Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist.

INTRODUCTION: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. MATERIAL AND METHODS: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. RESULTS: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. CONCLUSION: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective.

[Cytokines and other immunological parameters as markers of distant organ involvement in acute pancreatitis]. / Citocinas y otros parámetros inmunológicos como marcadores de alteración de órganos a distancia en la pancreatitis aguda.

BACKGROUND AND OBJECTIVE: There is a role of immunologic proinflammatory mediators in pathogenesis of distant organ disfunction in acute pancreatitis (AP). The aim is to evaluate the relationship between those mediators and liver, kidney and lung disfunction in patients with AP. PATIENTS AND METHOD: On the day of admission in 34 patients with AP, biochemical parameters of liver function, creatinine and arterial partial pressure of oxygen (PO2) were determined, and cut points were established. Soluble tumor necrosis factor receptor I (sTNFRI), interleukin (IL) 1 receptor antagonist (IL-1Ra), IL-6, soluble IL-6 receptor (sIL-6R), IL-18, and intercellular adhesion molecule-1 (ICAM-1) were determined on days 1, 2, 3 and 7, and were compared between patients with biochemical parameters and PO2 on admission higher or lower than an established cut point. RESULTS: Levels of sTNFRI, IL-18 and ICAM-1 were significantly higher and sustained, and IL-6 only the first day, in patients with parameters of liver function above the cut point. sTNFRI, IL-1Ra and ICAM-1 early showed significantly higher levels in relation with serum creatinine, and these and also IL-6 in those with PO2 below 60 mmHg. CONCLUSIONS: sTNFRI, IL-6, IL-18 and ICAM-1 behaved as early markers of hepatic alteration, sTNFRI, IL-1Ra and ICAM-1 of renal disfunction and these and IL-6 of lung injury.

Complicaciones cardio-respiratorias graves derivadas de la sedación con propofol controlado por endoscopista / Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist

Introducción: la sedación profunda con propofol controlada por endoscopista en las diferentes unidades de endoscopia ha sido un tema de continua controversia a lo largo de los últimos años, origen de conflictos de intereses entre las distintas sociedades científicas de Anestesiología y Gastroenterología. Numerosos estudios han demostrado ya la eficacia, eficiencia y escasa aparición de complicaciones en la sedación controlada por un endoscopista formado frente al anestesiólogo. Material y métodos: hemos revisado en nuestra base de datos el porcentaje de complicaciones cardio-respiratorias graves en nuestra unidad, en el periodo comprendido entre 2011 y 2016, en las distintas exploraciones endoscópicas que realizamos (gastroscopia, colonoscopia, colangiopancreatografía retrógrada endoscópica [CPRE] y ecoendoscopia [USE]) y cuya sedación es controlada por un endoscopista. Resultados: se llevó a cabo el análisis de 33.195 exploraciones durante el periodo de estudio. Obtuvimos un 0,13% de complicaciones cardio-respiratorias, la mayor parte de ellas desaturaciones graves (la mayoría respondieron a la apertura de la vía aérea asociada a la interrupción de la infusión del fármaco, precisando la necesidad de ambú en contadas ocasiones). No existieron diferencias estadísticamente significativas entre los diferentes grupos excepto en edad media, riesgo por tipo de exploración y riesgo ASA, donde la CPRE presentó una p < 0,01 frente al resto de exploraciones. Conclusión: con los datos de los que disponemos hasta la actualidad, existen numerosas evidencias en la literatura científica para divulgar que la sedación de las endoscopias controlada por un endoscopista formado es segura, eficaz y eficiente. No obstante, deben realizarse más estudios prospectivos que confirmen estas suposiciones, ya que hasta el momento la mayoría de los estudios son retrospectivos

Introduction: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. Material and methods: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. Results: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. Conclusion: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective

Enfermedad de Crohn esofágica / Esophageal Crohn’s disease

No disponible

Citocinas y otros parámetros inmunológicos como marcadores de alteración de órganos a distancia en la pancreatitis aguda / Cytokines and other immunological parameters as markers of distant organ involvement in acute pancreatitis

Fundamento y objetivo: Es conocido el papel que desempeñan los mediadores inmunológicos proinflamatorios en la patogenia de algunas alteraciones de órganos distantes en la pancreatitis aguda (PA). El objetivo de este estudio ha sido evaluar la relación entre dichos mediadores y la afectación hepática, renal y pulmonar en pacientes con PA. Pacientes y método: En 34 pacientes con PA se valoraron el día del ingreso, parámetros bioquímicos de función hepática, creatinina y presión parcial de oxígeno (PO2) arterial, y se establecieron puntos de corte. Se determinaron el receptor soluble tipo I del factor de necrosis tumoral (sTNFRI), el receptor antagonista de la interleucina (IL) 1 (IL-1Ra), la IL-6, el receptor soluble de la IL-6 (sIL-6R), la IL-18 y la molécula de adherencia intercelular-1 (ICAM-1) los días 1, 2, 3 y 7, y se compararon entre los pacientes con los parámetros en el momento del ingreso (bioquímicos y PO2) superiores o inferiores a un punto de corte establecido. Resultados: Se encontraron valores significativamente más elevados y mantenidos de sTNFRI, IL-18 e ICAM-1, y de IL-6 sólo el primer día, en los pacientes con algún parámetro de función hepática superior al punto de corte. sTNFRI, IL-1Ra e ICAM-1 presentaban al inicio valores significativamente superiores en los pacientes en relación con la creatinina, y de éstos e IL-6 en los que presentaban PO2 inferior a 60 mmHg. Conclusiones: sTNFRI, IL-6, IL-18 e ICAM-1 se comportaron como marcadores tempranos de lesión hepática; sTNFRI, IL-1Ra e ICAM-1, de disfunción renal, y éstos e IL-6, de afectación pulmonar

Background and objective: There is a role of immunologic proinflammatory mediators in pathogenesis of distant organ disfunction in acute pancreatitis (AP). The aim is to evaluate the relationship between those mediators and liver, kidney and lung disfunction in patients with AP. Patients and method: On the day of admission in 34 patients with AP, biochemical parameters of liver function, cretinine and arterial partial pressure of oxygen (PO2) were determined, and cut points were established. Soluble tumor necrosis factor receptor I (sTNFRI), interleukin (IL) 1 receptor antagonist (IL-1Ra), IL-6, soluble IL-6 receptor (sIL-6R), IL-18, and intercellular adhesion molecule-1 (ICAM-1) were determined on days 1, 2, 3 and 7, and were compared between patients with biochemical parameters and PO2 on admission higher or lower than an established cut point. Results: Levels of sTNFRI, IL-18 and ICAM-1 were significantly higher and sustained, and IL-6 only the first day, in patients with parameters of liver function above the cut point. sTNFRI, IL-1Ra and ICAM-1 early showed significantly higher levels in relation with serum creatinine, and these and also IL-6 in those with PO2 below 60 mmHg. Conclusions: sTNFRI, IL-6, IL-18 and ICAM-1 behaved as early markers of hepatic alteration, sTNFRI, IL-1Ra and ICAM-1 of renal disfunction and these and IL-6 of lung injury