[Dual atrioventricular nodal conduction and arrhythmia with severe hemodynamic alterations during liver retransplantation]. / Arritmia por doble via intranodal con descompensación hemodinámica grave en un retrasplante hepático.

We report the case of a man who developed tachycardia caused by atrioventricular reentry related to dual nodal conduction during liver retransplantation. The hemodynamic alterations were severe. Arrhythmia and altered cardiac conduction are potential complications of liver transplantation. The development of tachyarrhythmias--atrial fibrillation as well as episodes of supraventricular and ventricular tachycardia and bradycardia--have been described. Such arrhythmias tend to occur particularly during reperfusion of the graft. Risk factors implicated are the severe ion imbalances, acid-base imbalance, and hypothermia that accompany the reperfusion of a new organ. A review of the possible pathogenic and etiological mechanisms that lead to arrhythmia in patients with end-stage liver disease is provided.

Arritmia por doble vía intranodal con descompensación hemodinámica grave en un retrasplante hepático / Dual atrioventricular nodal conduction and arrythmia with severe hemodynamic alterations during liver retransplantation

Presentamos el caso de un paciente que presentó una taquicardia por reentrada auriculo-ventricular, en relación con la presencia de una doble vía intranodal con importante repercusión hemodinámica durante un retrasplante hepático. Las alteraciones del ritmo y de la conducción cardiaca representan unas de las complicaciones potenciales durante el trasplante hepático. Así están descritas la aparición de taquiarritmias del tipo de fibrilación auricular, taquicardias supraventriculares, ventriculares y bradiarritmias. Estas arritmias ocurren especialmente durante la reperfusión del injerto. Los factores implicados se relacionan con la presencia de alteraciones iónicas graves, del equilibrio ácido base y de la hipotermia que acompañan a la reperfusión del nuevo órgano. Se revisan los posibles mecanismos etiopatogénicos implicados en la aparición de las alteraciones del ritmo en los pacientes con enfermedad hepática terminal

We report the case of a man who developed tachycardia caused by atrioventricular reentry related to dual nodal conduction during liver retransplantation. The hemodynamic alterations were severe. Arrhythmia and altered cardiac conduction are potential complications of liver transplantation. The development of tachyarrhythmias —atrial fibrillation as well as episodes of supraventricular and ventricular tachycardia and bradycardia— have been described. Such arrhythmias tend to occur particularly during reperfusion of the graft. Risk factors implicated are the severe ion imbalances, acidbase imbalance, and hypothermia that accompany the reperfusion of a new organ. A review of the possible pathogenic and etiological mechanisms that lead to arrhythmia in patients with end-stage liver disease is provided

¿Es útil el tratamiento de las náuseas y vómitos postoperatorios con fármacos congéneres en caso de fracaso de la profilaxis? / When prophylaxis fails: is treatment of postoperative nausea and vomiting with sameclass antiemetics useful?

No disponible

Corticosteroides en anestesiología y cuidados críticos: controversias pasadas y presentes / No disponible

Los corticosteroides son hormonas secretadas por la glándula suprarrenal aplicándose el término también a sus análogos sintéticos. Su farmacología es compleja y sus efectos a nivel corporal son extensos y no siempre beneficiosos. A pesar de que los corticosteroides se han utilizado en el tratamiento de muchas entidades patológicas, su uso se ha sustentado en muchas ocasiones en una base empírica. La evidencia científica de su utilización perioperatoria y en cuidados críticos es aún débil en muchas de sus indicaciones. Este artículo pretende revisar la literatura médica actual en relación a las indicaciones de estos fármacos en anestesiología y cuidados críticos

Corticosteroids are hormones secreted by adrenal cortex or their synthetic analogs. The pharmacology of corticosteroids is complex and the drugs affect almost all body systems. Although corticosteroids have been employed in the management of many clinical disorders, their use has frecuently been on an empirical basis. The clinical evidence of their use in perioperative and critical care is still not solid in most of its indications. This article surveys the recent literature dealing with corticosteroids indications in perioperative and critical care medicine

Experiencia asistencial en el 11-M / Caring for the victims of M-11

No disponible

Consideraqciones perioperatorias en el paciente geriátrico: punto de vista del anestesiólogo / Perioperative considerations in elderly patient: anesthetist´s point of view

El paciente geriátrico, tiene todavía las mayores tasas de mortalidad y morbilidad dentro de la población quirúrgica adulta hospitalaria. La valoración clínica preoperatoria para detectar pacientes de alto riesgo y un abordaje anestésico específico en el intra y posoperatorio, son importantes para minimizar los eventos adversos en el anciano. El manejo de este tipo de pacientes requiere conocimientos de los cambios asociados a la edad y la fisiología de la cirugía y la anestesia. Con toda esta información, los pacientes pueden ser correctamente evaluados y las estrategias de cuidado perioperatorio (anestesia, cuidados críticos y terapia del dolor), puestas en marcha

Elderly patient still have the highest postoperative mortality and morbidity rate in the adult surgical hospitalary population. Preoperative clinical assessment to detect patients at risk of postoperative events, and speccific intraoperative and postoperative anesthesia management are important to minimize postoperative adverse events in the elderly. The management of these patients require knowledge of changes associated with aging and the physiology of surgery and anesthesia. Using this information, patients can be clinically evaluated effectively and plans made for their perioperative care (anesthesia, intensive care and treatment of pain)

Laringoespasmo asociado a la instilación de suero fisiológico intranasal en un paciente intervenido de septoplastia con mascarilla laríngea proseal / Laryngeal spasm related to intranasal instillation of physiological saline solution in a patient wearing a proseal laryngeal mask during septoplasty

No disponible

Anestesia general intravenosa con remifentanilo-propofol para adrenalectomía laparoscópica en dos casos de feocromocitoma / General intravenous anesthesia with remifentanil and propofol for laparoscopic adrenalectomy in 2 patients with pheochromocytomas

No disponible

Bolus application of remifentanil with propofol for dilatation and curettage.

BACKGROUND AND OBJECTIVE: This study was designed to determine which single bolus dose of remifentanil in combination with propofol and nitrous oxide is best to control the haemodynamic, autonomous and somatic responses in patients scheduled for dilatation and curettage of the uterine cervix. We evaluated the adequacy of different bolus doses of remifentanil, associated with propofol and nitrous oxide, for dilatation and curettage in a prospective double-blind study. METHODS: After institutional approval and informed consent, 34 healthy females undergoing curettage to remove material from the uterus after spontaneous abortion were randomized to receive remifentanil 0.5 microg kg(-1) intravenously (i.v.) (Group A; n = 4), 1 microg kg(-1) i.v. (Group B; n = 15) or 1.5 microg kg(-1) i.v. (Group C; n = 15), with propofol 2 mg kg (-1) i.v. in all groups. Anaesthesia was maintained with 60% nitrous oxide in oxygen. Haemodynamic, somatic and autonomic signs of light anaesthesia were registered to assess the response to surgical stress. Recovery times and Aldrete score were recorded at the end of the procedure. RESULTS: The groups were similar with regard to biometric data and duration of surgery. The poor results using the lowest dose of remifentanil obliged us to abandon this dose. The total dose of remifentanil was larger in Group C (100 +/- 5.7 microg vs. 65 +/- 4.1 microg in Group B; P < 0.05), but more patients required extra bolus injections in Group B (69% vs. 38% in Group C; P < 0.01). Recovery times were significantly shorter in Group C. Aldrete scores when leaving the operation room was similar. CONCLUSIONS: Remifentanil 1.5 microg kg(-1) i.v. with propofol 2 mg kg(-1) i.v. and 60% nitrous oxide in oxygen provided the best anaesthetic control with the fastest recovery times.

Anestesia epidural para vertebroplastia percutánea / Epidural anestesia for percutaneous vertebroplasty

No disponible

Anestesia subaracnoidea para una cesárea urgente en la enfermedad de Charcot-Marie-Tooth / Subarachnoid anesthesia for an emergency cesarean delivery in a patient with Charcot-Marie-Tooth disease

No disponible

El reflujo de sangre por el catéter al intentar canalizar la vena subclavia no es un signo fiable en caso de hemotórax / Subclavian venous reflux is not a reliable test of catheterization in cases of hemothorax

Un varón de 36 años, tras un accidente de tráfico, presentaba un traumatismo torácico, lesión neurovascular y de partes blandas del brazo izquierdo y lesiones en el macizo facial y en las extremidades. Estaba inestable hemodinámicamente, con mala respuesta a la reposición de volemia y administración de fármacos vasoactivos. Ante la sospecha de un neumotórax se colocó un tubo de tórax en el hemitórax izquierdo por el cual drenaron 1.500 ml de sangre. En la radiografía de tórax se apreció un hemotórax y contusión pulmonar izquierda, sin fracturas costales asociadas. Se intentó canalizar la vena subclavia izquierda, y dado que refluía sangre por el extremo distal del catéter, se transfundió sangre por él. El paciente continuaba muy inestable y por el tubo de tórax drenaron otros 1.000 ml de sangre. Se realizó una toracotomía exploradora que evidenció un desgarro de la vena subclavia, el catéter venoso en la cavidad pleural y fractura de la primera costilla izquierda. En los traumatismos torácicos con hemotórax, al canalizar la vena subclavia ipsilateral el reflujo de sangre por el catéter no es un signo seguro de colocación correcta. Hay que recurrir a otros métodos de comprobación como la morfología de la onda de presión, la radiografía con contraste por el catéter o la electrocardiografía intracavitaria mediante fiador metálico a través del catéter. Si hay una fractura de la primera costilla, que puede pasar desapercibida en la radiografía de tórax, es frecuente la lesión vascular asociada que provoca el hemotórax y ser el origen de una falsa vía al colocar un catéter subclavio (AU)

Arterial oxygenation during one-lung ventilation: combined versus general anesthesia.

UNLABELLED: The optimal anesthetic management of patients undergoing thoracotomy for pulmonary resection has not been definitely determined. We evaluated whether general i.v. anesthesia (propofol-fentanyl) provides superior PaO2 during one-lung ventilation (OLV) compared with thoracic epidural anesthesia (TEA) with supplemental local and general anesthetics. We studied 60 patients who had prolonged periods of OLV for elective thoracic surgery for lung cancer and who were prospectively randomized into two groups. In 30 patients (GA group), fentanyl/propofol/rocuronium anesthesia was used. Another 30 patients (TEA group) were anesthetized with propofol/rocuronium/epidural thoracic bupivacaine 0.5%. A double-lumen endotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV (OLV + 15 and OLV + 30, respectively) in all patients. We measured PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture percentage (Qs/Qt%), and arterial and central venous oxygen content. The mean values for PaO2 during OLV in the GA group after 15 min (175 mm Hg) and 30 min (182 mm Hg) were significantly (P < 0.05) higher compared with the TEA group (120 and 118 mm Hg, respectively). Furthermore, Qs/Qt% was significantly (P < 0.05) increased in the TEA group during OLV. There were no other significant differences. We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total i.v. anesthesia alone. IMPLICATIONS: Sixty patients undergoing elective lung surgery during a prolonged period of intraoperative one-lung ventilation were studied and randomized to receive general i.v. anesthesia or general i.v. anesthesia combined with thoracic epidural anesthesia. The arterial oxygenation in the first group was better than that in the second group during one-lung ventilation.