Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain.

OBJECTIVES: The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study is to evaluate the performance of the specialty of Anesthesiology in the management of CPR during the pandemic. METHODS: A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members. RESULTS: 225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26,3% have attended some cardiac arrest, 16,8% of the participants admitted to lead the manoeuvres, 16,8% detailed that it had been another department, and 66,2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anesthesia should lead the in-hospital CPR. CONCLUSION: The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.

Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa®) anaesthetic conserving device.

INTRODUCTION AND OBJECTIVE: Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa(®)) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit. MATERIALS AND METHODS: An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses' breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges. RESULTS: All badges corresponding to the nurses' breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation. CONCLUSIONS: Administration of sevoflurane through the AnaConDa(®) system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible.

[Intracardiac knotting of a Swan-Ganz catheter. Detection using intraoperative trans-esophageal echocardiography]. / Anudación intracardíaca de un catéter de Swan-Ganz. Detección mediante ecocardiografía transesofágica intraoperatoria.

Transoesophageal echocardiography is a new technique that allows continuous and noninvasive assessment of cardiac function during surgery. More recently this technique is being used to detect the presence of external objects into the cardiac cavities. We report a case of Swan-Ganz catheter knotting confirmed by this echocardiography technique. He was a 57 year old male with previous history of arterial hypertension and ischemic heart disease who was scheduled for surgery because poor response to medical therapy. After anesthetic induction a thermodilution catheter was introduced percutaneously into the right internal jugular vein under continuous pressure monitoring from the distal catheter hole. In view of the difficulties in introducing the catheter into the pulmonary artery an intravascular catheter knotting was suspected and a bidimensional transesophageal echocardiogram confirmed the diagnosis. During extracorporeal circulation the catheter was withdrawn through a right auriculotomy. Monitoring with a Swan-Ganz catheter, as other invasive monitoring techniques, is followed by a certain degree of complications which should be avoided by a careful manipulation. Echocardiography is a valuable diagnostic procedure to identify the position of monitoring catheters into the cardiac cavities.

[Reliability of cardiac output by thermodilution. Effect of marker temperature]. / Fiabilidad del gasto cardíaco por termodilución. Influencia de la temperatura del marcador.

Classically, the cardiac output is measured by the thermodilution method, employing a standard volume of 5% D/W at 4 degrees C. Recently, however, a room-temperature (17-24 degrees C) measurements have been used, in such a way that a lower gradient between the injectate and the patient temperature is established. This lact could question the sensitivity and reliability of the technique evaluated. We have studied 20 patients undergoing different operations, in whom the cardiac output was measured by injecting a standard volume of 5 ml 5% D/W at room-temperature or at 5 degrees C, randomly assigned, in order to evaluate any difference between the two techniques. Over a total of 100 cardiac output determinations taken in normothermic conditions (19-24 degrees C) the mean was 4.24 +/- 1.13 l/min (means +/- SD). In hypothermic conditions the cardiac output was 4.28 +/- 1.14 l/min (means +/- SD). Results showed no statistical difference between both methods.

[Anesthetic management of a patient with dystrophic ampullar epidermolysis]. / Tratamiento anestésico del paciente con epidermólisis ampollar distrófica.

We report the clinical case of a 56 years old male suffering dystrophic ampullar epidermolysis. He underwent brachial plexus blockade to remove a right hand tumor. The patient presented bilateral pseudosyndactylia, flexion retraction of the left hand, and erosive lesions in the inferior extremities, forearm, and trunk interfered monitorization and venous catheterization. Cutaneous friction or trauma should be carefully avoided since in this patient might produce detachment of the epidermis and subsequent ampullar formation. Cutaneous electrodes without adhesive components, padded sphygmomanometers, ear pulsimeter, and venous catheter sutured to the skin were used during monitorization. Anesthetic management of patients with dystrophic ampullar epidermolysis should consider careful airway manipulation, reduction of mucocutaneous contacts, prevention of pressure or friction skin trauma, appropriate electrolyte and plasma volume reposition, and use of nonadhesive material. To avoid airway manipulation regional anesthesia should be considered in patients with ampullar epidermolysis. We recommend regional anesthesia with ketamine.