transplantation (OLT) is currently the treatment of choice for patients with end-stage liver disease. Vascular complications can trigger a failure of treatment, so it must be watched closely. Clinical, diagnostic evaluation and interventions: We report the case of a patient taken three times to liver transplantation due to recurrent hepatic artery thrombosis. The perfusion defect persisted after the third transplant, although the short-term course was favourable. Conclusion: Hepatic artery thrombosis varies in its clinical presentation, but it usually requires early and aggressive management.

Introducción: El trasplante ortotópico hepático (TOH) es actualmente el tratamiento de elección para pacientes con enfermedades hepáticas terminales. Las complicaciones vasculares pueden desencadenar un fracaso del tratamiento, por lo que deben ser vigiladas estrechamente. Hallazgos clínicos, evaluación diagnóstica e intervenciones: presentamos el caso de un paciente sometido en tres ocasiones a trasplante hepático por trombosis recurrente de la arteria hepática. Tras el tercer trasplante persiste el defecto de perfusión, pese a lo cual la evolución a corto plazo fue favorable. Conclusión: las presentaciones clínicas de la trombosis de la arteria hepática son variables, pero suelen requerir un manejo agresivo y precoz.

Síndrome pierde sal en el postoperatorio de cirugía de fosa posterior: reporte de caso / Cerebral salt wasting syndrome in the posterior fossa surgery post-operative period: Case report

Hyponatremia is the most common electrolyte disorder following intracranial surgery. Its aetiology is multifactorial. We present a case of a patient taken to microvascular decompression (Janetta surgery) for the treatment of trigeminal neuralgia who developed a symptomatic magnification of basal hyponatremia in the immediate post-operative period. Cerebral salt wasting syndrome was diagnosed. The management of this condition poses a challenge for physicians involved in postoperative neurosurgical care.

La hiponatremia es el trastorno electrolítico más frecuente después de la cirugía intracraneal. Su etiología es multifactorial. A continuación presentamos un caso de un paciente sometido a una descompresión microvascular (cirugía de Janetta) como tratamiento de la neuralgia del trigémino que en el postoperatorio inmediato desarrolló una magnificación sintomática de su hiponatremia basal. Se diagnosticó un síndrome pierde sal cuyo manejo supone un reto para los médicos implicados en los cuidados neuroquirúrgicos postoperatorios.

Implicaciones anestésicas en la enfermedad de Von Recklinghausen / Anaesthetic implications in Von Recklinghausen disease: A case report

Von Recklinghausen disease or neurofibromatosis Type I (NF1) is an autosomal dominant disease with a wide spectrum of clinical manifestations. Neurofibromas are the characteristic lesions. This disorder is associated with important anaesthetic considerations, mainly when neurofibromas occur in the oropharynx and larynx, leading to difficult laryngoscopy and tracheal intubation. We describe the anaesthetic management of a patient with NF1 under general anaesthesia for facial neurofibroma excision. We performed a brief review of the literature with the aim of optimizing the anaesthetic management and reducing the number of complications associated with the systemic manifestations of this syndrome.

La enfermedad de Von Recklinghausen (EVR) o neurofibromatosis tipo I (NF1) es una enfermedad con herencia autosómica dominante con un amplio espectro de manifestaciones clínicas. Los neurofibromas son las lesiones características. Este trastorno se asocia con importantes consideraciones anestésicas, principalmente cuando los neurofibromas aparecen en la orofaringe y laringe, produciendo dificultades en la laringoscopia y en la intubación endotraqueal. Describimos el manejo anestésico de un paciente con NF1 bajo anestesia general para extirpación de neurofibromas faciales. Hemos realizado un breve repaso de la literatura existente para optimizar el manejo anestésico y reducir el número de complicaciones asociadas con las manifestaciones sistémicas de este síndrome.

Perioperative renal protection strategies in liver transplantation.

Renal failure is one of the most common and major complications in liver transplant recipients. It has been reported to occur at an incidence of 17% to 95%. This complication is associated with prolonged hospital stay in the intensive care unit, the need for postoperative dialysis, infectious complications, acute rejection, and increased mortality. The causes of renal function deterioration differ in the preoperative and postoperative periods. By identifying patients at risk of developing chronic renal failure and by implementing strategies for renal protection at an early stage, it is possible to slow down the progression of renal failure and improve the long-term outcomes in liver transplant recipients.

Perioperative morbi-mortality associated with bariatric surgery: from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach.

BACKGROUND: The effectiveness and safety of the different bariatric surgical procedures currently available depend, partly, on the characteristics of the populations under study, the technical approach, the expertise of surgical teams, and on institutional factors. To evaluate the effectiveness and safety of these procedures, we compared the surgical results for biliopancreatic diversion surgery versus laparoscopic gastric bypass and sleeve gastrectomies performed in our institution. METHODS: This was a retrospective observational study of 296 patients undergoing bariatric surgery from January 2005 through October 2010. We analyzed mortality rate, cardiocirculatory and pulmonary perioperative complications, duration of surgery, intensive care unit admissions, and length of stay. We describe the changes in the choice of the surgical procedures throughout the study period. RESULTS: We observed a rate of pulmonary complications of 2.3 % and a mortality rate 3 months after discharge of 2.36 % with sepsis secondary to anastomotic leak as the main cause of death. Biliopancreatic diversion surgery was associated with higher mortality rates (p value = 0.014) and longer hospital stay (median of 9 versus 6 days for laparoscopic gastric bypass and sleeve gastrectomy, p value <0.001). Body mass index ≥ 50 was also related to higher mortality (p value = 0.023). We confirmed a progressive increase in laparoscopic restrictive and mixed techniques in our institution (from 0 % in 2005 to 87 % of all procedures in 2010). CONCLUSIONS: Bariatric surgery in our institution has dramatically shifted from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach, which has made it possible to reduce hospital stay and mortality rates.