Embolismo de líquido amniótico: nuestra casuística en la última década / Amniotic fluid embolism: a case history over the last 10 years

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Traqueobroncopatía osteocondroplástica: vía aérea difícil no prevista / Osteochondroplastic tracheobronchopathy: an unexpected difficult airway

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Incendio en el quirófano durante la realización de una cesárea / No disponible

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[Combined posterior lumbar plexus and sacral block for emergency surgery to treat hip fracture]. / Bloqueo combinado del plexo lumbar por vía posterior y plexo sacro para tratamiento quirúrgico urgente de la fractura de cadera.

Ultrasound-guided peripheral nerve blocks are being used more widely in modern anesthesiology, yet spinal anesthesia remains the most commonly used technique for lower limb surgery in general and for hip fracture in particular. A combined lumbar plexus and sacral block may provide an alternative to other local and regional anesthetic techniques in special situations such as the treatment of patients with serious concomitant disease who are on treatment that affects platelet aggregation. We report 2 cases in which patients underwent emergency surgery for hip fracture. Patient histories included serious heart and lung conditions, double antiplatelet therapy, risk factors for difficult airway, and intracranial hypertension. The aforementioned nerve block provided appropriate conditions for surgery, hemodynamic stability, and postoperative analgesia without complications.

Bloqueo combinado del plexo lumbar por vía posterior y plexosacro para tratamiento quirúrgico urgente de la fractura de cadera / Combined posterior lumbar plexus and sacral block for emergency surgery to treat hip fracture

En la actualidad, la realización de bloqueos nerviososperiféricos y el empleo de la ultrasonografía para su ejecuciónconstituyen una práctica creciente en el ámbitode la anestesiología moderna. En la cirugía de la extremidadinferior, en general, y de la fractura de la cadera,en particular, la técnica anestésica más frecuentementeempleada es la anestesia intradural. Sin embargo, el bloqueocombinado de los plexos lumbar y sacro puedeconstituir una alternativa a otras técnicas de anestesialocorregional y a la anestesia general en situacionesespeciales como las de pacientes con patología grave asociaday con tratamiento que afecta a la agregación plaquetaria.Presentamos dos casos clínicos de pacientescon indicación quirúrgica urgente por fractura de cadera,con severa cardioneumopatía y doble antiagregación,y con predictores de vía aérea difícil e hipertensiónintracraneal, en los que dicho bloqueo proporcionó adecuadascondiciones para la cirugía, estabilidad hemodinámicay analgesia postoperatoria, sin morbilidad (AU)

Ultrasound-guided peripheral nerve blocks are beingused more widely in modern anesthesiology, yet spinalanesthesia remains the most commonly used techniquefor lower limb surgery in general and for hip fracture inparticular. A combined lumbar plexus and sacral blockmay provide an alternative to other local and regionalanesthetic techniques in special situations such as thetreatment of patients with serious concomitant diseasewho are on treatment that affects platelet aggregation.We report 2 cases in which patients underwentemergency surgery for hip fracture. Patient historiesincluded serious heart and lung conditions, doubleantiplatelet therapy, risk factors for difficult airway, andintracranial hypertension. The aforementioned nerveblock provided appropriate conditions for surgery,hemodynamic stability, and postoperative analgesiawithout complications (AU)

[Cost-effectiveness analysis of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole]. / Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol.

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P < .05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P = .05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was Euros 41.35 for the PCA group and Euros 56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion.

Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol / Cost-effectiveness of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole

OBJETIVOS: Existen pocos datos relativos al coste-efectividad de los sistemas de analgesia controlada por el paciente (PCA) en el postoperatorio. El presente estudio compara desde esta perspectiva la PCA con una infusión elastomérica continua. MATERIAL Y MÉTODO: Estudio prospectivo, controlado y aleatorizado en 50 pacientes ASA I o II sometidas a cirugía mayor ginecológica, que evalúa durante las primeras 48 horas de postoperatorio la efectividad, los efectos secundarios, la satisfacción y los costes derivados de la administración de una pauta PCA i.v de metamizol y tramadol (Grupo PCA), frente a la infusión elastomérica continua de la misma solución analgésica (Grupo Elastómero). RESULTADOS: La efectividad analgésica y los efectos secundarios de las pautas fueron similares, aunque más pacientes del Grupo Elastómero precisaron rescates analgésicos con morfina (61% frente al 33% del grupo PCA; p < 0,05). El 81% de las pacientes del Grupo PCA repetirían el tratamiento analgésico frente a sólo el 56% del grupo Elastómero -p = 0,05-). El número medio de intervenciones de enfermería fue de 16 y 19 para los grupos PCA y Elastómero respectivamente. Los gastos medios de los tratamientos (no incluida la bomba PCA facilitada por la industria) ascendieron en el grupo PCA a 41,35 euros frente a los 56,22 euros del grupo Elastómero. CONCLUSIONES: Ambas pautas presentaron una eficacia analgésica parecida aunque la PCA resultó más satisfactoria, a la vez que el elastómero fue más caro. En las condiciones particulares de nuestro estudio la PCA postoperatoria resultó más ventajosa que la infusión continua elastomérica (AU)

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P<.05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P=.05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was €41.35 for the PCA group and €56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion (AU)