Actualización de la práctica transfusional entre los anestesiólogos y su impacto en el paciente quirúrgico / Updating anesthesiologists' transfusion practices and the impact on surgical patients

OBJETIVO: Comprobar la eficacia de la introducción de un programa educacional en el personal del Servicio de Anestesia y Reanimación y valorar su efectividad en la reducción de la transfusión intraoperatoria (TIO). MATERIAL Y MÉTODOS: Revisamos la incidencia de TIO durante el primer semestre de los años 1996 y 2001 en Cirugía General, Urología, Otorrinolaringología (ORL), Cirugía Maxilofacial, Cirugía Torácica y Cirugía Vascular. Así mismo se controlaron otras variables como sexo, edad, tipo de intervención, urgencia, duración de la cirugía y consumo de hemoderivados. RESULTADOS: Se observó una reducción global de la TIO (número de pacientes transfundidos) estadísticamente significativa (4,9 por ciento de los pacientes en 1996 frente a 3,6 por ciento en 2001). Este descenso transfusional (18,8 por ciento menos de pacientes transfundidos), fue más acusado en Cirugía General y Urología especialmente en cirugía programada (4,1 por ciento en 1996 frente 2,6 por ciento en 2001).Sin embargo, el consumo total de concentrados de hematíes no mostró diferencias siendo el consumo por paciente mayor en 2001 (2,8 unidades/paciente) frente al de 1996 (2,4 unidades/paciente).En cirugía de urgencia la tasa transfusional aumentó del 7,6 por ciento en 1996 frente al 8,1 por ciento en 2001. También observamos una tasa de politransfusión (considerada como el consumo de 5 o más concentrados de hematíes durante la cirugía) mayor en el año 2001. CONCLUSIÓN: La introducción de un programa educacional entre los anestesiólogos se ha mostrado útil en la reducción de TIO, aunque el consumo de hemoderivados no haya disminuido (AU)

[Update on transfusion practice among anesthesiologists and its impact on the surgical patient]. / Actualización de la práctica transfusional entre los anestesiólogos y su impacto en el paciente quirúrgico.

OBJECTIVE: To determine the effectiveness of a new educational program on transfusion practice, directed to the staff of an anesthesia and postoperative recovery service, by evaluating its impact on intraoperative transfusion (IOT). MATERIAL AND METHODS: We reviewed the incidence of IOT during the first semesters of 1996 and 2001 for general, urologic, otolaryngologic, maxillofacial, thoracic, and vascular surgery. Other factors such as sex, age, type of intervention, emergency status, duration of operation, and use of blood products were also taken into consideration. RESULTS: A statistically significant overall reduction in IOT occurred between 1996 (4.9%) and 2001 (3.6%). The decrease in transfusions (a reduction of 18.8% in transfused patients) was even greater in general surgery and urology, particularly in scheduled surgery (4.1% in 1996 vs 2.6% in 2001). However, the total use of packed red blood cells did not change inasmuch as the number of units per patient was higher in 2001 (2.8 units/patient) than in 1996 (2.4 units/patient). In emergency surgery, the IOT rate increased from 7.6% in 1996 to 8.1% in 2001. We also noticed a higher rate of multiple transfusions (defined as the use of 5 or more units of packed red blood cells during surgery) in 2001. CONCLUSION: The introduction of an educational program directed to anesthesiologists has been useful for reducing IOT, although the overall use of blood products has not decreased.

Suero salino hipertónico 7.5% en el tratamiento de la a1calosis metabólica hipoclorémica grave / Hypertonic saline 7.5% to treat serious hypochloremic metabolic alkalosis

Un varón de 63 años con antecedentes de carcinoma de ano tratado con cirugía, quimioterapia y radioterapia hacía dos años, ingresó por presentar cuadro oclusivo de intestino delgado siendo intervenido de urgencia. Quince días después de esta cirugía fue nuevamente intervenido. Durante la intervención se apreció alcalosis metabólica grave, con pH 7,58, CO3H- 47,7 mmol/l y exceso de base 24,3 mmol/l. El paciente presentaba factores etiológicos preoperatorios favorecedores de la aparición de alcalosis metabólica hipoclorémica (niveles bajos de CI y K, aspiración prolongada del contenido gástrico, volemia baja y nutrición parenteral). La alcalosis metabólica fue tratada con 250 ml de suero salino hipertónico 7,5%, 40 mEq de CIK y medidas generales (adecuación del patrón ventilatorio, sustitución de la perfusión de Ringer lactado por suero fisiológico 0,9% y administración de omeprazol). La respuesta al tratamiento fue adecuada remitiendo los valores elevados a niveles aceptables en 2 b. La alcalosis metabólica es una alteración del equilibrio ácido-base frecuente en la clínica cuya etiología es variada y que presenta importantes implicaciones anestésicas. El suero salino hipertónico tiene una posible utilidad como parte del tratamiento de la alcalosis metabólica hipoclorémica aguda grave (AU)

A 63 year-old man with a history of anal carcinoma treated by surgery, chemotherapy and radiotherapy was admitted to our hospital two years later with small bowel obstruction requiring emergency surgery. Fifteen days later, be bad to be operated on once again. During the procedure, severe metabolic alkalosis developed: pH 7.58, CO3H- 47.7 mmol/L and a base excess or 24.3 mmol/L. The patient had the following preoperative risk factors for hypochloremic metabolic alkalosis: low levels or CI and K, prolonged aspiration of gastric contents, low plasma volume and parenteral nutrition. Metabolic alkalosis was managed with 250 mL or 7.5% hypertonic saline, 40 mEq of KCI, readjustment of the ventilatory pattern, perfusion of lactated Ringer's solution instead of 0.9% saline and administration of omeprazole. Response to treatment was good as elevated values fell to acceptable levels within two hours. Metabolic alkalosis is a common acid-base balance disorder which arises for a variety of reasons and which has significant anesthetic implications. Hypertonic saline may be useful for treating severe, acute bypochloremic metabolic alkalosis (AU)

[Hypertonic saline 7.5% in the treatment of severe hypochloremic metabolic alkalosis]. / Suero salino hipertónico 7,5% en el tratamiento de la alcalosis metabólica hipoclorémica grave.

A 63 year-old man with a history of anal carcinoma treated by surgery, chemotherapy and radiotherapy was admitted to our hospital two years later with small bowel obstruction requiring emergency surgery. Fifteen days later, he had to be operated on once again. During the procedure, severe metabolic alkalosis developed: pH 7.58, CO3H- 47.7 mmol/L and a base excess of 24.3 mmol/L. The patient had the following preoperative risk factors for hypochloremic metabolic alkalosis: low levels of Cl and K, prolonged aspiration of gastric contents, low plasma volume and parenteral nutrition. Metabolic alkalosis was managed with 250 mL of 7.5% hypertonic saline, 40 mEq of KCl, readjustment of the ventilatory pattern, perfusion of lactated Ringer's solution instead of 0.9% saline and administration of omeprazole. Response to treatment was good as elevated values fell to acceptable levels within two hours. Metabolic alkalosis is a common acid-base balance disorder which arises for a variety of reasons and which has significant anesthetic implications. Hypertonic saline may be useful for treating severe, acute hypochloremic metabolic alkalosis.

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.