Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study.

BACKGROUND: ProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent. METHODS: Altogether, 45 patients ASA (American Society Anaesthesiologists) physical status I-II, aged 18-60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration's risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL- 1. ET50 was calculated with a modified Dixon's up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient's response to LMA insertion was classified as "movement" or "no movement". Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from "movement" to "no movement". RESULTS: The ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019). CONCLUSIONS: The end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.

Oxidative stress and cell death induction by amitraz and its metabolite BTS-27271 mediated through cytochrome P450 and NRF2 pathway alteration in primary hippocampal cell.

Amitraz is a neurotoxic formamidine pesticide that induces cell death in hippocampal neurons, although its mechanisms are unknown. Amitraz produces reactive oxygen species (ROS), which could lead to cell death. Amitraz was shown to induce different cytochrome P450 (CYP) isoenzymes involved with ROS and apoptotic cell death induction. Finally, amitraz was described to decrease the activity of antioxidant enzymes regulated through KEAP1/NRF2 pathway, thus likely leading to a reduction of ROS elimination and to cell death induction. We evaluated the effect of amitraz or BTS-27271 co-treatment with or without the antioxidant N-acetylcysteine and/or the unspecific CYP inhibitor 1-aminobenzotriazole on cell viability and its related mechanisms in wild type and silenced primary hippocampal neurons after 24 h treatment. We observed that amitraz produced oxidative stress and CYPs induction leading to apoptotic cell death. ROS generation was partially mediated by CYPs induction and downregulation of NRF2-pathway through KEAP1 overexpression. These data could help explain the mechanism by which amitraz induces cell death and oxidative stress and provide a therapeutic strategy to protect against this effect in case of poisoning.

Análisis de las sentencias judiciales en la práctica de la cardiología resueltas en segunda instancia en España entre 1992 y 2007 / Analysis of judgments in the practice of cardiology resolved on appeal in Spain between 1992 and 2007

Introducción y objetivos. El incremento de la judicialización de los asuntos sanitarios ha aumentado el interés hacia las demandas contra médicos. El objetivo es analizar las sentencias relacionadas con la práctica de la cardiología en España en época reciente. Métodos. Se han analizado las 1.899 sentencias judiciales sanitarias emitidas en España en segunda instancia o posteriores durante el periodo de 1992 a 2007. La ficha de datos consta de 25 variables administrativas, clínicas y judiciales. Al estudio descriptivo, se añaden comparaciones estadísticas entre variables cuya posible relación se juzga de interés. Resultados. Existen 32 sentencias en ámbito cardiológico, y son condenatorias el 31%, con cuantías nunca superiores a los 365.000 euros. Se ha cuadruplicado el número de denuncias en 2000-2007 comparado con 1992-1999. La patología más frecuente es el síndrome coronario (50%). Hay relación estadística (p=0,004) entre tipo de profesional implicado y causa de la demanda: las causas más frecuentes (error diagnóstico y/o mala praxis) afectaron a los no cardiólogos, mientras que las demandas por defecto de información (que alcanzan el 9,5%) recaen mayoritariamente en cardiólogos. El fallecimiento del paciente se produjo en el 75% de los casos. Conclusiones. Aunque la cardiología tiene «bajo riesgo» de demanda judicial comparada con otras especialidades, la actividad litigante aumentó notablemente en años recientes. Las causas de demanda se relacionaron con el tipo de profesional implicado, y destacan el error diagnóstico y la mala praxis por su frecuencia y el defecto de información por su novedad (AU)

Introduction and objectives. The increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. Methods. We analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. Results. There were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. Conclusions. Despite cardiology being a "low-risk discipline" compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty (AU)

Analysis of judgments in the practice of cardiology resolved on appeal in Spain between 1992 and 2007.

INTRODUCTION AND OBJECTIVES: The increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. METHODS: We analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. RESULTS: There were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. CONCLUSIONS: Despite cardiology being a "low-risk discipline" compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty.

[Development of a porcine experimental model of alcoholic intoxication]. / Puesta en marcha de un modelo experimental porcino bajo intoxicación etílica.

Despite important epidemiologic suggestions that alcohol causes a variety of cardiovascular abnormalitíes, and particularly cardiac arrhythmias, the demonstration of this causal effect in animal models is still lacking. Previous open-chest models, heavily instrumented and using epicardial stimulation have failed to demonstrate such causal effect. We developed a porcine, closed-chest model with sedation, a rigorous control of venous alcohol concentration and endocardial electrical stimulation, in a multidisciplinary framework. In this model, we observed that the infusion of alcohol facilitated atrial tachyarrhythmias. This model is available to study a variety of alcohol effects "in vivo", in a controlled fashion.