[Epidural anesthesia for cesarean section in a patient with von Hippel-Lindau disease]. / Anestesia epidural para cesárea en una paciente con enfermedad de von Hippel-Lindau.

Von Hippel-Lindau disease is a dominant autosomal genetic condition with variable penetrance and expressivity. It is characterized by hemangioblastomas in multiple organs but mainly in the retina and cerebellum. There is a predisposition to carcinoma. We report a cesarean section in a 28-year-old woman with von Hippel-Lindau disease. She had no neurologic symptoms at the time of the operation but a history of ocular and cerebellar involvement and several procedures to remove cerebellar hemangioblastomas. Epidural anesthesia was chosen given that there was no nervous system involvement at the time of surgery.

Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure. / Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva.

OBJECTIVE: The overall objective of the study is to determine the ability of TOF-Cuff device (blood-pressure modified cuff, including stimulation electrodes) to monitor with the same device the non-invasive blood pressure (NIBP) and the depth of a neuromuscular blockade (NMB) induced pharmacologically, by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure. MATERIAL AND METHOD: Clinical, single-centre, open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position, for the validation of neuromuscular monitoring, comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography (MMG) (control method) during the recovery phase of NMB, when a TOF ratio>0.7 and>0.9 (primary endpoint) were reached respectively. And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter. All data were analyzed using the Bland-Altman method. RESULTS: Recovery from NMB measured with the TOF-Cuff was earlier compared to MMG. Comparing TOF-ratio>0.9 measured with TOF-Cuff vs TOF-ratio>0.7 with MMG, a specificity of 91% and a positive predictive value of 84% were obtained. In NIBP measurement, the mean error and standard deviation of both systolic blood pressure (1.6±7mmHg) and diastolic blood pressure (-3.4±6.3) were within the European accuracy requirements for medical devices. CONCLUSIONS: The TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP, with no patient presenting any adverse events, skin-level lesions or residual pain. It is not interchangeable with MMG, having a TOF-ratio>0.9 quantified by the TOF-Cuff device, a good correlation with a TOF-ratio>0.7 on MMG.

[Bibliometric analysis of the original articles published in the Revista Española de Anesthesiología y Renimación in 10 years (1987-1996)]. / Análisis bibliométrico de los artículos originales publicados en la Revista Española de Anestesiología y Reanimación durante 10 años (1987-1996).

OBJECTIVE: To describe the original research articles published in Revista Española De Anestesiología y Reanimación (REAR) from 1987 through 1996, as well as to characterize the citations included in those articles. MATERIAL AND METHODS: The 299 articles published as original research in REAR over the past 10 years (1987 through 1996) were analyzed. The bibliographic aspects examined were coauthorship (authors/paper index), citations per article, isolation in function of language of publication of references, degree of obsolescence of articles based on year of references cited ("half-life"), self-citation and degree of dispersion of citations. RESULTS: The authors/paper index was 5.16 +/- 1.62. No statistically significant difference was found in number of authors over the 10-year study period. Mean number of references cited per article was 24.05 +/- 12.02. We found statistically significant differences for 1993 and the period 1987 to 1988, and 1994 and the year 1987 (p < 0.001). The "half-life" of articles was 6 when analyzing on a year-by-year basis; this index ranged from 5.5 to 7, with no significant annual differences. REAR articles accounted for 4.02% of all citations. English was the most frequent language of cited publications, with 6,240 references (86.8%), followed by Spanish with 621 (8.64%), French with 223 (3.1%) and German with 74 (1.03%). Of the 7,191 references analyzed, 6,447 (89.65%) were of scientific journals. Books are the second most commonly cited type of document, with 623 (8.66%) citations. Analyzing journals cited 25 or more times, we found that 74.19% of the articles (4,783/6,447) had been published in 5.3% of the journals (36/678). Seven journals of anesthesia, which represented 1.03% of all journals (7/678) appeared in 52.81% of references of this type (3,405/6,447). CONCLUSIONS: The number of authors of original research articles published in REAR in the last 10 years was high. Spanish authors in anesthesiology cite mainly literature in English; use up-to-date sources of information, mainly journals; and take a large proportion of information from a small number of journals, which are those of greatest international impact in our specialty.

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva / Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure

Objetivo. Determinar la capacidad del dispositivo TOF-Cuff (manguito de presión modificado que incluye electrodos de estimulación) para monitorizar la presión arterial no invasiva (PANI) y el nivel de bloqueo neuromuscular (BNM) inducido farmacológicamente. Material y método. Estudio observacional, prospectivo, de 32 pacientes adultos ASA I-III programados para cirugía bajo anestesia general, para la validación de la monitorización del BNM con el dispositivo TOF-Cuff vs. mecanomiografía (MMG, método control) durante la fase de recuperación del BNM, cuando se alcanzó un TOF-ratio de 0,9 con TOF-Cuff y de 0,7 con la MMG (variable principal). Para completar el estudio principal se realizó un estudio adicional consecutivo al anterior y que incluyó a 17 pacientes para validar el dispositivo TOF-Cuff en la monitorización de la PANI en comparación con la presión arterial invasiva a nivel de la arteria radial (método control). Los datos fueron analizados mediante el método de Bland-Altman. Resultados. Se produjo un adelanto de la recuperación medida con TOF-Cuff respecto a la mecanomiografía. Al comparar un TOF-ratio>0,9 cuantificado mediante TOF-Cuff con un TOF-ratio>0,7 en la MMG tuvo una especificidad del 91% y un valor predictivo positivo del 84%. En la medición de la PANI, el error medio y la desviación estándar tanto de la presión arterial sistólica (1,6±7mmHg) como diastólica (−3,4±6,3) estuvieron dentro de los requisitos europeos de precisión para aparatos sanitarios. Conclusiones. El dispositivo TOF-Cuff ha mostrado ser válido y seguro en la monitorización del BNM y en la medición de la PANI, no presentando ningún paciente acontecimientos adversos, lesiones a nivel de la piel o dolor residual. No es intercambiable con la MMG, teniendo un TOF-ratio>0,9 cuantificado mediante el dispositivo TOF-Cuff, una buena correlación con un TOF-ratio>0,7 en la MMG (AU)

Objective. The overall objective of the study is to determine the ability of TOF-Cuff device (blood-pressure modified cuff, including stimulation electrodes) to monitor with the same device the non-invasive blood pressure (NIBP) and the depth of a neuromuscular blockade (NMB) induced pharmacologically, by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure. Material and method. Clinical, single-centre, open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position, for the validation of neuromuscular monitoring, comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography (MMG) (control method) during the recovery phase of NMB, when a TOF ratio>0.7 and>0.9 (primary endpoint) were reached respectively. And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter. All data were analyzed using the Bland-Altman method. Results. Recovery from NMB measured with the TOF-Cuff was earlier compared to MMG. Comparing TOF-ratio>0.9 measured with TOF-Cuff vs TOF-ratio>0.7 with MMG, a specificity of 91% and a positive predictive value of 84% were obtained. In NIBP measurement, the mean error and standard deviation of both systolic blood pressure (1.6±7mmHg) and diastolic blood pressure (−3.4±6.3) were within the European accuracy requirements for medical devices. Conclusions. The TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP, with no patient presenting any adverse events, skin-level lesions or residual pain. It is not interchangeable with MMG, having a TOF-ratio>0.9 quantified by the TOF-Cuff device, a good correlation with a TOF-ratio>0.7 on MMG (AU)

Anaesthetic management in patients suspected of, or at risk of, having Creutzfeldt-Jakob disease.

We report two young patients who had repeated neurosurgical procedures and who were thought to be at risk of developing Creutzfeldt-Jakob disease (CJD). The first patient had been given a lyophilized dural graft in the course of removal of a cerebellar medulloblastoma 15 yr previously. The second patient had received pituitary-derived growth hormone for treatment of growth hormone deficiency, secondary to a third ventricle teratoma, exised 13 yr earlier. The presence of cerebellar symptoms together with being recipients of growth hormone or dural graft of cadaveric extraction arose suspicion of a diagnosis of CJD in both individuals. Precautions in the anaesthetic and surgical management of these two patients are discussed, and pertinent literature is reviewed briefly.

Anestesia epidural para cesárea en una paciente con enfermedad de Von Hippel-Lindau / Epidural anesthesia for cesarean section in a patient with von Hippel-Lindau disease

La enfermedad de von Hippel Lindau es un transtornogenético autosómico dominante con penetranciavariable, caracterizado por hemangioblastomas multiorgánicosprincipalmente en la retina y cerebelo y con predisposicióna desarrollar carcinoma. Se comunica el casode una gestante a término de 28 años de edad, portadorade la enfermedad de von Hippel Lindau, sin clínicaneurológica en el momento de la cesárea, con historia deafectación ocular y cerebelosa, a quien se le habían extirpadohemangioblastomas cerebelosos en varias ocasiones.Se eligió anestesia epidural por no presentar afectacióndel sistema nervioso, en el momento de la cirugía(AU)

Von Hippel-Lindau disease is a dominant autosomalgenetic condition with variable penetrance and expre -ssivity. It is characterized by hemangioblastomas inmultiple organs but mainly in the retina and cerebellum.There is a predisposition to carcinoma. We report acesarean section in a 28-year-old woman with von Hippel-Lindau disease. She had no neurologic symptoms at thetime of the operation but a history of ocular and cerebellarinvolvement and several procedures to remove cerebellarhemangioblastomas. Epidural anesthesia was chosen giventhat there was no nervous system involvement at the timeof surgery(AU)