Complicaciones perianestésicas en una paciente con osteomalacia no conocida secundaria a cirugía bariátrica previa / Perianesthetic complications in a woman with undiagnosed osteomalacia secondary to earlier gastric bypass surgery

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Hallazgo de quiste hidatídico intraarterial en el curso de toracotomía diagnóstica / An intra-arterial hydatic cyst found during diagnostic thoracotomy

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[Reduction of blood transfusion need with aprotinin in orthopedic surgery. Spanish Study Group on the Use of Aprotinin in Hip Arthroplasty (GEEEAAC)]. / Reducción de las necesidades transfusionales con aprotinina en cirugía ortopédica. Grupo Español de Estudio del Empleo de Aprotinina en Artroplastia de Cadera (GEEEAAC).

Aprotinin is a protease inhibitor of interest for its antifibrinolytic effect of reducing perioperative bleeding in certain types of surgery, with wide use in heart surgery, liver transplantation and vascular surgery. The application of aprotinin during orthopedic surgery has recently been suggested. Such use is controversial, as there is lack of consensus as to the type of patient for whom aprotinin administration would be indicated, the surgical procedure during which it would be most effective (hip or knee arthroplasty, spinal arthrodesis, major tumor or septic surgery), the doses to administer, its safety and its real efficacy for conserving homologous blood. That is to say, there is no agreement as to the cost/benefit relation of aprotinin for the various types of orthopedic surgery. This critical review of the literature leads to the conclusion that aprotinin is a promising drug for use in orthopedic surgery, given that published studies have established the benefit in blood product savings and decreased blood loss during surgery.

Reducción de las necesidades transfusionales con aprotinina en cirugía ortopédica / Reduced transfusional requirements with aprotinin in orthopedic surgery

La aprotinina es un inhibidor de las proteasas que tiene interés en la actualidad en su calidad de antifibrinolítico para disminuir el sangrado perioperatorio en determinados tipos de cirugía, y su uso está admitido ampliamente en cirugía cardíaca, en el trasplante hepático y en cirugía vascular.Recientemente se ha propuesto su empleo en cirugía ortopédica. Se trata de una indicación controvertida por la falta de unanimidad en el tipo de paciente en el que la aprotinina estaría indicada, en el procedimiento quirúrgico en el que se conseguiría una mayor efectividad (artroplastia de cadera, artroplastia de rodilla, artrodesis raquídea, cirugía mayor tumoral o séptica), en las dosis que se deben administrar, en la seguridad de su empleo y en la eficacia real en el ahorro de sangre homóloga. Es decir, no hay acuerdo en cuanto al rendimiento de la relación coste/beneficio del fármaco en los diferentes procedimientos de cirugía ortopédica.En esta revisión se hace un estudio crítico de las publicaciones al respecto, concluyendo finalmente que se trata de un fármaco prometedor en cirugía ortopédica, dado que en los estudios publicados se ha obtenido un beneficio en relación con el ahorro de hemoderivados y con la disminución de sangrado perioperatorio (AU)

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[Heart arrest in cemented hip arthroplasty]. / Paro cardíaco en artroplastia de cadera cementada.

Hip arthroplasty is a common surgical intervention in our hospital practice, involving high perioperative risk related to patients age and multiple concomitant diseases. Hemodynamic complications described vary from slight hypotension during surgery to heart failure and sudden death, particularly if the operation involves a cemented femoral component. Because of the type of patients undergoing such operations (elderly patients, with osteoporosis and scarce cardiopulmonary reserve), the unclear origin of complications and the lack of consensus on what constitutes adequate monitoring during surgery, hip arthroplasty is problematic for the specialists involved. We report on five deaths during cemented hip arthroplasty; after reviewing the case history and autopsy report of one, we believe the events leading to death were triggered by massive pulmonary embolism.

A case of cardiac hydatidosis.

We present the case of a female patient with a diagnosis of hydatidosis located in the heart. Although echinococcosis is endemic to our country, very few cases of cardiac hydatidosis are normally reported. In our patient, the hydatid cyst was located in the septum and in the right ventricular cavity; it presented other unusual features, such as the fact that it was located exclusively in the heart, that it first manifested as anaphylactic shock of unknown origin and that it required immediate surgical treatment because of severe haemodynamic compromise.

[The utility of digital infiltration of mepivacaine and ketorolac in postoperative analgesia of the unilateral hallux valgus]. / Utilidad de la infiltración digital con mepivacaína y ketorolaco en la analgesia postoperatoria del hallux valgus unilateral.

OBJECTIVES: To determine whether locally injected ketorolac provides analgesia additional to that of mepivacaine, and also to prevent, diminish or delay the peripheral hypersensitivity response of postoperative pain. PATIENTS AND METHODS: Prospective, randomized, double-blind study of 72 patients scheduled for surgery to correct unilateral hallux valgus. Group 1 (n = 24) received median infiltration at the first metatarsus of 5 ml of 2% mepivacaine and 1 ml (30 mg) of ketorolac. Group 2 (n = 21) received local infiltration of 5 ml of 2% mepivacaine and 1 ml of saline solution. Group 3, the control group (n = 27) received the same solution as did group 2, plus 30 mg of ketorolac intravenously. The postoperative analgesia prescribed was 10 mg of ketorolac orally every 8 hours. Pain was measured on a visual analog scale (VAS) 0, 1, 4, 8 and 24 hours after surgery. Time elapsed until the appearance of pain, number of ketorolac pills consumed and overall patient satisfaction were recorded. RESULTS: There were no differences in anthropometric characteristics. Time until pain appeared was significantly longer in group 1 than in groups 2 and 3 (14.66 +/- 7.19, 5.90 +/- 2.27 and 8.70 +/- 5.02 hours, respectively). The VAS scores were significantly lower in group 1 after the fourth postoperative hour. Analgesic consumption was significantly lower in group 1. CONCLUSIONS: Infiltration of 30 mg of ketorolac along with mepivacaine delays the appearance of postoperative pain and diminishes it in the first 24 hours after surgery to correct hallux valgus, in comparison with infiltration of mepivacaine alone plus intravenous ketorolac.