[Bacterial pneumonia in HIV-infected patients (excluding mycobacterial infection)]. / Pneumonies bactériennes chez les personnes infectées par le VIH (hors mycobactéries).

Respiratory infections are the most common complications in HIV patients, regardless of the degree of immunosuppression. Even though antiretroviral therapy has a protective effect on the risk of bacterial pneumonia, this still remains high (including those with CD(4)>500/mm(3)). The most frequently isolated bacteria are Streptococcus pneumoniae and Haemophilus influenzae. The clinical and radiological presentations of lower respiratory tract infections in HIV patients are quite variable. The clinical presentation is more severe and the radiological presentation is more atypical if the immunosuppression is severe. The first-line antibiotic therapy is an injectable third-generation cephalosporin (ceftriaxone or cefotaxime) or co-amoxiclav. Pneumococcal vaccination (as well as influenza vaccine) is recommended. Although rare, Nocardia spp. and Rhodococcus equi seem more common among AIDS patients.

[Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity]. / Anestesia para la cirugía de la escoliosis. Estudio preoperatorio y selección de pacientes de riesgo en la cirugía de las deformidades raquídeas.

Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity--such as neuromuscular disease--are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient's total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success.

Anestesia para la cirugía de la escoliosis. Estudio preoperatorio y selección de pacientes de riesgo en la cirugía de las deformidades raquídeas / Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity

La deformidad de la columna se asocia con alteraciones, en ocasiones graves, de la función respiratoria y cardiaca. Estas alteraciones, junto con la patología propia de la enfermedad causal de la deformidad –por ejemplo en las deformidades secundarias a las enfermedades neuromusculares– son factores de riesgo que modifican el pronóstico anestésico-quirúrgico de los pacientes con escoliosis. Desde el punto de vista anestesiológico es importante realizar una cuidadosa evaluación preoperatoria con el fin de identificar a los pacientes de riesgo, para disminuir la morbimortalidad asociada a la correción quirúrgica de su deformidad. Deberemos de tener en cuenta, en primer lugar, el riesgo de lesión de la función espinal o lesión medular. El manejo del paciente en posiciones anómalas, el riesgo asociado de hipotermia, secundaria a la exposición de un gran campo quirúrgico con una cirugía de larga duración, y el sangrado total, que en ocasiones puede superar la volemia del paciente. En la cirugía de la escoliosis es muy probable que todas estas condiciones puedan asociarse en un mismo procedimiento, obligándonos por ello a ser cuidadosos en la monitorización intraoperatoria, sobre todo en la de la función espinal, en la elección de una técnica anestésica adecuada y en un correcto seguimiento de la evolución postoperatoria inmediata para prever todas las posibles complicaciones que nos puedan aparecer. Por su carácter multidisciplinar, se trata de una cirugía en la que es imprescindible la colaboración entre los diferentes equipos participantes para asegurar el éxito del procedimiento

Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity—such as neuromuscular disease—are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient’s total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success