[Malignant hyperthermia in a pig anesthesized with desflurane]. / Hipertermia maligna en un cerdo anestesiado con desflurano.

A large-white pig that had not been genetically selected to develop malignant hyperthermia (MH) during anesthesia nevertheless suffered an episode of severe MH after repeated exposure to increasing concentrations of desflurane. MH is a hypermetabolic alteration that may develop in susceptible patients who have inhaled certain drugs or agents that act as triggers. Early identification and appropriate treatment are essential to reduce the likelihood of death associated with this severe alteration. We report a case of late-developing MH triggered by low concentrations of inhaled desflurane.

Hipertermia maligna en un cerdo anestesiado con desflurano / Malignant hyperthermia in a pig anesthestized with desflurane

Un cerdo de la raza Large-White, no seleccionado genéticamente para desarrollar hipertermia maligna (HM) durante la anestesia, presentó un episodio de hipertermia maligna grave tras la exposición repetida a concentraciones crecientes con desflurano.La hipertermia maligna es una alteración hipermetabólica que se puede presentar en pacientes susceptibles a los que se le administran ciertos fármacos o agentes inhalatorios que actúan como agentes desencadenantes. La identificación precoz y el tratamiento adecuado son imprescindibles para disminuir la mortalidad asociada a tan grave alteración.Este caso de hipertermia maligna desencadenado por desflurano se caracterizó por una presentación tardía y por desarrollarse con una concentración mínima de agente inhalatorio (AU)

Diagnóstico diferencial de meningitis postoperatoria tras anestesia subaracnoidea / Differential diagnosis of postoperative meningitis following subaracnoid anesthesia

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[Transfusion needs during intraoperative and immediate postoperative periods in arthroplasty of the hip and knee]. / Necesidades transfusionales durante el intra y postoperatorio inmediato de la artroplastia de cadera y rodilla. Incidencia y factores asociados.

OBJECTIVES: To determine the factors associated with immediate perioperative transfusion requirements of hip or knee arthroplasty patients who have not been enrolled in a blood salvage program. PATIENTS AND METHODS: This prospective study collected demographic (age, sex, weight, height, etc.), physiological (hemoglobin levels, coagulation times, preoperative platelet counts, etc.), clinical history and anesthetic and surgical data (type of anesthesia, surgical diagnosis, duration of procedure) in 112 patients undergoing orthopedic surgery: 19 cases of primary knee arthroplasty, 77 cases of hip arthroplasty and 16 replacements of hip arthroplasty. Logistic regression analysis of the aforementioned variables was performed to search for factors related to transfusional needs during and after hip arthroplasty or after knee arthroplasty, which was performed with a tourniquet applied to render intraoperative transfusion unnecessary. RESULTS: The variables that increased the risk of transfusion during surgery were duration of procedure exceeding 120 min (OR 15.24; p = 0.01) and loss of over 500 ml of blood during surgery (OR 11.4; p = 0.02). The variables associated with perioperative transfusion were loss of over 500 ml in the postanesthetic recovery room (OR 12.6; p < 0.0001), hypotensive episodes during recovery (OR 11.7; p = 0.0001), prosthetic replacement (OR 6.33; p = 0.005), height < 160 cm (OR 5.03; p = 0.02), preoperative hemoglobin level < 13.5 g/dl (OR 4.97; p = 0.02), and surgery for reasons other than osteoarthritis (arthritis, pathological fractures, etc.) (OR 4.60; p = 0.04). Variables associated with transfusion of over two units of packed red cells were a history of neoplastic disease unrelated to arthroplasty (OR 378.67; p = 0.005), prosthetic replacement (OR 49.71; p = 0.009), diabetes (OR 36.49; p = 0.02) and a hypotensive event while in the postanesthetic recovery room (OR 29.12; p = 0.02). CONCLUSION: These results suggest that certain modifiable factors increase the risk of blood transfusion in knee and hip arthroplasty. Specifically, they are duration of surgery, intra- and postoperative bleeding, preoperative hemoglobin level and instances of perioperative hypotension. Other factors outside our control are height or patient clinical history.