Aislamiento pulmonar en pacientes con resecciones pulmonares previas: bloqueo lobular selectivo secuencial con bloqueador bronquial Fuji Uniblocker® / Lung isolation in patients with previous lung resections: Selective sequential lobar blockade using a Fuji Uniblocker® endobronchial blocker

El aislamiento pulmonar es obligado durante la cirugía torácica, al permitir la visualización y manipulación por parte del cirujano del pulmón intervenido. La aparición de hipoxemia durante el aislamiento pulmonar es habitual, y aún es más frecuente en aquellos pacientes con reserva funcional pulmonar disminuida. Presentamos 2 casos clínicos de pacientes con antecedentes de resección pulmonar previa izquierda (1.° lobectomía inferior izquierda y 2.° lobectomía inferior izquierda y segmentectomía del lóbulo superior izquierdo), en los que se realizó bloqueo lobular secuencial selectivo (BLSS), con BB Fuji Uniblocker® para la realización de resecciones atípicas de pulmón derecho (LSD, LM y LID). En nuestra experiencia la técnica fue satisfactoria, el campo quirúrgico fue óptimo y no registramos ningún tipo de complicación intra o postoperatoria derivada de su uso, pudiendo ser una alternativa al aislamiento pulmonar tradicional, en pacientes con función respiratoria comprometida (reserva funcional escasa o resecciones pulmonares previas) (AU)

Lung isolation is essential during thoracic surgery, as it allows the thoracic surgeon to visualise and work in the surgical field. The occurrence of hypoxaemia during lung isolation is common, and is even more so in patients with decreased pulmonary functional reserve. The clinical cases are presented of 2 patients with a history of left pulmonary resections (1st left lower lobectomy, 2nd left lower lobectomy and left upper lobe segmentectomy), in which sequential selective lobar blockade was performed with Fuji Uniblocker® endobronchial blocker for performing right lung atypical resections (right upper lobe, middle lobe, and right lower lobe). In our experience the technique was successful, the surgical field was optimal and no intra- or post-operative complications were found. This technique may be an alternative to traditional lung isolation in patients with compromised respiratory function (low functional reserve or previous contralateral lung resections) (AU)

Lung isolation in patients with previous lung resections: Selective sequential lobar blockade using a Fuji Uniblocker® endobronchial blocker. / Aislamiento pulmonar en pacientes con resecciones pulmonares previas: bloqueo lobular selectivo secuencial con bloqueador bronquial Fuji Uniblocker®.

Lung isolation is essential during thoracic surgery, as it allows the thoracic surgeon to visualise and work in the surgical field. The occurrence of hypoxaemia during lung isolation is common, and is even more so in patients with decreased pulmonary functional reserve. The clinical cases are presented of 2 patients with a history of left pulmonary resections (1st left lower lobectomy, 2nd left lower lobectomy and left upper lobe segmentectomy), in which sequential selective lobar blockade was performed with Fuji Uniblocker® endobronchial blocker for performing right lung atypical resections (right upper lobe, middle lobe, and right lower lobe). In our experience the technique was successful, the surgical field was optimal and no intra- or post-operative complications were found. This technique may be an alternative to traditional lung isolation in patients with compromised respiratory function (low functional reserve or previous contralateral lung resections).

[Neostigmine-induced neuromuscular blockade in the corrugator supercilii muscle]. / Bloqueo neuromuscular inducido por neostigmina en el músculo Corrugator supercilii.

OBJECTIVE: To investigate whether a single dose of neostigmine, administered when the adductor pollicis muscle presents 2 twitches in train-of-four (TOF) stimulation, can reduce the TOF ratio in the corrugator supercilii muscle. PATIENTS AND METHODS: We designed a case-control study of patients between 18 and 65 years of age classified ASA 1-2. We used 2 accelerometers--1 for the cubital nerve/thumb adductor muscle and 1 for the facial nerve/corrugator supercilii muscle. Neuromuscular blockade was induced with 0.6 mg x kg(-1) of rocuronium, and 40 microg x kg(-1) of neostigmine was administered at the third twitch in the TOF in the thumb adductor. If the TOF ratio in the corrugator supercilii fell by 10% or more at that time, the patient was classified as a case. We recorded the age, sex, weight, height, body mass index, duration of the procedure, and TOF ratio in the corrugator supercilii muscle when the neostigmine was administered. RESULTS: Ten cases and 10 controls were enrolled. No significant differences between cases and controls were found in any variables except the mean (SD) TOF ratio in the corrugator supercilii muscle: 70.9% (17.8%) in cases and 35.3% (7.8%) in controls (P < .001). CONCLUSIONS: In our patients, administration of neostigmine after the appearance of the third twitch in TOF stimulation of the thumb adductor was associated with a reduction in the TOF ratio in the corrugator supercilii. The similarity between blockades of the corrugator muscle, the diaphragm, and the larynx is of clinical interest.

Bloqueo neuromuscular inducido por neostigmina en el músculo Corrugator supercilii / Neostigmine-induced neuromuscular blockade in the corrugator supercilii muscle

Objetivo: Investigar si una dosis de neostigmina administrada cuando el adductor pollicis presenta dos respuestas al tren de cuatro estímulos (TOF), puede producir una atenuación del cociente del TOF en el músculo corrugator supercilii (CS). Pacientes y métodos: Se diseñó un estudio casos-control con pacientes ASA I-II entre 18 y 65 años. Se utilizaron dos acelerómetros: nervio cubital/músculo aductor del pulgar y nervio facial/músculo CS. El bloqueo neuromuscular se indujo con rocuronio 0,6 mg Kg–1. Cuando el TOF ratio en el aductor del pulgar mostraba tres respuestas se administró neostigmina (40 μg Kg–1). Si en ese momento el TOF ratio en el CS disminuía 10 o más puntos se clasificaba como “caso”. Se midieron las variables edad, sexo, peso, talla, índice de masa corporal (IMC), duración y TOF ratio en el CS cuando se administró neostigmina. Resultados: Se incluyeron 10 casos y 10 controles. No hubo diferencias significativas excepto en el TOF ratio en el CS (media, [DE]): 70,9% (17,8%) en los casos frente a 35,3% (7,8%) en los controles (p < 0,001). Conclusiones: En nuestros pacientes administrar neostigmina tras la aparición de la tercera respuesta al TOF en el aductor del pulgar se asoció con un descenso del TOF ratio en el CS. La similitud del bloqueo del corrugator con el diafragma y la laringe tiene interés sobre la relevancia clínica del fenómeno(AU)

Objective: To investigate whether a single dose of neostigmine, administered when the adductor pollicis muscle presents 2 twitches in train-of-four (TOF) stimulation, can reduce the TOF ratio in the corrugator supercilii muscle. Patients and methods: We designed a case-control study of patients between 18 and 65 years of age classified ASA 1-2. We used 2 accelerometers—1 for the cubital nerve/thumb adductor muscle and 1 for the facial nerve/corrugator supercilii muscle. Neuromuscular blockade was induced with 0.6 mg·kg–1 of rocuronium, and 40 μg·kg–1 of neostigmine was administered at the third twitch in the TOF in the thumb adductor. If the TOF ratio in the corrugator supercilii fell by 10% or more at that time, the patient was classified as a case. We recorded the age, sex, weight, height, body mass index, duration of the procedure, and TOF ratio in the corrugator supercilii muscle when the neostigmine was administered. Results: Ten cases and 10 controls were enrolled. No significant differences between cases and controls were found in any variables except the mean (SD) TOF ratio in the corrugator supercilii muscle: 70.9% (17.8%) in cases and 35.3% (7.8%) in controls (P<.001). Conclusions: In our patients, administration of neostigmine after the appearance of the third twitch in TOF stimulation of the thumb adductor was associated with a reduction in the TOF ratio in the corrugator supercilii. The similarity between blockades of the corrugator muscle, the diaphragm, and the larynx is of clinical interest(AU)

La realización de accesos vasculares para hemodiálisis es segura en régimen ambulatorio / No disponible

No disponible

Cirugía de la incontinencia urinaria bajo anestesia general sin ingreso / No disponible

No disponible

[Assessing preoperative use of medicinal plants during preanesthetic interviews]. / Valoración del consumo preoperatorio de plantas medicinales en la consulta preanestésica.

OBJECTIVES: To assess the use of medicinal plant preparations in preanesthetic interviews at a Spanish university hospital. MATERIALS AND METHODS: A total of 500 questionnaires were randomly distributed over a period of 3 months to patients attending a preanesthetic assessment interview. RESULTS: Of the 431 valid questionnaires returned, 154 (35.73%) were from patients who reported consumption of some type of herbal remedy and 55 (12.76%) were from patients who used a medicinal plant considered in the literature to be potentially toxic. Consumption was higher among women (64.28%) (P < 0.001). Among users of these plants, 137 (88.96%) reported that they did not consider them to be medications and 141 (91.55%) would not have told the anesthesiologist about their use during a routine clinical interview. CONCLUSION: There is considerable use of medicinal herbs with potentially adverse interactions with various drugs used during the perioperative period. Anesthesiologists need to be familiar with such herbs and their effects and to ask specific questions about their use during the preanesthetic interview.

Valoración del consumo preoperatorio de plantas medicinales en la consulta preanestésica / Assesing preoperative use of medicinal plants during preanesthetic interviews

OBJETIVOS: Valorar el consumo de plantas medicinales en la consulta preanestésica de un hospital universitario español. MATERIAL Y MÉTODOS: Durante tres meses se llevaron a cabo un total de 500 encuestas repartidas de forma aleatoria en pacientes que acudían a consulta para valoración preanestésica RESULTADOS: De las 431 encuestas válidas, 35,73 % (154) de los pacientes encuestados afirmaron estar consumiendo algún tipo de planta medicinal y el 12,76% (55) afirmaron estar consumiendo alguna planta medicinal recogida en la bibliografía consultada como potencialmente tóxica. El consumo fue mayor en mujeres 64,28% (P<0,001). De los consumidores, 88,96% (137) no consideraban a las plantas medicinales como medicamentos y el 91,55% (141) no habría informado al anestesiólogo de su consumo durante una entrevista clínica rutinaria. CONCLUSIÓN: En la muestra estudiada el consumo de plantas medicinales con potenciales efectos adversos e interacciones farmacológicas con distintos fármacos utilizados habitualmente durante el periodo perioperatorio es importante. Es necesario que los anestesiólogos conozcan dichas plantas medicinales y sus efectos, e interroguen de forma específica sobre su consumo durante la consulta preanestésica

OBJECTIVES: To assess the use of medicinal plant preparations in preanesthetic interviews at a Spanish university hospital. MATERIALS AND METHODS: A total of 500 questionnaires were randomly distributed over a period of 3 months to patients attending a preanesthetic assessment interview. RESULTS: Of the 431 valid questionnaires returned, 154 (35.73%) were from patients who reported consumption of some type of herbal remedy and 55 (12.76%) were from patients who used a medicinal plant considered in the literature to be potentially toxic. Consumption was higher among women (64.28%) (P<0.001). Among users of these plants, 137 (88.96%) reported that they did not consider them to be medications and 141 (91.55%) would not have told the anesthesiologist about their use during a routine clinical interview. CONCLUSION: There is considerable use of medicinal herbs with potentially adverse interactions with various drugs used during the perioperative period. Anesthesiologists need to be familiar with such herbs and their effects and to ask specific questions about their use during the preanesthetic interview

Isquemia aguda de la mano como complicación de la canalización de la arteria radial. A propósito de dos casos tras cirugía de sarcoma abdominal / Acute ischemia of the hand as a complication of radial artery catheterization: a report of two cases after surgery for abdominal sarcoma

La canalización arterial es una técnica sencilla que aporta grandes beneficios, como son la monitorización continua de la presión arterial y la posibilidad de extraer analíticas seriadas, pero no está exenta de complicaciones. Dentro de estas últimas, las principales son la isquemia de la extremidad y la embolia gaseosa. A fin de disminuir el riesgo de aparición de complicaciones, existen unas normas para la canalización y mantenimiento de los catéteres arteriales.Presentamos 2 casos clínicos de isquemia aguda de la mano secundaria a cateterización arterial. Ambos pacientes fueron intervenidos de cáncer abdominal tipo sarcoma y presentaron, en el intervalo de unas horas, isquemia aguda de la mano. Fueron tratados con prostaglandinas, y a uno de ellos se le realizaron bloqueos del ganglio estrellado. La mejoría en los días siguientes fue leve y quedó establecida una necrosis seca de parte de la mano. En los 2 casos se encontró, como antecedente predisponente para la presentación de la isquemia, la existencia de un tumor muy avanzado abdominal tipo sarcoma, probablemente asociado a un estado de hipercoagulabilidad (AU)

[Acute ischemia of the hand as a complication of radial artery catheterization. Apropos of 2 cases following abdominal sarcoma surgery]. / Isquemia aguda de la mano como complicación de la canalización de la arteria radial. A propósito de dos casos tras cirugía de sarcoma abdominal.

Arterial catheterization is a simple technique that yields great benefits, such as continuous monitoring of arterial pressure and the possibility of taking repeated samples for analysis. However, it is not free of complications, the main ones being limb ischemia and gas embolism. To reduce the risk of complications, guidelines for insertion and maintenance of arterial catheters have been established. We report two cases of acute hand ischemia secondary to arterial catheterization. Both patients were undergoing surgery for sarcoma-type abdominal cancer and developed acute ischemia of the hand lasting several hours. The predisposing factor in both cases was the existence of a highly advanced sarcoma-type abdominal tumor, probably related to a state of hypercoagulability.