Trombo en tránsito izquierdo intraoperatorio en trasplante bipulmonar diagnosticado por ecocardiografía transesofágica: ¿qué es lo siguiente? / Left side clot in transit in double-lung transplantation diagnosticated by transesophageal echocardiography: What's next?

Un varón de 61 años sin predisposición trombótica es sometido a trasplante bipulmonar como último tratamiento para su EPOC terminal sin soporte de ECMO. Tras el implante y la reperfusión de ambos pulmones, se realizó un examen ecocardiográfico transesofágico completo para comprobar principalmente las anastomosis de las venas pulmonares. En este estudio se identificó una gran masa móvil, hiperecogénica, densa y heterogénea en la aurícula izquierda, compatible con un trombo en tránsito desde la circulación venosa pulmonar. Este hallazgo fue comunicado al equipo quirúrgico inmediatamente para reabrir la anastomosis y retirar el coágulo antes de mayores consecuencias. No hubo manifestaciones clínicas cuando se despertó al paciente.(AU)

61-year-old man without any thrombotic predisposition was undergone double sequential lung transplantation due to terminal stage of COPD without extracorporeal membrane oxygenation (ECMO) support. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography exam was performed to check especially the pulmonary venous anastomosis. In this exam, a large heterogenous, dense, hyperechoic mobile mass was identified in the LA, which was compatible with a thrombus in transit from pulmonary veins circulation. This finding was communicated to the surgical team to reopen the anastomosis and remove the clot before further consequences. There were no clinical manifestations when the patient was awakened.(AU)

Left side clot in transit in double-lung transplantation diagnosticated by transesophageal echocardiography: what's next?

A 61-year-old man with no predisposition to thrombosis underwent sequential double lung transplantation without extracorporeal membrane oxygenation (ECMO) support due to terminal stage COPD. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography study was performed to check the pulmonary venous anastomosis. The study showed a large, heterogeneous, dense, hyperechoic free-floating mass in the left atrium compatible with a clot in transit from the pulmonary circulation. The surgical team were notified of this finding so that they could reopen the anastomosis and remove the clot to prevent a major complication. There were no clinical manifestations when the patient was awakened.

[Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator]. / Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19.

Background: The severe acute respiratory syndrome-coronavirus 2 pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. Methods: Validation consisted of (a) testing tidal volume delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome by saline lavage. Results: Differences in tidal volume in the simulated models were marginally different (largest difference 33 ml [95% CI 31 to 36]; P < .001). Plateau pressure was not different (-0.3 cmH2O [95% CI -0.9 to 0.3]; P = .409), and positive end-expiratory pressure was marginally different (0.3 cmH2O [95% CI 0.2 to 0.3]; P < .001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias -0.29 [limits of agreement 0.82 to -1.42], and mean bias 0.56 [limits of agreement 1.94 to -0.81], at a plateau pressure of 15 and 30 cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after acute respiratory distress syndrome induction. Conclusions: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The ACUTE-19 can provide the basis for the development of a future affordable commercial ventilator.

Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator.

BACKGROUND: The Severe Acute Respiratory Syndrome (SARS)-Coronavirus 2 (CoV-2) pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. METHODS: Validation consisted of (a) testing tidal volume (VT) delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome (ARDS) by saline lavage. RESULTS: Differences in VT in the simulated models were marginally different (largest difference 33ml [95%-confidence interval (CI) 31-36]; P<.001ml). Plateau pressure (Pplat) was not different (-0.3cmH2O [95%-CI -0.9 to 0.3]; P=.409), and positive end-expiratory pressure (PEEP) was marginally different (0.3 cmH2O [95%-CI 0.2 to 0.3]; P<.001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias, -0.29, [limits of agreement, 0.82 to -1.42], and mean bias 0.56 [limits of agreement, 1.94 to -0.81], at a Pplat of 15 and 30cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after ARDS induction. CONCLUSIONS: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The acute 19 can provide the basis for the development of a future affordable commercial ventilator.

Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve / Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain

La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables. Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation

Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain. / Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve.

Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.

Hipertensión arterial en el paciente quirúrgico. Adecuación de la medicación y criterios de suspensión / Arterial hypertension in the surgical patient. Medication adequacy and suspension criteria

La hipertensión arterial (HTA) es un factor de riesgo modificable para las enfermedades cardiovasculares, que puede tener un impacto en las complicaciones perioperatorias, en función del daño orgánico que sufre el paciente. El manejo perioperatorio del tratamiento farmacológico de la hipertensión arterial es un pilar fundamental en la valoración preanestésica previa a cualquier intervención. No parece razonable retrasar la cirugía únicamente por valores de la presión arterial (PA), aunque en pacientes con PA > 180/110mmHg la decisión de realizar una intervención quirúrgica electiva debe ser valorada cuidadosamente

Arterial hypertension (AHT) is a modifiable risk factor for cardiovascular diseases, which may have an impact on perioperative complications, depending on the organ damage suffered by the patient. The perioperative management of treatment of arterial hypertension, is a mainstay in the preoperative assesment prior to any intervention. It doesn't seem reasonable to delay surgery solely due to blood pressure values, although for patients with BP > 180/110mmHg, the decision to perform scheduled surgeries should be carefully assessed

Déficit motor en el puerperio. ¿Es la analgesia neuroaxial la causa más frecuente? / Motor deficit in the puerperium. Is neuroaxial analgesia the most frequent cause?

Los déficits motores de miembros inferiores durante el embarazo y el puerperio son relativamente frecuentes. Se atribuyen habitualmente a complicaciones asociadas a las técnicas neuroaxiales que son realizadas por el anestesiólogo. Pero existen otras posibles causas, como la osteoporosis transitoria de caderas. La osteoporosis transitoria del embarazo es una patología infrecuente y autolimitada de origen desconocido. La complicación más severa que puede presentar son las fracturas patológicas, fundamentalmente en las articulaciones de carga. Esta patología suele presentarse en el tercer trimestre del embarazo y cursa con dolor e impotencia funcional del miembro inferior afecto. Presentamos el caso de una mujer de 35 años, gestante de 40+3 semanas que inicia trabajo de parto. Se coloca catéter epidural normofuncionante y finalmente se decide cesárea por parto estacionado; 48h después comienza con impotencia funcional en miembro inferior izquierdo y dolor. Se realiza RM donde se descarta hematoma epidural y se objetiva osteopenia de caderas, siendo diagnosticada de osteoporosis transitoria el embarazo

Motor deficits of lower limbs during pregnancy and the puerperium are relatively frequent. They are usually attributed to complications which are associated with neuroaxial techniques performed by the anesthesiologist. But there are other possible causes, such as transient osteoporosis of the hips. Transient osteoporosis of pregnancy is a rare and self-limited pathology of unknown etiology. The most severe complication that can occur are pathological fractures, mainly in the load joints. This pathology usually occurs in the third trimester of pregnancy and is showed up with pain and functional impotence of the lower limb affected. We present the case of a 35-year-old woman, 40+3 weeks of pregnancy who starts labour. Normally functioning epidural catheter is placed and finally cesarean section is decided because failure to progress; 48h later the patient begins with functional impotence and pain in the lower left limb. MRI is performed, epidural hematoma is ruled out and osteopenia of the hips is proved. The patient is diagnosed with transient osteoporosis of pregnancy

Motor deficit in the puerperium. Is neuroaxial analgesia the most frequent cause? / Déficit motor en el puerperio. ¿Es la analgesia neuroaxial la causa más frecuente?

Motor deficits of lower limbs during pregnancy and the puerperium are relatively frequent. They are usually attributed to complications which are associated with neuroaxial techniques performed by the anesthesiologist. But there are other possible causes, such as transient osteoporosis of the hips. Transient osteoporosis of pregnancy is a rare and self-limited pathology of unknown etiology. The most severe complication that can occur are pathological fractures, mainly in the load joints. This pathology usually occurs in the third trimester of pregnancy and is showed up with pain and functional impotence of the lower limb affected. We present the case of a 35-year-old woman, 40+3 weeks of pregnancy who starts labour. Normally functioning epidural catheter is placed and finally cesarean section is decided because failure to progress; 48h later the patient begins with functional impotence and pain in the lower left limb. MRI is performed, epidural hematoma is ruled out and osteopenia of the hips is proved. The patient is diagnosed with transient osteoporosis of pregnancy.

Factores perioperatorios que contribuyen a la aparición de dolor o náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria / Perioperative factors that contribute to postoperative pain and/or nausea and vomiting in ambulatory laparoscopic surgery

Introducción: Tanto el dolor como las náuseas y vómitos postoperatorios constituyen condicionantes principales del tiempo y la calidad de la recuperación en cirugía laparoscópica. Objetivo: Determinar los factores perioperatorios que contribuyen a la aparición de dolor y de náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria. Materiales y métodos: Estudio prospectivo de una cohorte de 297 pacientes intervenidos mediante cirugía laparoscópica ambulatoria. Como variables de estudio se consideraron: a) factores preoperatorios, incluyendo medicación habitual y riesgo anestésico; b) intraoperatorios, entre otros tiempos quirúrgico y anestésico, fármacos y presión de neumoperitoneo y c) postoperatorios, como complicaciones mayores o menores y tiempos de recuperación. Como variables dependientes se consideraron los síntomas postoperatorios náuseas, vómitos y dolor. Resultados: Considerando como variable combinada la aparición de náuseas, vómitos o dolor moderado/severo según una escala visual analógica, presentaron uno o más de estos síntomas el 58,7% de los pacientes (IC 95%: 52,8-64,4). Mediante regresión logística, las variables asociadas a la aparición de síntomas fueron: sexo femenino (OR: 3,4), tiempo de espera previo a quirófano superior a 45 min (OR: 4,9) y ausencia de profilaxis antiemética (OR: 12,2). Conclusiones: En pacientes operados mediante cirugía laparoscópica ambulatoria, uno de cada 4presenta náuseas y vómitos postoperatorios y la mitad presentan dolor de intensidad moderada antes del alta. Considerando globalmente la aparición de dolor o náuseas y vómitos postoperatorios, estos síntomas afectan a más de la mitad de los pacientes y son más frecuentes en mujeres y en quienes más tardan en acceder al quirófano

Introduction: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. Objective: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. Material and methods: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. Results: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). Conclusions: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room

Perioperative factors that contribute to postoperative pain and/or nausea and vomiting in ambulatory laparoscopic surgery. / Factores perioperatorios que contribuyen a la aparición de dolor o náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria.

INTRODUCTION: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. OBJECTIVE: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. MATERIAL AND METHODS: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. RESULTS: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). CONCLUSIONS: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room.

Sonda nasoduodenal de duodopa en localización endobronquial / Duodopa nasoduodenal tube at intrabronchial position

No disponible

Tecnologías de la información y comunicación aplicadas a la gestión en cirugía ambulatoria / ICT applied to day surgery managemen

No disponible

Sistema automático de autoevaluación telefónica en cirugía ambulatoria / Automatic self-assessment system in ambulatory surgery

Introducción: las tecnologías de la información y comunicación, aplicadas al control domiciliario, pueden permitir una mejora en el control y seguimiento de los pacientes en el área de la cirugía ambulatoria. En el presente estudio se valora la aplicación de un sistema de auto-chequeo por parte de pacientes sometidos a intervenciones de cirugía ambulatoria en el postoperatorio inmediato domiciliario. También se pretende analizar la utilidad y rendimiento según el nivel ASI (incapacidad postoperatoria esperada según intervención).Material y métodos: se realiza un estudio randomizado, prospectivo y multicéntrico en el que se incluyen 2.037 pacientes, la mitad en el grupo control y la otra mitad en el grupo piloto. Estos últimos realizan un auto-chequeo vía telefónica: son atendidos por un programa virtual que, según las respuestas obtenidas, los clasifica seleccionando a aquellos que necesitan ponerse en contacto directo con un profesional sanitario. Todos los pacientes del grupo control reciben las llamadas telefónicas convencionales del personal de las unidades correspondientes. Resultados: los resultados de los 2 grupos son similares, lo que demuestra la validez del sistema analizado. Numerosos pacientes del grupo piloto no realizan el auto-chequeo a pesar de haberse comprometido con el estudio. Asimismo, a mayor nivel ASI, mayor número de alertas y llamadas fuera de protocolo. Las llamadas evitan en muchos casos la visita a urgencias, con el considerable ahorro social y económico que ello implica. Discusión: el sistema de auto-chequeo puede ser una alternativa válida al control telefónico en los parámetros analizados. Aunque en el grupo piloto se observa un seguimiento del protocolo menor y genera una mayor actividad telefónica, evita más visitas a urgencias en pacientes con menor ASI. El sistema de auto-chequeo no aumenta el número de visitas a urgencias ni reingresos ni reintervenciones (AU)

Introduction: Information and communication technologies permit a better patient monitoring. Ambulatory surgery is a field where they can be relevant, mainly at the domiciliary control. The aim of our study is to validate the applications of an auto-check system in ambulatory surgery patients at home. We also want to analyze the usefulness and output depending on the ASI level (Ambulatory Surgery Incapacity level). Patients and methods: 2037 patients were included in a randomized, prospective and metacentric study: half in the control group and the other half in the study group. This group is attended by a virtual program that classifies them in base of their answers and selects those who may get in contact with medical staff. The control group receives the habitual phone control made by the respective units. Results: Results of both groups are similar, demonstrating the system validity. Many patients in the pilot group did not make the self-checkup despite their compromise. Likewise, the higher the ASI, the greater alerts and off protocol calls. In many cases, telephone calls avoided emergency department visits, with the social and economic saving it implies. Discussion: Auto-check may be a valid and safe alternative to the telephone control in the analyzed parameters. Although the protocol accomplishment is diminished and it generates more telephonic activity, it avoids more emergency visits in patients with lower postoperative disability. The auto-check system does not increase the number of visits to the emergency room or readmissions or reoperations (AU)

Telemedicina en cirugía ambulatoria / No disponible

No disponible