Metrorragia masiva en una paciente anticoagulada con warfarina. Reversión rápida con concentrado de complejo protrombínico (Prothromplex Immuno TIM 4 600 UI) / Massive metrorrhagia in a patient under warfarin anticoagulation. Rapid reversal with a concentrated prothrombin complex (Prothromplex Immuno TIM 4 600 IU)

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Anaesthetic considerations in Castleman's disease.

Castleman's disease is a lymphoreticular disorder, often localized and clinically silent. Systemic manifestations may occur. Castleman's disease may be associated with pathologies such as POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes), AIDS, amyloidosis, pemphigus vulgaris, and other types of cancer such as lymphoma and Kaposi's sarcoma. Careful preoperative evaluation is required to determine whether associated mediastinal or spinal canal masses or haematological disorders are present. The significance of these pathologies for anaesthetic management is discussed. We present the case of a 27-year-old female patient with Castleman's disease (hyaline-vascular variant) requiring vaginal reconstruction due to recurrent sores and synechiae.

Réplica a la carta "cuidados críticos en la paciente obstétrica" / Reply to "Critical care of the obstetric patient"

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[Complications and morbidity and mortality rates in a postanesthetic intensive care unit]. / Patología y morbimortalidad en una Unidad de Reanimación Obstétrica.

OBJECTIVES: To describe the complications leading to admission of obstetric patients to intensive care or intensive postanesthetic care units. To describe the morbidity and mortality rates in such patients. MATERIAL AND METHODS: We carried out a descriptive study based on patient records of 23,246 births at the Hospital Materno Infantil belonging to the University Hospitals Virgen del Rocio in Sevilla, Spain, over a 3-year period (2001-2003). RESULTS: In the 23,246 births reviewed, 746 women (3%) required admission to the obstetric postoperative intensive care unit. The most common reasons were pre-eclampsia in 146 cases (19%), ectopic pregnancy in 97 cases (13%), and postpartum bleeding in 75 cases (10%). Among the 146 cases of preeclampsia treated in the unit, there were 8 cases of eclampsia and 7 of acute pulmonary edema. Two deaths (0.3%) occurred, due to eclampsia in 1 case and to pulmonary thromboembolism in the other. CONCLUSIONS: Obstetric patients are at risk of serious complications that require admission to intensive care or intensive postanesthetic care units, and we therefore emphasize the need to create such units at tertiary care hospitals.

Patología y morbimortalidad en una Unidad de Reanimación Obstétrica / Complications and morbidity and mortality rates in a postanesthetic intensive care unit

OBJETIVOS: Describir la patología susceptible de ingreso en unidades de reanimación o cuidados intensivos, en las pacientes obstétricas, así como su morbimortalidad. MATERIAL Y MÉTODOS: Realizamos un análisis descriptivo utilizando la base de datos del Hospital Materno Infantil de los Hospitales Universitarios Virgen del Rocío de Sevilla de los 23.246 partos realizados en un período de tres años (2001-2003). RESULTADOS: De los 23.246 partos revisados,746 pacientes (3%)necesitaron ingreso en la Unidad de Reanimación Obstétrica. Las causas más frecuentes fueron: preeclampsia con 146 casos (19%),gestaciones ectópicas con 97 casos (13%)y hemorragias postparto con 75 casos (10%).Entre las 146 preeclampsias atendidas en la unidad de reanimación obstétrica, hubo 8 casos de eclampsia y 7 de edema agudo de pulmón. Hubo dos casos de muerte (0,3%),una por eclampsia y otra por tromboembolismo pulmonar. CONCLUSIONES: Las pacientes obstétricas son susceptibles de sufrir patologías graves durante el período gestacional, que requieren su ingreso en unidades de cuida- dos intensivos o reanimación, por lo que destacamos la necesidad de potenciar su creación en hospitales de tercer nivel

OBJECTIVES: To describe the complications leading to admission of obstetric patients to intensive care or intensive post anesthetic care units. To describe the morbidity and mortality rates in such patients. MATERIAL AND METHODS: We carried out a descriptive study based on patient records of 23,246 births at the Hospital Materno Infantil belonging to the University Hospitals Virgen del Rocio in Sevilla, Spain, over a 3- year period (2001-2003). RESULTS: In the 23,246 births reviewed,746 women (3%)required admission to the obstetric postoperative intensive care unit. The most common reasons were pre- eclampsia in 146 cases (19%),ectopic pregnancy in 97 cases (13%),and postpartum bleeding in 75 cases (10%). Among the 146 cases of preeclampsia treated in the unit, there were 8 cases of eclampsia and 7 of acute pulmonary edema. Two deaths (0.3%) occurred, due to eclampsia in 1 case and to pulmonary thromboembolism in the other. CONCLUSIONS: Obstetric patients are at risk of serious complications that require admission to intensive care or intensive post anesthetic care units, and we therefore emphasize the need to create such units at tertiary care hospitals

Papel de la ventilación mecánica no invasiva en un caso de edema agudo pulmonar de una paciente puérpera obesa mórbida / Role of noninvasive ventilation in a case of acute pulmonary edema in a morbidly obese woman following childbirth

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¿Subdural o epidural? Dos posibles nuevos casos de punción subdural / Subdural or epidural? Two possible new cases of subdural perforation

Presentamos dos casos clínicos de posible bloqueo subdural accidental tras la identificación del espacio epidural para la administración de analgesia en gestante a término para trabajo de parto. En los casos que describimos, la localización del espacio epidural se realizó sin incidencias. Las pruebas de identificación fueron favorables. Fue en ambos casos que se apreció la salida de líquido cefalorraquídeo cuando se introdujo el catéter. Describimos la posibilidad de haber localizado "un espacio vacío" con la aguja de Tuhoy, que bien pudo ser el espacio subdural, pero fue el catéter el que perforó la membrana subaracnoidea. Planteamos la discusión en torno a cómo hubiéramos podido saber la posición de la aguja y así haber evitado la perforación subaracnoidea con el catéter. ¿Es lógico pensar, hoy día, que deben imponerse técnicas de localización del espacio epidural más sofisticadas? (AU)

[Psychological profile of anesthesia residents in the province of Andalucia]. / Perfil psicológico de la población de médicos residentes de anestesiología en una provincia de Andalucía.

OBJECTIVES: To describe the personality traits and value systems of the population of residents in anesthesiology of a province in Andalusia and to analyze what the ideal profile of an anesthesiologist in training would be. SUBJECTS AND METHOD: Forty-four residents in anesthesiology were invited to participate, of whom 22 accepted. The participants voluntarily completed anonymous written questionnaires with 232 items: the sixteen personality factors questionnaire, form A (R.B. Cattell), and the survey of interpersonal values (L.V. Gordon). RESULTS: The residents scored high on primary factors of intelligence (B), self-sufficiency (Q2) and conservatism (Q1). High scores were also recorded on the secondary factors of anxiety (QI) and socialization (QIII); low scores were seen for independence (QIV). Four theoretical personality models (alpha, beta, gamma and delta) were established based on the data. Four residents were alphas (18%), 10 were betas (45%), 6 were gammas (27%) and 2 were deltas (10%). CONCLUSIONS: An ideal personal profile for residents in anesthesiology by American authors has been available since the 1960s. An ideal resident should be independent, calm, aware, stable, secure, self-disciplined and alert; moreover, he or she should enjoy team work. The residents with alpha personalities were ideal. At present, the training of residents and the selection criteria for access to specialized training based on a personality test are scarcely valued in our discipline.