The application of three-dimensional printing in the management of a difficult airway due to Treacher Collins syndrome.

We describe the use of three-dimensional printing to create precise airway models for a patient with Treacher Collins syndrome who presented for bimaxillary temporomandibular joint prostheses, and for whom airway management was predicted to be difficult. The model was based on pre-operative cone beam computed tomography images and printed in the 3D Lab of Hospital Universitario La Paz. Transparent models allowed clear visualisation for simulation and iterative refinement of airway management techniques and aided in risk assessment and instrument sizing. This case report emphasises the utility of this approach in complex airway scenarios.

Research priorities in perioperative fluid therapy and hemodynamic monitoring: A Delphi Consensus Survey from the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR).

BACKGROUND: Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS: Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS: 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS: The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.

Intraoperative crystalloid utilization variability and association with postoperative outcomes: A post hoc analysis of two multicenter prospective cohort studies.

BACKGROUND: The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS: We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS: 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.

¿Es correcta la inclusión del lactato en la nueva definición de sepsis? / Is it correct to include lactate in the new septic shock definition?

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¿Es la albúmina una alternativa real en el tratamiento de pacientes sépticos? / Is albumin a real alternative to starches in septic patients?

No disponible

Fluidoterapia de mantenimiento administrada en un hospital terciario: estudio de prevalencia / Maintenance fluid therapy in a tertiary hospital: a prevalence study

Objetivos. Evaluar el tipo de «fluidos/sueros» de mantenimiento administrados en nuestro hospital, y comparar como se ajustan a las recomendaciones actuales, tanto en volumen como en composición. Material y métodos. Estudio observacional y transversal. Se registró el volumen y tipo de fluidoterapia de mantenimiento que se pautaba durante 24h a pacientes ingresados en diferentes servicios del hospital. Se excluyeron aquellos en los que la administración de líquidos estuviese condicionada por un exceso o déficit de líquidos y electrólitos. Resultados. Se recogieron los datos de 198 pacientes, de los cuales 74 (37,4%) fueron excluidos por no cumplir los criterios de inclusión. El volumen medio administrado fue de 2.500cc/día. La dosis media de glucosa fue de 36g cada 24h (DE: 31,4). La combinación más frecuente incluyó suero salino fisiológico (SSF) con glucosado 5% (64,4% de los casos). La cantidad media de sodio administrada en 24h fue de 173mEq (DE: 74,8) y la de cloro de 168mEq (DE: 75), lo que supone superávit de +87,4mEq y +85mEq, respectivamente. En relación con el potasio, magnesio y calcio, el déficit fue de -50mEq, -22mEq y -21mEq día, respectivamente. La administración de sustancias buffer fue excepcional, siendo las más frecuentemente utilizadas el bicarbonato (2,29%), acetato (1,29%), lactato (1,15%) y gluconato (1,10%). Conclusión. El SSF es la solución más frecuentemente utilizada. En contraste con el exceso de sodio y cloro habitualmente pautado, la cantidad de otros iones, como potasio, magnesio, sustancias buffer y aporte calórico, es muy deficitaria (AU)

Objective. To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. Material and methods. Observational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. Results. Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, -50mEq, -22mEq and -21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. Conclusion. NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed (AU)

Maintenance fluid therapy in a tertiary hospital: A prevalence study. / Fluidoterapia de mantenimiento administrada en un hospital terciario: estudio de prevalencia.

OBJECTIVE: To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. MATERIAL AND METHODS: Observational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. RESULTS: Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, -50mEq, -22mEq and -21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. CONCLUSION: NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed.

Intraoperatorive hydroxyethyl starch: a safe therapy or a poison? / Almidones intraoperatorios: ¿medicamentos o venenos?

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Paraganglioma productor de catecolaminas en una paciente con síndrome de Eisenmenger y ventrículo único. Interés de la administración de óxido nítrico y monitorización hemodinámica mínimamente invasiva / Catecholamine-secreting paraganglioma in a patient with Eisenmenger syndrome and a single ventricle. Nitric oxide administration and minimally invasive haemodynamic monitoring

La cirugía de tumores neuroendocrinos que producen catecolaminas (paragangliomas, feocromocitomas) implican un alto riesgo anestésico que aumenta si coexisten con cardiopatías congénitas como el ventrículo único y el síndrome de Eisenmenger. Presentamos el caso de una paciente con ventrículo único y síndrome de Eisenmenger diagnosticada de paraganglioma abdominal. Resaltamos las limitaciones de la medición del gasto cardiaco por termodilución debido a la alteración del tránsito normal del indicador (suero frío), y reseñamos el beneficio que puede suponer la utilización de sistemas autocalibrados de análisis de la onda de presión arterial. Además, queremos destacar la utilidad del óxido nítrico en determinados momentos de compromiso respiratorio por hipertensión pulmonar como consecuencia de la manipulación quirúrgica. En cuanto a la técnica anestésica, no hay ninguna de elección, pero con independencia de la elegida lo importante es que no produzca repercusiones hemodinámicas (AU)

Surgery for catecholamine-secreting neuroendocrine tumours poses a high anaesthetic risk that might increase due to coexisting congenital heart diseases, such as a single ventricle and Eisenmenger syndrome. This report emphasises the usefulness of pulse range haemodynamic monitoring over thermodilution in a patient with a single ventricle. In addition, the importance of nitric oxide is stressed in the management of respiratory problems associated to surgical-related pulmonary hypertension. As to the anaesthetic techniques, none is preferred as long as the one chosen has no haemodynamic repercussions (AU)

[Catecholamine-secreting paraganglioma in a patient with Eisenmenger syndrome and a single ventricle. Nitric oxide administration and minimally invasive haemodynamic monitoring]. / Paraganglioma productor de catecolaminas en una paciente con síndrome de Eisenmenger y ventrículo único. Interés de la administración de óxido nítrico y monitorización hemodinámica mínimamente invasiva.

Surgery for catecholamine-secreting neuroendocrine tumours poses a high anaesthetic risk that might increase due to coexisting congenital heart diseases, such as a single ventricle and Eisenmenger syndrome. This report emphasises the usefulness of pulse range haemodynamic monitoring over thermodilution in a patient with a single ventricle. In addition, the importance of nitric oxide is stressed in the management of respiratory problems associated to surgical-related pulmonary hypertension. As to the anaesthetic techniques, none is preferred as long as the one chosen has no haemodynamic repercussions.

Craneotomía en el paciente consciente. Consideraciones en situaciones especiales / Awake craniotomy. Considerations in special situations

La craneotomía con el paciente despierto es un procedimiento ancestral, que vuelve a estar de actualidad. Confinada durante mucho tiempo a la cirugía de la epilepsia, sus indicaciones se han ampliado, siendo una técnica ampliamente reconocida para la resección de lesiones próximas a regiones corticales fundamentales, y en neurocirugía funcional. Es un procedimiento seguro, que además de proporcionar excelentes resultados, ahorra dinero y recursos. El anestesiólogo ha de estar familiarizado con los fundamentos de la neuroanestesia, conocer la técnica concreta de infiltración, así como los protocolos de sedación, y manejarse cómodamente con la vía aérea. El objetivo principal es que el paciente colabore en los momentos en que el cirujano lo precise (anestesia basada en la analgesia). Esta revisión pretende sintetizar lo publicado hasta la fecha, pues cada vez son más los procedimientos de esta naturaleza que se van a realizar, sobre todo en la población pediátrica(AU)

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population(AU)

[Awake craniotomy. Considerations in special situations]. / Craneotomía en el paciente consciente. Consideraciones en situaciones especiales.

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.

[Anesthesia in drug addiction]. / Tratamiento anestésico del paciente con adicción a drogas.

The growing social problem of drug abuse has increased the likelihood that anesthesiologists will find acute or chronic drug users among patients requiring anesthesia for elective or emergency surgery. We must therefore be aware of the effects drugs have on the organism and their possible pharmacokinetic and pharmacodynamic interactions with anesthetic agents in order to prevent complications during surgery and postoperative recovery. Such knowledge is required for the management of abstinence syndrome or overdose, which pose the greatest potential dangers for the hospitalized drug addict.

Tratamiento anestésico del paciente con adicción a drogas / Anesthesia in drug addiction

El consumo de drogas es un problema creciente en la sociedad actual. Las probabilidades de encontrar pacientes bajo efecto agudo o crónico de estas sustancias, que requieran tratamiento quirúrgico y por lo tanto anestésico de manera electiva o de urgencia, son cada vez mayores. Esto hace necesario conocer los efectos que estas sustancias ejercen sobre el organismo, así como las posibles interacciones farmacocinéticas y farmacodinámicas con los distintos fármacos utilizados en la anestesia, evitando complicaciones tanto en el quirófano, como en el periodo postoperatorio. Este conocimiento es necesario para el anestesiólogo a fin de manejar el síndrome de abstinencia o la sobredosis, que son los mayores peligros potenciales para el paciente drogodependiente durante su estancia en el hospital (AU)

The growing social problem of drug abuse has increased the likelihood that anesthesiologists will find acute or chronic drug users among patients requiring anesthesia for elective or emergency surgery. We must therefore be aware of the effects drugs have on the organism and their possible pharmacokinetic and pharmacodynamic interactions with anesthetic agents in order to prevent complications during surgery and postoperative recovery. Such knowledge is required for the management of abstinence syndrome or overdose, which pose the greatest potential dangers for the hospitalized drug addict (AU)

[Convulsions in the operating room in a man with AIDS]. / Convulsión en el quirófano de un paciente con sida.

More than 50 million individuals are infected by the human immunodeficiency virus (HIV), and it is estimated that as many as 25% of them will require surgery. The anesthesiologist must be familiar with the implications of this disease for multiorgan failure and opportunistic infections. Above all, the effects of antiretroviral agents on anesthetics must be understood. We describe the case of an HIV-infected man at risk for difficult intubation who experienced convulsions in the operating room.