[Locoregional anesthesia and drugs that affect hemostasis. Suggestions of the expert meeting in the ESRA Congress in Barcelona]. / Anestesia locorregional y fármacos que alteran la hemostasia. Sugerencias de la reunión de expertos en el Congreso de la ESRA de Barcelona.

Growing interest in the effect of hemostasis-altering medications on regional anesthetic techniques was analyzed recently in a review article suggesting certain safety measures, by Llau and colleages in Revista Española de Anestesiología y Reanimación. Since that review, however, it has become necessary to extend the discussion of clinical issues, based on information presented at the Eighth Local Meeting of the European Society for Regional Anesthesia (ESRA) of May 2002. There, participants debated the most controversial aspects, with attention to practical questions such as temporal safety margins and approaches to take given certain platelet antiaggregants, fibrinolytics or drug combinations. This paper faithfully presents the suggestions made by participants at the meeting. As most anesthesiologists expressed the need to set guidelines for fibrinolytics, the main issues related to those drugs in regional anesthesia are reviewed.

Criterios actuales en la medicina transfusional perioperatoria / Current opinions in perioperative transfusion medicine

Blood transfusion as well as blood conservation strategies are the basis of so-called transfusion medicine, which is founded on the multidisciplinary work of anaesthesiologists, surgeons, haematologists, internists, etc. Its main objective is to avoid unnecessary transfusions. It is out of the question that a knowledge of transfusion indications, with the application of physiological triggers for red blood cells and the use of viscoelastic test-based guidelines for plasma and platelets, forces us to stay constantly abreast of the latest guidelines in this field. It is true that the blood products transfused today are the safest ever, although a zero-risk situation is impossible to reach. So, it is always important to keep in mind, as an essential part of transfusion medicine, a balance between risk and benefits in the indication of every single hemoderivate we prescribe. Taking into account the need for better criteria in the final transfusion decision, trying to use every resource available to minimise allogenic blood administration (also avoiding infra-transfusion), the concept of "patient blood management" has been developed. Its main objective for the surgical patient is to optimise preparation in the preoperative period, to minimise blood loss and bleeding during surgery, as well as to optimise the physiological tolerance of anaemia in the postoperative period

La transfusión de hemoderivados y sus técnicas de ahorro son la base de la medicina transfusional, que se fundamenta en el trabajo multidisciplinario de anestesiólogos, cirujanos, hematólogos, internistas, entre otros. Su objetivo esencial es disminuir o evitar las denominadas transfusiones innecesarias. No cabe duda de que el conocimiento de las indicaciones de administración de cada uno de los hemoderivados, con la aplicación de los triggers fisiológicos cuando se hace referencia a los concentrados de hematíes, o de la monitorización con pruebas de viscoelasticidad cuando se habla de la transfusión de hemostáticos, hacen que debamos ser conocedores de las nuevas tendencias decisionales en este campo. La sangre que se transfunde en el momento actual es la más segura que hemos tenido nunca, pero es imposible llegar al "riesgo cero", por lo que siempre es necesario tener en cuenta, como parte de la medicina transfusional, el equilibrio entre riesgo y beneficio en la indicación de cada uno de los hemoderivados que administramos. A partir de la premisa de transfundir con mejor criterio, tratando de emplear todos los recursos para minimizar la transfusión de sangre alogénica sin entrar en la infratransfusión, se desarrolla el concepto de "patient blood management", cuya esencia es la óptima preparación del paciente, la minimización del sangrado y las pérdidas hemáticas durante la cirugía y el aprovechamiento y la optimización de la reserva fisiológica de cada paciente en el posoperatorio

Anestesia locorregional, tromboprofilaxis y su relación con el desarrollo de hematoma espinal / Regional anesthesia, thromboprophilaxis and their relationship with the spinal hematoma Spanish experience

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