Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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Anafilaxia en anestesia / Anaphylaxis in anesthesia

Esta guía representa el consenso actualizado de expertos en el ámbito de las reacciones de hipersensibilidad de distintas sociedades científicas internacionales y la experiencia de nuestra unidad en el diagnóstico de las reacciones de anafilaxia perioperatorias. El correcto manejo de la anafilaxia perioperatoria requiere una sospecha diagnóstica precoz basada en la clínica que presenta el paciente. Se requiere la puesta en marcha de las pruebas de laboratorio inmediatas (triptasa sérica e histamina en plasma) para confirmar la reacción de hipersensibilidad, sin que ello interfiera el inicio precoz del tratamiento adecuado. La adrenalina sigue siendo el fármaco de elección en las reacciones de anafilaxia graves. El anestesiólogo es el responsable de la puesta en marcha de esta primera fase. La investigación tardía del mecanismo responsable y el agente etiológico corresponde a los alergólogos. Finalmente, y de forma conjunta, se debe realizar un informe basado en los hallazgos de los estudios realizados (inmediatos y tardíos) y la concordancia con la clínica. En el informe deben figurar los resultados de las pruebas, los fármacos y/o sustancias identificadas como responsables de la reacción, y las recomendaciones para futuras anestesias (AU)

This article represents the combination of expert consensus on hypersensitivity reactions of distinct international scientific societies and the experience of our unit in the diagnosis of perioperative anaphylactic reactions. The appropriate management of perioperative anaphylaxis requires early diagnostic suspicion, based on the patient's symptoms. Immediate laboratory tests (serum tryptase and plasma histamine) are required to confirm the hypersensitivity reaction but should not interfere with the start of appropriate treatment. The drug of choice in severe anaphylactic reactions continues to be adrenalin. The anesthesiologist is responsible for instigating this first phase while subsequent investigation of the causative mechanism and the etiological agent is performed by allergists. Finally, a joint report based on the findings of the (immediate and late) studies and the patient's symptoms should be provided. This report should contain information on the results of tests, the drugs and/or substances identified as causing the reaction, and recommendations for future anesthesia (AU)

Respuesta a la carta al director "Comentarios al artículo comparación de la eficacia y seguridad de tres técnicas analgésicas (epidural, bloqueo femoral y bloqueo femoral-ciático) en el postoperatorio de prótesis total de rodilla" / No disponible

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[Epidural analgesia versus femoral or femoral-sciatic nerve block after total knee replacement: comparison of efficacy and safety]. / Comparación de la eficacia y seguridad de tres técnicas analgésicas (epidural, bloqueo femoral y bloqueo femoral-ciático) en el postoperatorio de prótesis total de rodilla.

OBJECTIVE: Pain after total knee replacement surgery is intense. The aim of this study was to compare 3 techniques for providing postoperative analgesia (epidural analgesia, femoral nerve block, and a combined femoral-sciatic nerve block) in total knee arthroplasty. MATERIAL AND METHODS: Observational study of 1550 elective primary unilateral total knee replacement operations. The safety and efficacy of the following 3 techniques were compared: epidural analgesia, femoral nerve block, and femoral-sciatic nerve block. Demographic, anesthetic, and surgical data were recorded. Study variables included pain intensity on a visual analog scale every 4 hours, need for rescue analgesia (morphine), complications and adverse events within 5 postoperative days. RESULTS: No significant differences were found in demographic, anesthetic, or surgical variables. In the first 24 hours after surgery, pain intensity was significantly less for patients who received a femoral-sciatic nerve block. The mean levels of morphine consumption in the first 96 hours after surgery were similar in the femoral-sciatic nerve block group (3.18 mg) and the epidural analgesia group (3.19 mg); morphine consumption in the femoral block group was significantly higher (4.51 mg). Epidural analgesia was associated with the highest rate of complications (17%). CONCLUSIONS: A sciatic nerve block combined with a femoral nerve block attenuates pain more effectively and is associated with less postoperative morphine consumption in comparison with a femoral nerve block alone. Peripheral nerve block techniques have fewer adverse side effects than epidural analgesia.

Comparación de la eficacia y seguridad de tres técnicas analgésicas(epidural, bloqueo femoral y bloqueo femoral-ciático) en elpostoperatorio de prótesis total de rodilla / Epidural analgesia versus femoral or femoralsciatic nerve block after total knee replacement: comparison of efficacy and safety

OBJETIVOS: El dolor postoperatorio de la prótesis totalde rodilla es de una gran intensidad. El objetivo fuecomparar tres técnicas de analgesia postoperatoria (epidural,bloqueo del nervio femoral y bloqueo de los nerviosfemoral y ciático combinados) después de intervenciónde prótesis total de rodilla.MATERIAL Y MÉTODOS: Estudio observacional de 1.550intervenciones de prótesis de rodilla unilateral primariaselectivas. Se compararon tres técnicas de analgesia postoperatoria(epidural, bloqueo femoral y bloqueo femoralciático)para valorar eficacia y seguridad. Se recogierondatos demográficos, anestésicos y quirúrgicos, intensidaddel dolor según escala visual analógica cada 4 horas,rescate analgésico con morfina, complicaciones e incidenciasdurante los 5 primeros días del postoperatorio.RESULTADOS: No hallamos diferencias en las variablesdemográficas, anestésicas y quirúrgicas. La intensidad deldolor fue significativamente menor en el grupo bloqueofemoral y ciático respecto a los grupos epidural y bloqueofemoral durante las primeras 24 horas del postoperatorio.El consumo medio de morfina a las 96 horas tras la intervenciónfue similar en el grupo con bloqueo femoral y ciático(3,18 mg) y epidural (3,19 mg), y significativamentemayor con el bloqueo femoral (4,51 mg). La analgesia epiduralpresento el mayor índice de complicaciones (17%).CONCLUSIONES: Asociar un bloqueo ciático al bloqueofemoral disminuye el dolor y el consumo de morfina postoperatoriorespecto al bloqueo femoral aislado. Las técnicasanalgésicas de bloqueo periférico presentan menosefectos indeseables que la analgesia epidural (AU)

OBJECTIVE: Pain after total knee replacement surgeryis intense. The aim of this study was to compare 3techniques for providing postoperative analgesia(epidural analgesia, femoral nerve block, and acombined femoral-sciatic nerve block) in total kneearthroplasty.MATERIAL AND METHODS: Observational study of 1550elective primary unilateral total knee replacementoperations. The safety and efficacy of the following 3techniques were compared: epidural analgesia, femoralnerve block, and femoral-sciatic nerve block.Demographic, anesthetic, and surgical data wererecorded. Study variables included pain intensity on avisual analog scale every 4 hours, need for rescueanalgesia (morphine), complications and adverse eventswithin 5 postoperative days.RESULTS: No significant differences were found indemographic, anesthetic, or surgical variables. In thefirst 24 hours after surgery, pain intensity wassignificantly less for patients who received a femoralsciaticnerve block. The mean levels of morphineconsumption in the first 96 hours after surgery weresimilar in the femoral-sciatic nerve block group(3.18 mg) and the epidural analgesia group (3.19 mg);morphine consumption in the femoral block group wassignificantly higher (4.51 mg). Epidural analgesia wasassociated with the highest rate of complications (17%).CONCLUSIONS: A sciatic nerve block combined with afemoral nerve block attenuates pain more effectively andis associated with less postoperative morphineconsumption in comparison with a femoral nerve blockalone. Peripheral nerve block techniques have feweradverse side effects than epidural analgesia (AU)

[Patients' perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received]. / Percepción de seguridad en la decisión del paciente quirúrgico: relación con la información previa recibida.

OBJECTIVE: To evaluate the certainty of patients deciding whether or not to undergo a proposed operation and the relationship between the degree of certainty and the prior information received. METHODS: A cross-sectional study was performed using the decisional conflict scale (DCS) to evaluate the degree of certainty of patients deciding to undergo surgery. A standardized questionnaire was used to obtain demographic data (age, sex, and level of education) and details about the information the patients had received regarding the surgical procedure. Patients were classified as certain or uncertain of their decision to undergo surgery according to the DCS score. A logistic regression model was constructed to adjust for confounding factors and to analyze the relationship between certainty and variables reflecting the information received by the patient. RESULTS: A total of 358 patients were included. Thirty percent of the patients stated that they had not received prior information and 31.6% showed uncertainty in their decision. Younger men with a higher level of education felt more certain of their decision. After adjusting for age, sex, and level of education, we found that uncertainty was related to the perception of not having received enough prior information (odds ratio, 43; 95% confidence interval, 2.4-7.7). CONCLUSION: The perception of certainty is clearly linked to patients' understanding of prior information received. The results show a need to improve the information given to patients--particularly to elderly patients and those with a low level of education.

Percepción de seguridad en la decisión del paciente quirúrgico: Relación con la información previa recibida / Patients’ perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received

OBJETIVO: Evaluar la seguridad mostrada por elpaciente ante el proceso quirúrgico propuesto y su relacióncon la información previa recibida.MÉTODO: Se realizó un estudio transversal en el quese valoró la seguridad en la decisión de operarse delpaciente mediante la “Decisional Conflict Scale” (DCS).Con un cuestionario estandarizado se obtuvo informaciónsobre datos demográficos (edad, sexo y nivel deestudios) y sobre la información recibida relativa a laintervención quirúrgica. En función de la puntuaciónobtenida en la DCS, se clasificaron los pacientes en segurose inseguros en su decisión de operarse. Se creó unmodelo de regresión logística para ajustar posibles factoresde confusión y analizar la seguridad con las variablesrelativas a la información recibida.RESULTADOS: Se incluyeron 358 pacientes. El 31,6%de pacientes mostraron inseguridad en la decisión tomaday un 30% manifestaron no haber recibido información.Los hombres más jóvenes, con nivel de estudiossuperior mostraron más seguridad en la decisión. Lainseguridad del paciente guardó relación con la percepciónde no haber recibido suficiente información previa(OR = 4,3; 95% IC = 2,4-7,7) ajustando por edad, sexo ynivel de estudios.CONCLUSIÓN: La percepción de seguridad en la decisióndel paciente está en clara relación con la comprensiónde la información previa recibida. Los resultadosobtenidos muestran la necesidad de mejorar la informaciónque damos a los pacientes, principalmente enpacientes mayores y con bajo nivel de estudios (AU)

OBJETIVE: To evaluate the certainty of patientsdeciding whether or not to undergo a proposedoperation and the relationship between the degree ofcertainty and the prior information received.METHODS: A cross-sectional study was performedusing the decisional conflict scale (DCS) to evaluate thedegree of certainty of patients deciding to undergosurgery. A standardized questionnaire was used toobtain demographic data (age, sex, and level ofeducation) and details about the information thepatients had received regarding the surgical procedure.Patients were classified as certain or uncertain of theirdecision to undergo surgery according to the DCS score.A logistic regression model was constructed to adjust forconfounding factors and to analyze the relationshipbetween certainty and variables reflecting theinformation received by the patient.RESULTS: A total of 358 patients were included. Thirtypercent of the patients stated that they had not receivedprior information and 31.6% showed uncertainty intheir decision. Younger men with a higher level ofeducation felt more certain of their decision. Afteradjusting for age, sex, and level of education, we foundthat uncertainty was related to the perception of nothaving received enough prior information (odds ratio,4.3; 95% confidence interval, 2.4-7.7).CONCLUSION: The perception of certainty is clearlylinked to patients’ understanding of prior informationreceived. The results show a need to improve theinformation given to patients—particularly to elderlypatients and those with a low level of education (AU)

Uso inadecuado de adrenalina en las reacciones de anafilaxia: a propósito de dos casos / Inappropriate epinephrine (adrenaline) use during anaphylactic reactions: a report of 2 cases

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[Update on the anesthetic management of patients with malignant carcinoid syndrome]. / Actualización del manejo anestésico de un paciente con síndrome carcinoide.

Carcinoid crisis during surgery can lead to severe hemodynamic alterations (hypo- and hypertension) and bronchospasm. Intravenous infusion of octreotide, preceded by preoperative subcutaneous administration, can allow such crises to be brought under control quickly. Given the high prevalence of carcinoid cardiopathy, which increases the risk of a crisis in these patients, a preoperative echocardiogram should be performed. General anesthesia combined with epidural blockade is effective in this context. Block onset should be gradual to avoid the development of hypotension, which is difficult to treat. The pharmacodynamic profile of remifentanil, its elevated potency, and low histamine releasing potential mean that this opioid offers novel advantages during general anesthesia.

Actualización del manejo anestésico de un paciente con síndrome carcinoide / Update on the anesthetic management of patients with malignant carcinoid syndrome

Las crisis carcinoides durante el intraoperatorio pueden dar lugar a severas alteraciones hemodinámicas (hipo e hipertensión)y broncospasmo. La administración de octeótrida endovenosa para el control de las crisis, precedido de su administración subcutánea preoperatoria, permite un rápido control. Dada la elevada frecuencia de cardiopatía carcinoide en estos pacientes, debe realizarse un ecocardiograma preoperatoriamente en todos. Su presencia supone un factor de riesgo para la presentación de las crisis. La anestesia general combinada con bloqueo epidural supone una alternativa eficaz en estos pacientes. Se debe instaurar el bloqueo progresivamente para evitar la aparición de hipotensión, de difícil tratamiento. El empleo del remifentanilo como opioide durante la anestesia general nos ofrece nuevas ventajas en este tipo de pacientes, gracias a su perfil farmacocinético, elevada potencia y bajo potencial histaminoliberador, dando buenos resultados

Carcinoid crisis during surgery can lead to severe hemodynamic alterations (hypo-and hypertension)and bronchospasm. Intravenous infusion of octreotide, pre- ceded by preoperative subcutaneous administration, can allow such crises to be brought under control quickly. Given the high prevalence of carcinoid cardiopathy, which increases the risk of a crisis in these patients, a preoperative echocardiogram should be performed. General anesthesia combined with epidural blockade is effective in this context. Block onset should be gradual to avoid the development of hypotension, which is difficult to treat. The pharmacodynamic profile of remifentanil, its elevated potency, and low histamine releasing potential mean that this opioid offers novel advantages during general anesthesia

Reacciones alérgicas durante la anestesia. Situación actual y perspectivas de futuro / Allergic reactions during anesthesia: the current situation and a look toward the future

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Sensibilidad y especificidad de las pruebas "in vitro" en las reacciones alérgica al altes / Sensitivity and specificity of "in vitro" test for latex allergy

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Reflexiones sobre la valoración anestésica preoperatoria / Thougts abaut preoperative anesthesic assesment

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