[Recombinant activated factor VII in the postanesthetic recovery unit: review of 16 cases]. / Utilización del rFVIIa en una unidad de reanimación. Revisión de 16 casos.

We describe a series of 16 cases in which recombinant activated factor VII (rFVIIa) was used in our postanesthetic recovery unit. The mean age of the patients was 53.5 years (range, 30-84 years). Eleven were men and 5 women. The mean dose of rFVIIa used was 75 microg x kg(-1) (range, 60-90 microg x kg(-1)) and 25% of the patients needed a second dose. All the patients had postoperative bleeding, 62.5% after general surgery, 25% after a liver transplant, and 12.5% after a lung transplant. rFVIIa therapy was effective in 66% of the patients and no adverse thrombotic events related to treatment were observed. rFVIIa can be an efficacious therapeutic option for bleeding and coagulation disorders that are refractory to conventional replacement therapy. Approval to use rFVIIa in this setting and the establishment of indications should be based on further research.

Utilización del rFVIIa en una Unidad de Reanimación. Revisión de 16 casos / Recombinant activated factor VII in the postanesthetic recovery unit: review of 16 cases

Describimos una serie de 16 pacientes en los que seutilizó el factor VII recombinante activado (rFVIIa) ennuestro Servicio de Reanimación.La media de edad fue de 53,5 años (30-84), 11 varonesy 5 mujeres. La dosis media de rFVIIa utilizada fue de75 µg kg-1 (60-90 µg kg-1) precisando repetir la dosis en el25% de los casos. Todos los pacientes padecían complicacioneshemorrágicas postoperatorias, el 62,5% trascirugía general, el 25% tras trasplante hepático y el12,5% tras trasplante pulmonar.En el 66% de los enfermos, el factor fue efectivo y nohubo episodios trombóticos clínicos secundarios al tratamiento.El rFVIIa puede ser un arma terapéutica efectiva enhemorragias con coagulopatía refractarias al tratamientosustitutivo habitual. La aprobación para su uso eneste contexto así como la determinación de sus indicacionesprecisa de más estudios de investigación

We describe a series of 16 cases in which recombinantactivated factor VII (rFVIIa) was used in our postanestheticrecovery unit.The mean age of the patients was 53.5 years (range, 30-84 years). Eleven were men and 5 women. The mean doseof rFVIIa used was 75 µg·kg-1 (range, 60-90 µg·kg-1) and25% of the patients needed a second dose. All the patientshad postoperative bleeding, 62.5% after general surgery,25% after a liver transplant, and 12.5% after a lung transplant.rFVIIa therapy was effective in 66% of the patients andno adverse thrombotic events related to treatment wereobserved.rFVIIa can be an efficacious therapeutic option for bleedingand coagulation disorders that are refractory to conventionalreplacement therapy. Approval to use rFVIIa inthis setting and the establishment of indications should bebased on further research

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

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[Carotid endarterectomy: postoperative morbimortality and requirements for intensive care]. / Endarterectomía carotídea: morbimortalidad postoperatoria y requerimientos de vigilancia intensiva.

OBJECTIVES: To analyze risk factors, morbidity and mortality of carotid endarterectomy, and to determine whether prolonged attention in the postoperative intensive care recovery unit is needed by all patients. PATIENTS AND METHODS: A retrospective study of 102 carotid endarterectomy patients between January 1991 and February 1997. The following data were analyzed: preoperative risk factors, prior neurologic symptoms, time of stay in the recovery unit, postoperative complications requiring intensive treatment and the time of onset of such events, and mortality after 30 days. RESULTS: Some type of postoperative complication developed in 35% of patients in the recovery unit, requiring specialized medical attention; 94.8% occurred within eight hours of admission to the unit and the most common complication was hypertension. After transfer to the ward, 9 more patients (8.8%) suffered severe complications, most commonly coronary ischemia. Mortality was 1.9% and the combined rate of mortality plus severe neurologic event was 2.9%. Preoperative hypertension and the presence of more than three risk factors in the same patient was statistically related to the development of postoperative complications. Presurgical coronary disease was related to postoperative ischemic complications. CONCLUSIONS: Patients undergoing carotid endarterectomy with fewer than four risk factors and no ischemic heart disease or severe hypertension can probably be transferred to the hospital ward eight hours after admission to the recovery unit if no complications have developed, thus reducing hospital costs. We believe that appropriate vigilance of such patients should then be provided on the ward.