Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana / Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination

Objetivos. Comprobar si la adición de bajas dosis de antibiótico (vancomicina) al suero de lavado del recuperador celular reduce la incidencia de contaminación bacteriana del concentrado de hematíes (CH) autógeno recuperado. Material y método. Estudio experimental, aleatorizado, doble ciego, en forma de grupos paralelos, sobre 20 pacientes consecutivos, programados para cirugía de artrodesis vertebral posterior. La hemorragia intraoperatoria se procesó mediante un recuperador de sangre modelo HaemoLite® 2+, en cuyo proceso los hematíes se lavaron según grupo de aleatorización, con suero fisiológico (grupo control) o con suero fisiológico+10μg/ml−1 de vancomicina (grupo vanco). Se recogieron los datos referentes a edad, peso, volumen procesado y recuperado, hemograma, hemocultivo y concentración de vancomicina del CH obtenido e incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue 843±403ml y el volumen recuperado 121±29ml, con hemoglobina 10,4±5,0g/dl−1 y hematocrito 29,1±15,9% (media±DE). El hemocultivo del CH recuperado fue positivo a Staphylococcus coagulasa negativo en 5 casos (50%) en el grupo control mientras que fue estéril en todos los casos en el grupo vanco (p=0,016). La diferencia entre la concentración teórica de vancomicina administrada y la determinada en CH recuperado fue de 1,31μg/ml−1 (IC 95% 1,19-1,43; p=0,074). Conclusiones. La adición de vancomicina a una concentración de 10μg/ml−1 en el suero de lavado del recuperador consigue concentraciones similares en la sangre autógena recuperada y permite la eliminación de las bacterias, obteniéndose hemocultivos negativos en todos los casos (AU)

Objectives. The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. Material and method. Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml−1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. Results. Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl−1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml−1 (95% CI 1.19 to 1.43; P=.074). Conclusions. The addition of vancomycin at a concentration of 10ug/ml−1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases (AU)

Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination. / Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana.

OBJECTIVES: The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD: Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10µg/ml-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. RESULTS: Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31µg/ml-1 (95% CI 1.19 to 1.43; P=.074). CONCLUSIONS: The addition of vancomycin at a concentration of 10ug/ml-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.

Ventilación con mascarilla facial en decúbito prono para tratamiento radioterápico en niños / Ventilation with facial mask in the prone position for radiotherapy procedures in children

Objetivos. La ventilación de los pacientes para procedimientos en decúbito prono representa un reto para el anestesiólogo, especialmente cuando se intenta evitar la intubación endotraqueal. Presentamos un estudio concebido para comprobar la efectividad y la seguridad de un prototipo diseñado para ventilación con mascarilla facial en decúbito prono en niños. Material y métodos. Estudio descriptivo prospectivo de 105 sedaciones realizadas en 3 niños programados para tratamiento radioterápico en decúbito prono por meduloblastoma desmoplásico de fosa posterior (2 pacientes de 4 y 6 años de edad) y neuroblastoma en área temporal (un paciente de 4 años). La inducción y el mantenimiento de la sedación se realizaron con sevoflurano en oxígeno, manteniendo ventilación espontánea. Tras la pérdida de consciencia e inmovilidad del paciente se procedía a colocarlo en decúbito prono y a fijar su cabeza con frente y cara apoyadas en un prototipo creado con un molde de poliexpan que contenía la mascarilla facial (conectada a un circuito Mapleson D,) y la parte posterior de la cabeza inmovilizada con una capa de material termoplástico. Se recogieron variables de tiempo y posibles complicaciones. Resultados. Las 105 sedaciones se realizaron según el protocolo previsto. No se produjeron desaturaciones por debajo del 95%, movimientos durante el procedimiento ni otras complicaciones. El tiempo de estancia en el hospital incluyendo procedimiento y recuperación postanestésica fue de 54,4 ± 7,9 min (media ± DE). Conclusiones. El prototipo y técnica de sedación con mascarilla facial en decúbito prono empleados fueron efectivos y seguros permitiendo la realización del tratamiento radioterápico, asegurando la vía aérea de forma mínimamente invasiva, manteniendo la ventilación adecuada, una sedación superficial y posibilitando un alta a domicilio precoz (AU)

Objectives. Ventilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. Material and methods. A prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. Results. All sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9 min (mean ± SD). Conclusions. The prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge (AU)

Implementación de un programa de alternativas a la transfusión sanguínea en cirugía de escoliosis en pediatría / Implementation of a patient blood management program in pediatric scoliosis surgery

Objetivos. Determinar si la puesta en marcha de un programa de ahorro de sangre y la adopción y asociación progresiva de diferentes métodos reducen las necesidades transfusionales en pacientes pediátricos intervenidos de escoliosis de múltiples etiologías. Material y método. Estudio cuasiexperimental, no aleatorizado y descriptivo, aprobado por el Comité de Ética para la Investigación de nuestra institución. Se incluyeron 50 pacientes pediátricos (ASA I-III) de edades comprendidas entre los 5 y los 18 años, intervenidos de cirugía de escoliosis de cualquier etiología mediante un único tiempo posterior o doble abordaje, anterior y posterior. Se compararon un grupo histórico (recogida retrospectiva de datos), sin alternativas a la transfusión (Grupo No ahorro = 15 pacientes), y otros 3 grupos prospectivamente: Grupo HNA (hemodilución normovolémica aguda) = 9 pacientes, Grupo HNA + Rec (recuperación intraoperatoria) = 14 pacientes, Grupo EPO (HNA + Rec + eritropoyetina ± donación preoperatoria) = 12 pacientes, conforme se implementaron las diferentes alternativas a la transfusión en nuestra institución. Resultados. La tasa de transfusión en los diferentes grupos (No ahorro, HNA, HNA + Rec, EPO) fue del 100, 66, 57 y 0% de los pacientes, con una media ± DE de 3,40 ± 1,59; 1,33 ± 1,41; 1,43 ± 1,50; 0 ± 0 unidades de CH transfundidas por paciente, respectivamente, con diferencias estadísticamente significativas (p < 0,001) tanto en la tasa de transfusión como en el número de unidades. Conclusiones. La aplicación de un programa multimodal de alternativas a la transfusión sanguínea en cirugía de escoliosis pediátrica, individualizado para cada paciente, puede evitar la transfusión en la práctica totalidad de los casos (AU)

Objectives. To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. Material and method. Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro = 15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution) = 9 patients; Group HNA + Rec (intraoperative blood salvage) = 14 patients, and Group EPO (HNA + Rec + erythropoietin ± preoperative donation) = 12 patients; according with the implementation schedule of the transfusion alternatives in our institution. Results. The rate of transfusion in different groups (No ahorro, HNA, HNA + Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean ± SD of 3.40 ± 1.59; 1.33 ± 1.41; 1.43 ± 1.50; 0 ± 0 RBC units transfused per patient, respectively. Statistically significant differences (P < .001) were found in both the transfusion rate and number of RBC units. Conclusions. The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases (AU)

Características y calidad de la sangre autóloga recuperada del campo quirúrgico durante cirugía de escoliosis en pediatría / Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery

Objetivos. Determinar las características hematológicas y microbiológicas de la sangre recuperada mediante el uso de un recuperador celular con campana centrifugadora pediátrica rígida (100 ml) en cirugía de escoliosis en pediatría y comprobar si se ajusta al estándar esperado en el paciente adulto. Material y método. Estudio de cohorte transversal, descriptivo, sobre 24 unidades consecutivas de sangre recuperada del campo quirúrgico procesadas mediante un recuperador de sangre modelo Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.). Se recogieron los datos referentes a edad, peso, abordaje (anterior o posterior) de la cirugía de escoliosis, volumen procesado y volumen de concentrado de hematíes (CH) autógeno recuperado, hemograma y hemocultivo del concentrado obtenido y la incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue muy escaso (939 ± 569 ml) con gran variabilidad (coeficiente de variación = 0,6), a diferencia del volumen recuperado 129 ± 50 ml (coeficiente de variación = 0,38). Se estableció correlación estadísticamente significativa entre el volumen procesado y el hematocrito del CH recuperado (Pearson, r = 0,659; p = 0,001) que fue menor del esperado. Los parámetros hematológicos más relevantes de los concentrados recuperados fueron: Hb 11 ± 5,3 g dl−1; HTO: 32,1 ± 15,4%; leucocitos 5,34 ± 4,22 × 103 μl−1; plaquetas 37,88 ± 23,5 × 103 μl−1 (media ± DE). El hemocultivo del CH recuperado fue positivo en 13 casos (54,2%) en los que se aisló Staphylococcus coagulasa (−). Conclusiones. Los recuperadores celulares con campana centrifugadora de volumen fijo (incluso pediátrica) no obtienen la concentración esperada si se procesan bajos volúmenes, por lo que no son la mejor opción en el niño (AU)

Objective. To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100 ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. Material and methods. A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. Results. The processed shed volume was very low (939 ± 569 ml) with high variability (coefficient of variation = 0.6), unlike the recovered volume 129 ± 50 ml (coefficient of variation = 0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11 ± 5.3 g dl−1; haematocrit: 32.1 ± 15.4% (lower than expected); white cells 5.34 ± 4.22 × 103 ul−1; platelets 37.88 ± 23.5 × 103 ul−1 (mean ± SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (−) was isolated. Conclusions. Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery (AU)

Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery.

OBJECTIVE: To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS: A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS: The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS: Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.

Ventilation with facial mask in the prone position for radiotherapy procedures in children.

OBJECTIVES: Ventilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. MATERIAL AND METHODS: A prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. RESULTS: All sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9 min (mean±SD). CONCLUSIONS: The prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge.

Implementation of a patient blood management program in pediatric scoliosis surgery.

OBJECTIVES: To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. MATERIAL AND METHOD: Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. RESULTS: The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. CONCLUSIONS: The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.

Early thromboelastometry variables predict maximum clot firmness in children undergoing cardiac and non-cardiac surgery.

BACKGROUND: Early clot amplitudes measured on thromboelastometry (ROTEM®) predict maximum clot firmness (MCF) in adults. In this multicentre, retrospective study, we aimed to confirm the suspected relationship between early ROTEM® variables and MCF, in children undergoing cardiac or non-cardiac surgery. METHODS: 4762 ROTEM® tests (e.g. EXTEM, INTEM, FIBTEM, APTEM, and HEPTEM) performed in children undergoing cardiac or non-cardiac surgery at three University hospitals between January 2011 and June 2014 were reviewed. To assess the correlation between clot amplitudes measured after 5, 10 and 15 min and MCF, each variable was compared with the corresponding MCF by calculating Spearman's correlation coefficient. RESULTS: For the EXTEM® test, we observed that amplitude measured after 5 min (A5: r=0.91, P<0.001), 10 min (A10: r=0.95, P<0.001) and 15 min (A15: r=0.96, P<0.001) were strongly correlated to MCF. The same correlations were observed for INTEM® test (A5: r=0.93, P<0.001; A10: r=0.97, P<0.001; A15: r=0.97, P<0.001), and FIBTEM® test (A5: r=0.93, P<0.001; A10: r=0.94, P<0.001; A15: r=0.96, P<0.001). In addition, the amplitudes measured after five, 10 and 15 min were also strongly correlated with MCF in the APTEM® and the HEPTEM® tests. Receiver operating characteristics (ROC) analysis confirmed that A5, A10, A15 strongly predicted decreased MCF on all ROTEM® tests. CONCLUSIONS: This study confirmed that early values of clot amplitudes measured as soon as five, 10 or 15 min after clotting time could be used to predict maximum clot firmness in all ROTEM® tests.

Arbuscular mycorrhizal symbiosis alleviates detrimental effects of saline reclaimed water in lettuce plants.

The present study evaluated the effects of inoculation with arbuscular mycorrhizal fungi (AMF; Glomus iranicum var. tenuihypharum sp. nova) on the physiological performance and production of lettuce plants grown under greenhouse conditions and supplied with reclaimed water (RW; urban-treated wastewater with high electrical conductivity; 4.19 dS m(-1)). Four treatments, fresh water, fresh water plus AMF inoculation, RW and RW plus AMF inoculation, were applied and their effects, over time, analyzed. Root mycorrhizal colonization, plant biomass, leaf-ion content, stomatal conductance and net photosynthesis were assessed. Overall, our results highlight the significance of the AMF in alleviation of salt stress and their beneficial effects on plant growth and productivity. Inoculated plants increased the ability to acquire N, Ca, and K from both non-saline and saline media. Moreover, mycorrhization significantly reduced Na plant uptake. Under RW conditions, inoculated plants also showed a better performance of physiological parameters such as net photosynthesis, stomatal conductance and water-use efficiency than non-mycorrhizal plants. Additionally, the high concentration of nutrients already dissolved in reclaimed water suggested that adjustments in the calculation of the fertigation should be conducted by farmers. Finally, this experiment has proved that mycorrhization could be a suitable way to induce salt stress resistance in iceberg lettuce crops as plants supplied with reclaimed water satisfied minimum legal commercial size thresholds. Moreover, the maximum values of Escherichia coli in the reclaimed water were close to but never exceeded the international thresholds established (Spanish Royal Decree 1620/2007; Italian Decree, 2003) and hence lettuces were apt for sale.

Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes / Relationship between arginase activity and the storage time of packed red blood cells

Objetivos. Dada la creciente evidencia a favor de una relación entre el tiempo de conservación de los concentrados de hematíes y las complicaciones postransfusionales, nos planteamos analizar la relación existente entre los niveles de enzima arginasa, parámetros bioquímicos y de hemólisis, con el tiempo de conservación de concentrados de hematíes transfundidos. Material y métodos. Diseñamos un estudio prospectivo que incluyó 24 unidades de concentrado de hematíes, que habían sido transfundidos consecutivamente a pacientes de nuestro hospital. Luego de registrar el tiempo de conservación de cada bolsa, se extrajeron 15ml de sangre para determinar la actividad arginasa, los datos bioquímicos y de hemólisis. Se realizó un análisis univariante de todos los parámetros registrados y se incluyeron aquellos que resultaron significativos en un modelo de regresión múltiple (p<0,05). Resultados. El tiempo promedio de conservación fue de 18,6±6,1 días (rango: 6-31 días), con un hematocrito de 59,8%±0,05%, una hemoglobina 20,3±1,8g/dl, un pH de 6,5±0,1 y una actividad arginasa de 140,1±124,0 mU/ml. Se observó una relación lineal en el análisis univariante entre el tiempo de conservación y el pH (p=0,001), el HCO3act (p=0,001), el índice hemolítico (p=0,035) y la SpO2 (p=0,01). Una vez ajustados las variables de confusión procedentes del modelo univariante, se observó una relación lineal entre la actividad arginasa y el tiempo de conservación (p=0,031). Conclusiones. Nuestro trabajo muestra una relación lineal directamente proporcional entre el tiempo de conservación de los concentrados de hematíes y la actividad arginasa presente en los mismos. Sugerimos que estos hallazgos podrían estar relacionados con la elevada incidencia de complicaciones tras la transfusión que puede ser directamente proporcional a su tiempo de conservación(AU)

Objectives. Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. Material and methods. We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). Results. The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actualHCO3 (P=.001), the haemolysis index (P=.035) and the SpO2 (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). Conclusions. Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time(AU)

[Relationship between arginase activity and the storage time of packed red blood cells]. / Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes.

OBJECTIVES: Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. MATERIAL AND METHODS: We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15 ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). RESULTS: The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8 g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0 mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actual HCO(3) (P=.001), the haemolysis index (P=.035) and the SpO(2) (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). CONCLUSIONS: Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time.

Importancia de la monitorización de la hemostasia / No disponible

No disponible

Anestesia con remifentanilo para timectomía toracoscópica en paciente pediátrico con miastenia gravis / Anesthesia with remifentanil for thoracoscopic thymectomy in a girl with myasthenia gravis

No disponible

Complicaciones respiratorias perioperatorias en pacientes pediátricos con masas mediastínicas: A propósito de dos casos / Perioperative respiratory complications in pediatric patients with mediastinal masses: a report of 2 cases

La anestesia general en pacientes con masas mediastínicaspuede conducir a la aparición de complicacionescardiorrespiratorias que pongan en peligro la vida delpaciente.Presentamos los casos clínicos de dos pacientes pediátricoscon masas mediastínicas que presentaron gravescomplicaciones durante la anestesia general. El primero deellos, un paciente de 13 años con sospecha diagnostica delinfoma no Hodgkin de alto grado-células T, adenopatías yuna masa en mediastino anterior, presentó edema pulmonarpor presión negativa durante el transcurso de la anestesiageneral secundario a una obstrucción severa de la víaaérea superior en presencia de ventilación espontánea. Elsegundo, un paciente de 14 años diagnosticado de enfermedadde Rosai-Dorfman y con adenopatías paratraqueales,presentó un cuadro de obstrucción severa de la víaaérea en el postoperatorio inmediato.Los problemas anestésicos que pueden presentar estospacientes comprenden oclusión aguda de la vía aérea,síndrome de la vena cava superior, compresión cardiacao de la arteria pulmonar, edema agudo de pulmón ycolapso cardiopulmonar1-3. Se considera de elección unainducción anestésica inhalatoria y mantenimiento de laventilación espontánea, evitando el uso de relajantesneuromusculares

General anesthesia in patients with mediastinal massescan lead to life-threatening cardiorespiratory complications.We report the cases of 2 pediatric patients withmediastinal masses who developed serious complicationsduring general anesthesia. The first was a 13-year-oldboy with a suspected diagnosis of high-grade T-cellnon-Hodgkin lymphoma, lymph node disease, and ananterior mediastinal mass. He developed negative pressurepulmonary edema secondary to severe upper airwayobstruction in spontaneous ventilation. The second was a14-year-old boy with Rosai-Dorfman disease andparatracheal lymph node involvement. He developed severeairway obstruction in the early postoperative period.The anesthetic difficulties that arise in these casesinclude acute airway occlusion, superior vena cavasyndrome, pulmonary artery or cardiac compression,acute pulmonary edema, and cardiopulmonary collapse.The technique of choice is induction with inhaledanesthetics and maintenance of spontaneous ventilation.Neuromuscular relaxants are avoided

Analgesia administrada para el tratamiento del dolor depués de adenomigdalectomía en niños / Analgesia for pain treatment after tonsillectomy in children

No disponible

[Perioperative respiratory complications in pediatric patients with mediastinal masses: a report of 2 cases]. / Complicaciones respiratorias perioperatorias en pacientes pediátricos con masas mediastínicas: a propósito de dos casos.

General anesthesia in patients with mediastinal masses can lead to life-threatening cardiorespiratory complications. We report the cases of 2 pediatric patients with mediastinal masses who developed serious complications during general anesthesia. The first was a 13-year-old boy with a suspected diagnosis of high-grade T-cell non-Hodgkin lymphoma, lymph node disease, and an anterior mediastinal mass. He developed negative pressure pulmonary edema secondary to severe upper airway obstruction in spontaneous ventilation. The second was a 14-year-old boy with Rosai-Dorfman disease and paratracheal lymph node involvement. He developed severe airway obstruction in the early postoperative period. The anesthetic difficulties that arise in these cases include acute airway occlusion, superior vena cava syndrome, pulmonary artery or cardiac compression, acute pulmonary edema, and cardiopulmonary collapse. The technique of choice is induction with inhaled anesthetics and maintenance of spontaneous ventilation. Neuromuscular relaxants are avoided.