RESUMEN
Quick implementation of specific protocols and protective measures in a tertiary hospital in Spain allowed for the early diagnosis and optimal management of patients with SARS-CoV-2 infection and proper protection of staff and inpatients. From the COVID-19 outbreak in this country until the time of writing, 14 patients in our hospital underwent surgery with COVID-19, or COVID-19 developed postoperatively. Their postoperative outcomes did not differ from those in our routine clinical practice, with a 0% respiratory failure rate and a 7.14% mortality rate, in contrast with other published series. COVID-19 did not develop in any of the healthcare workers present in the operating room during these procedures or in those who cared for these patients on the ward.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Control de Infecciones/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Procedimientos Quirúrgicos Operativos , Adulto , Anciano , Anciano de 80 o más Años , COVID-19 , Protocolos Clínicos , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , SARS-CoV-2 , España , Resultado del TratamientoRESUMEN
BACKGROUND: End-stage liver disease is associated with a concomitant reduction of pro- and anticoagulant factors that typically leads to rebalanced hemostasis. This rebalanced hemostasis can be easily disturbed, encountering both hemostasis-related bleeding episodes and thrombotic events. METHODS: This article reports a case of a 52-year-old man diagnosed with portal vein thrombosis and treated with Acenocumarol. The patient received ortothopic liver transplant. The preprocedure international normalized ratio was 3.5. A transfusion of 2000 units of prothrombin complex concentrate was indicated by Hematology. RESULTS: Repeated intra- and postoperative hepatic artery thrombosis resulted in graft loss and patient retransplantation in first 24 hours. CONCLUSIONS: The new concept of rebalanced hemostasis in these patients forces us to change our clinical decisions in preoperative coagulation management, avoiding old practices based on the traditional model such as transfusion guided by international normalized ratio and platelet count, among others that will be analyzed in present work.
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Hepatopatías , Trasplante de Hígado , Trombosis , Coagulación Sanguínea , Arteria Hepática/cirugía , Humanos , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Trombosis/etiologíaRESUMEN
BACKGROUND: Hepatic artery thrombosis (HAT) is the second cause of graft failure, after primary disfunction. It has a significant morbidity, with a retransplant and mortality rate in early hepatic artery thrombosis of 50%. The incidence of this event goes from 2% to 9% in the adult population. METHODS: The objective is to assess the incidence of HAT in a third-level hospital. The study design is an observational retrospective study, collecting data of the transplant recipient from 2010 to 2020. RESULTS: Incidence of HAT was 5.33% (39/732). A statistical difference was found with the blood intraoperative administration (P = .002) and with the presence of anatomic abnormalities in the hepatic artery between the HAT and the non-HAT group. We did not find any statistical difference with portal thrombosis (P = .73) between the groups. CONCLUSIONS: HAT is a fatal complication after an orthotopic liver transplant, which can lead to graft loss and even recipient death. For these reasons, we should early identify risk factors associated with this event early and try to minimize them to avoid the devastating consequences.
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Hepatopatías , Trasplante de Hígado , Trombosis , Adulto , Arteria Hepática , Humanos , Trasplante de Hígado/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Trombosis/epidemiología , Trombosis/etiologíaRESUMEN
BACKGROUND: The use of the Model of End-Stage Liver Disease (MELD) to predict morbidity and mortality after orthotopic liver transplant (OLT) is controversial. Acute and chronic liver failure-sequential evaluation of organ failure (CLIF-SOFA) is a new score that assess the patient's global status and that have been developed exclusively for patients with end-stage liver disease. The objective is to evaluate whether the CLIF-SOFA system predicts postoperative morbidity and mortality in the short and medium term. METHODS: A cohort of 123 patients who underwent OLT in a tertiary care hospital between January 2016 and December 2017 was retrospectively analyzed. The patients were divided into 2 groups: group 1 with a CLIF-SOFA score <7 and group 2 with a score CLIF-SOFA ≥7. RESULTS: Patients with a CLIF-SOFA ≥7 present, with statistical significance, had higher mortality at 1 and 3 years; longer duration of admission to the critical care unit; longer hospital stay; need for prolonged mechanical ventilation; surgical reintervention; higher rate of transfusion of blood products; pulmonary, neurologic, hemodynamic, surgical, infectious, kidney, metabolic, thrombotic, vascular, and graft complications; and need for kidney replacement therapy. However, no statistically significant differences were found in mortality in the first month, the need for hospital readmission, retransplant, digestive, endocrine, nutritional, hematologic, or biliary complications, and the presence of ascites. CONCLUSIONS: The role of CLIF-SOFA as a prognostic factor for mortality after OLT must be taken into account. Our results should be taken with caution, and more studies are necessary.
Asunto(s)
Insuficiencia Hepática Crónica Agudizada , Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Humanos , Puntuaciones en la Disfunción de Órganos , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado/efectos adversos , Estudios Retrospectivos , Pronóstico , Insuficiencia Hepática Crónica Agudizada/diagnóstico , Insuficiencia Hepática Crónica Agudizada/etiología , Insuficiencia Hepática Crónica Agudizada/cirugía , Cirrosis Hepática/complicacionesRESUMEN
BACKGROUND: Early extubation is a fundamental element integrated into enhanced recovery protocols in orthotopic liver transplantation (OLT). The aim is to evaluate whether early extubation influences short- and medium-term postoperative morbidity and mortality. METHODS: A cohort of 209 patients who underwent OLT in a tertiary hospital in a period from January 2016 to December 2018 were retrospectively analyzed. Patients were divided into 2 groups: group 1: early extubation in the intensive care unit and group 2: delayed extubation. Mortality is compared between both groups in the first month and first and third year. Postoperative morbidity was also compared. RESULTS: Patients in group 1 (n = 165, 79.9%) presented, with statistical significance, lower mortality at 1 month, 1 year, and 3 years; shorter duration of admission to the critical care unit and of hospital stay; lower incidence of surgical reoperation and retransplant; lower rate of transfusion of blood products; fewer pulmonary, digestive, neurologic, cardiologic, hemodynamic, kidney, surgical, infectious, metabolic, thrombotic, vascular, and graft complications; less need for kidney replacement therapy; less refractory ascites; and greater infectious risk. However, no statistically significant differences were found in the need for hospital readmission; in biliary, endocrine, nutritional, hematologic, thrombotic, and hematologic complications; or in graft rejection. In group 1, 6.6% of patients required reintubation. In group 2, 97% of patients could be extubated during the first week; 7.8% required noninvasive mechanical ventilation type bilevel positive airway pressure and 8.1% high flow. Only 2.8% of patients required tracheotomy. CONCLUSIONS: The role of early extubation seems key to improve outcomes in OLT because it reduces the incidence of multiple complications and mortality, with low reintubation rates. It is a feasible and safe procedure.
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Extubación Traqueal , Trasplante de Hígado , Humanos , Extubación Traqueal/efectos adversos , Extubación Traqueal/métodos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Estudios Retrospectivos , Respiración Artificial , Tiempo de Internación , Intubación Intratraqueal , MorbilidadRESUMEN
BACKGROUND: Patient satisfaction is a reliable and measurable indicator of the quality provided by a healthcare service. There are several questionnaires for measuring it, but only a few have shown good psychometric properties, an outstanding one being the EVAN-G (Evaluation du Vécu de l'Anesthésie Générale) questionnaire, which measures patient satisfaction regarding perioperative care and is validated in French. The aim of this study is the validation of a Spanish version of the EVAN-G questionnaire. METHODS: A translation/back-translation of the questionnaire into Spanish was carried out and the final version obtained was administered to three hundred patients. Its psychometric properties were measured and compared with those of the original EVAN-G questionnaire to verify that they had been maintained after the previous translation process. The questionnaire's content, construct and external validity were measured. To calculate reliability, Cronbach-α coefficient and test-retest method were used. The Global Satisfaction Index was calculated and satisfaction level in our sample was analyzed. RESULTS: Content, construct and external validity were proven with similar results that in the original EVAN-G. The translated version of the questionnaire showed good reliability: Cronbach-α coefficient was 0.92 and intraclass correlation coefficient measured by test-retest method was 0.9. The acceptability was high. The average Global Satisfaction Index in our sample was 73±12. CONCLUSIONS: The translation into Spanish and cross-cultural adaptation of the EVAN-G questionnaire has proven its validity, reliability, and acceptability to measure patient satisfaction in interventions performed under general anesthesia.
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Comparación Transcultural , Satisfacción Personal , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , TraduccionesRESUMEN
BACKGROUND AND OBJECTIVES: Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. CASE REPORT: We report the case of a 24-hour-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. CONCLUSIONS: The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
RESUMEN
BACKGROUND AND OBJECTIVES: Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. CASE REPORT: We report the case of a 24-h-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. CONCLUSIONS: The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
Asunto(s)
Anestésicos/administración & dosificación , Atresia Esofágica/cirugía , Síndrome de Goldenhar/cirugía , Fístula Traqueoesofágica/cirugía , Manejo de la Vía Aérea/métodos , Broncoscopía/métodos , Competencia Clínica , Atresia Esofágica/etiología , Atresia Esofágica/patología , Síndrome de Goldenhar/fisiopatología , Humanos , Recién Nacido , Intubación Intratraqueal/métodos , Masculino , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/patologíaRESUMEN
Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery. We report the case of a 24-h-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia. The finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula.
A síndrome de Goldenhar é um quadro de polimalformação que consiste em uma disostose craniofacial que determina uma via respiratória difícil em até 40% dos casos. Nós descrevemos um caso de um recém-nascido com síndrome de Goldenhar com atresia de esôfago e fístula traqueoesofágica para a qual foi feita cirurgia de reparo. Apresentamos o caso de um recém-nascido de 24 horas de vida com síndrome de Goldenhar. Ele apresentava atresia de esôfago, com fístula traqueoesofágica distal. Decidiu-se por uma cirurgia de emergência para reparo. Ela foi feita sob sedação, intubação com fibrobroncoscópio distal à fístula, para limitar passagem do ar para o esôfago e possível distensão abdominal. Após o reparo completo da atresia de esôfago e ligadura da fístula, o paciente foi transferido para a unidade de terapia intensiva e intubado com sedoanalgesia. O achado de um paciente com síndrome de Goldenhar e atresia de esôfago supõe uma situação excepcional e um desafio para os anestesiologistas, pois o manejo anestésico depende da comorbidade do paciente, do tipo de fístula traqueoesofágica, da prática hospitalar habitual e das habilidades do anestesiologista responsável, sendo que a peculiaridade principal é manter uma ventilação pulmonar adequada na presença de uma comunicação entre a via respiratória e o esôfago. A intubação com fibrobroncoscópio distal à fístula resolve o manejo da via respiratória provavelmente difícil e limita a passagem de ar para o esôfago através da fístula.
El síndrome de Goldenhar es un cuadro polimalformativo consistente en una disostosis craneofacial que condiciona una vía aérea difícil hasta en el 40% de los casos. Describimos un caso de un neonato con síndrome de Goldenhar con atresia de esófago y fístula traqueoesofágica al que se practicó cirugía de reparación de la misma. Presentamos un caso de un neonato con síndrome de Goldenhar de 24 h de vida. Presentaba atresia esofágica con fístula traqueoesofágica distal. Se decidió una intervención quirúrgica urgente para la reparación de la misma. Se realizó bajo sedación, intubación con fibrobroncoscopio distal a la fístula, para limitar el paso de aire a esófago y la posible distensión abdominal. Tras la completa reparación de la atresia esofágica y la ligadura de la fístula, el paciente fue trasladado a la unidad de cuidados intensivos con sedoanalgesia e intubado. el hallazgo de un paciente con síndrome de Goldenhar y atresia de esófago supone una situación excepcional y un reto para los anestesiólogos, por lo que el manejo anestésico depende de la comorbilidad del paciente, del tipo de fístula traqueoesofágica, de la práctica hospitalaria habitual y de las habilidades del anestesiólogo responsable, siendo la principal particularidad el mantenimiento de una adecuada ventilación pulmonar en presencia de una comunicación entre la vía aérea y el esófago. La intubación con fibrobroncoscopio distal a la fístula solventa el manejo de la vía aérea probablemente difícil y limita el paso de aire al esófago a través de la fístula.
Asunto(s)
Humanos , Masculino , Recién Nacido , Fístula Traqueoesofágica/cirugía , Atresia Esofágica/cirugía , Síndrome de Goldenhar/cirugía , Anestésicos/administración & dosificación , Broncoscopía/métodos , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/patología , Competencia Clínica , Atresia Esofágica/etiología , Atresia Esofágica/patología , Manejo de la Vía Aérea/métodos , Síndrome de Goldenhar/fisiopatología , Intubación Intratraqueal/métodosRESUMEN
Introducción: La ecobroncoscopia es una nueva técnica diagnóstica en la detección del cáncer de pulmón. Permite realizar la punción aspirativa con aguja fina de adenopatías mediastínicas e hiliares, lo que ayuda a determinar el estadio de la enfermedad. Es una técnica mínimamente invasiva que se realiza bajo sedación consciente y que no requiere ingreso. Objetivos: Presentación de un caso clínico en el que se emplea esta nueva técnica diagnóstica y exposición del manejo anestésico fuera del área quirúrgica. Material y métodos: Exposición del caso clínico. Conclusiones: El principal objetivo de la sedación durante la realización de esta prueba es la correcta analgesia acompañada de la inmovilidad completa del paciente, todo esto manteniendo la estabilidad hemodinámica y respiratoria. El anestesiólogo debe proporcionar al paciente el mayor confort y seguridad posibles, facilitando la labor del médico explorador. La comunicación entre especialistas es fundamental.
Introduction: Endobronchial ultrasound is a new diagnostic technique for the detection of lung cancer. The technique enables a fine needle aspiration of mediastinal and hilar adenopathies to help stage the pathology. This is a minimally invasive technique performed under conscious sedation and does not require admission. Objectives: Presenting a clinical case using this new diagnostic technique and illustrate the anesthetic management outside the operating room. Material and methods: Presentation of the clinical case. Conclusions: The main objective of sedating the patient undergoing the procedure is proper analgesia and total patient immobility, while maintaining hemodynamic and respiratory stability. The anesthetist should provide maximum comfort and safety to the patient, facilitating the work of de physician doing the exploration. Communication between the two specialists is of the essence.