Unificación de "Anestesiología y Reanimación" con "Medicina Intensiva" / No disponible

No disponible

[Hemodynamic effects of levosimendan following cardiac surgery]. / Efectos hemodinámicos del levosimendan en el postoperatorio de pacientes sometidos a cirugía cardiaca.

The hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 microg x kg(-1) followed in 15 to 20 minutes by start of infusion at a rate of 0.2 microg x kg(-1) min(-1) for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 microg x kg(-1) min(-1). Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec(-1)/cm(-5)) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec(-1)/cm(-5)) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P < 0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P < 0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndrome.

Efectos hemodinámicos del levosimendan en el postoperatorio de pacientes sometidos a cirugía cardiaca / Hemodynamic effects of levosimendan following cardiac surgery

Se compararon 30 pacientes adultos sometidos a cirugía cardiaca programada con circulación extracorpórea al objeto de estudiar el efecto de la dobutamina y levosimendan sobre la hemodinámica. Quince pacientes recibieron levosimendan en dosis bolus de 12 μg kg-1 en 15-20 min seguidos de una infusión de 0,2 μg kg-1 min-1 durante 24 horas (grupo levosimendan). Otros 15 enfermos recibieron una infusión de dobutamina en dosis de 7,5 μg kg-1 min-1. Los parámetros hemodinámicos fueron medidos antes de comenzar la infusión del fármaco y a las 24 horas de tratamiento. La evolución de los principales parámetros hemodinámicos es la siguiente: Grupo dobutamina: Frecuencia cardiaca (latidos /min) 87,15 ± 10,22 (basal) 87,91 ± 6,00 (24 horas); Presión arterial media (mmHg) 83,96 ± 10,57 (basal) 86,41 ± 13,29 (24 horas); Índice cardiaco (l/min/m2): 2,21 ± 0,23 (basal) 2,53 ± 0,35 (24 horas); resistencias vasculares periféricas (dyn seg-1cm-5): 1436,74 ± 311,48 (basal) 1378,35 ± 320,68 (24 horas). Grupo levosimendan: Frecuencia cardiaca (latidos/ min) 84,28 ± 12,18 (basal) 96,02 ± 9,10 (24 horas); Presión arterial media (mm Hg) 83,59 ± 9,05 (basal) 74,29 ± 6,33 (24 horas); Índice cardiaco (l/min/m2): 2,16 ± 0,28 (basal) 3,02 ± 0,34 (24 horas); resistencias vasculares periféricas (dyn seg-1cm-5): 1578,93 ± 334,88 (basal) 1136,68 ± 158,60 (24 horas). Encontramos que las resistencias vasculares y la presión arterial media disminuyen de forma significativa (p<0,05) en el grupo levosimendan, pero no en el grupo dobutamina y que la frecuencia cardiaca y el índice cardiaco aumentan en el grupo levosimendan pero no en el grupo dobutamina. Concluimos que el levosimendan mejora la situación hemodinámica de estos pacientes y es una alternativa en el tratamiento del síndrome de bajo gasto postoperatorio

The hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 µg.kg-1 followed in 15 to 20 minutes by start of infusion at a rate of 0.2 µg.kg-1min-1 for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 µg.kg-1min-1. Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P<0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P<0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndromeThe hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 μg.kg-1 followed in 15 to 20 minutes by start of infusion at a rate of 0.2 μg.kg-1min-1 for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 μg.kg-1min-1. Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P<0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P<0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndrome

Formación en Medicina de Cuidados Intensivos / Training in Intensive Care Medicine

No disponible

Anestesiología y Medicina de Cuidados Intensivos / Specialization in Anesthesiology and in Intensive Care

No disponible

[Continuous renal replacement therapy: management of acute renal insufficiency in critical care units]. / Terapias continuas de sustitución renal: tratamiento de la insuficiencia renal aguda en las unidades de cuidados críticos.

Acute renal insufficiency is characterized by a sudden decrease in renal function. Various causes are implicated and the physiopathological mechanisms are quite complex. When kidney failure is associated with other organ or system failure, the patient is usually treated in an intensive care unit. Such "critical status" patients are characterized by severe cardiovascular, respiratory and metabolic unstability that may make conventional methods of dialysis (intermittent hemodialysis and peritoneal dialysis) impossible or inadvisable. Continuous methods of renal replacement include 24-hour extracorporeal blood filtration for an indefinite period of time. Such aspects of renal function as electrolyte regulation of nitrogenated products, inflammatory mediators and so forth are replaced or supplemented by various continuous modes available. In this review we discuss the functions and indications for the continuous renal replacement techniques available. The components of each technique are studied exhaustively with a view to obtaining benefit.

[Perforation and entrapment of an intra-aortic balloon: a complication related to the duration of implantation]. / Perforación y atrapamiento de un balón intraaórtico: una complicación relacionada con el tiempo de inserción.

A 69-year-old man was admitted to the Intensive Care Recovery Unit after heart surgery, carrying an intra balloon counterpulsation (IABCP) device inserted percutaneously days before surgery to provide hemodynamic support and which was still required after surgery. Fifteen days after insertion, blood was observed in the safety chamber. Surgical removal of the catheter was required when attempts to remove it manually failed. The balloon was seen to be perforated and clotted blood was found inside. We believe that long-term maintenance of IABCP carries high risk of perforation and entry of blood, which will clot, as well as of catheter entrapment unless removal is prompt.

Bradycardia and asystole following atropine-neostigmine administration after caesarean section in a parturient receiving methyldopa for pregnancy-induced hypertension.

We report one case of bradycardia and asystole immediately after the administration of 1 mg atropine and 2 mg neostigmine after the completion of an urgent caesarean section. We attribute this adverse reaction to the treatment of pregnancy-induced hypertension with methyldopa, perhaps facilitated by other drugs employed. Similar reactions have been reported relating to beta-receptor antagonists and tricyclic antidepressants, but not to methyldopa.

[Tracheal rupture during a transhiatal esophagectomy without thoracotomy. Intra- and postoperative treatment]. / Rotura traqueal en el curso de una esofagectomía transhiatal sin toracotomía. Tratamiento intra y postoperatorio.

We report the case of a male patient with a carcinoma of the upper third of the esophagus who presented a tracheal rupture during a transhiatal esophagectomy. The clinical picture was characterized by a severe alteration of the ventilatory function that required selective intubation and, later on, a right thoracotomy for repairing the tracheal lesion. After surgery the patient was treated at the Recovery Unit. He received high-frequency mechanic ventilation (jet ventilation type) during nine days in a attempt to decrease the risk for dehiscence of the tracheal suture and to ensure an adequate oxygenation and hemodynamic control. The clinical course was favourable.