Practical recommendations for the perioperative management of the patient with suspection or serious infection by coronavirus SARS-CoV. / Recomendaciones prácticas para el manejo perioperatorio del paciente con sospecha o infección grave por coronavirus SARS-CoV-2.

In December 2019, the Wuhan Municipal Health and health Commission (Hubei Province, China) reported a series of cases of pneumonia of unknown etiology. On January 7, 2020, the Chinese authorities identified as a causative agent of the outbreak a new type of virus of the Coronaviridiae family, called SARS-CoV-2. Since then, thounsands of cases have been reported with global dissemination. Infections in humans cause a broad clinical spectrum ranging from mild upper respiratory tract infection, to severe acute respiratory distress syndrome and sepsis. There is not specific treatment for SARS-CoV-2, which is why the fundamental aspects are to establish adequate prevention measures and support treatment and management of complications.

Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients.

BACKGROUND: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. METHODS: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. RESULTS: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). CONCLUSION: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.

ANTECEDENTES: La estratificación de la gravedad de una infección se basa actualmente en la puntuación SOFA (Sequential Organ Failure Assessment), que es difícil de calcular fuera de la unidad de cuidados intensivos. Los biomarcadores podrían ayudar a estratificar la gravedad de la infección en pacientes quirúrgicos. MÉTODOS: Se compararon las concentraciones de 10 biomarcadores que denotan disfunción endotelial, 22 que indican granulopoyesis de emergencia y 6 que expresan la degranulación de neutrófilos en tres grupos de pacientes de tres hospitales españoles (100 con infección, 95 con sepsis y 57 con shock séptico) en las primeras doce horas después del diagnóstico. RESULTADOS: Siete biomarcadores que expresan disfunción endotelial (proadrenomedulina, sindecan-1, trombomodulina, angiopoyetina-2, endocan-1, molécula de adhesión endotelial 1 y E-selectina) mostraron una fuerte asociación con la sepsis en comparación con la infección aislada. La proadrenomedulina presentó el valor más alto de la razón de oportunidades (odds ratio, OR) en el análisis multivariable (OR 11,53, i.c. del 95% 4,15-32,08, P = 0,006) y la mejor área bajo la curva para detectar sepsis (AUC 0,86, i.c. del 95% 0,80-0,91, P < 0,001). En la comparación entre sepsis y shock séptico, los biomarcadores que mostraron la asociación más estrecha con el shock séptico fueron dos biomarcadores de degranulación de neutrófilos (proteinasa-3 y lipocalina-2) (OR 8,09, i.c. del 9% 1,34-48,91, P = 0,028; OR 6.62, i.c. del 95% 2,47-17,77, P = 0,002), pero la lipocalina-2 presentó la mejor AUC (0,81, i.c. del 95% 0,73-0,90, P < 0,001). CONCLUSIÓN: la proadrenomedulina y la lipocalina-2 podrían representar alternativas a la puntuación SOFA para detectar sepsis y shock séptico en pacientes quirúrgicos con infección.

Neumoencéfalo tras punción dural accidental durante la realización de un bloqueo epidural para analgesia del parto / No disponible

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[Health-care workload and instructional capacity of Spanish hospitals accredited to train residents in anesthesiology]. / Actividad asistencial y capacidad docente de los hospitales españoles acreditados para la formación de residentes de anestesiología.

OBJECTIVES: To describe the health-care workload and instructional capacity of Spanish hospitals accredited to train anesthesiology residents. METHODS: Survey of supervisors of anesthesiology residents in 2008 to determine caseloads in surgery and obstetrics as well as in pain clinics and critical care units. The results are presented for different Spanish autonomous communities. The maximum theoretical capacity for instruction in accordance with European guidelines is calculated. RESULTS: The 100 hospitals surveyed train 325 residents per year and could theoretically increase the training opportunities they offer, within certain limits. Given optimal distribution of resources, the system could train 397 residents per year in pediatric surgery in 3-month rotations, 442 residents in neurosurgery in 2-month rotations, and 479 residents in thoracic surgery in 1-month rotations. Some Spanish communities presently have problems giving training in the settings of pediatric, thoracic, and major outpatient surgery. Furthermore, even though anesthesiologists are presently responsible for 41.6% of available critical care beds, 46 hospitals do not have a sufficient number of beds to give training in this setting. This shortage may have negative repercussions on the accreditation of training programs. CONCLUSIONS: Although certain limitations were found, the survey showed that the training capacity of the system is greater than accreditation suggests. It would therefore be possible to increase the number of residents.

Actividad asistencial y capacidad docente de los hospitales españoles acreditados para la formación de residentes de Anestesiología / Health-care workload and instructional capacity of Spanish hospitals accredited to train residents in anesthesiology

OBJETIVOS: Presentar la actividad asistencial y calcularla capacidad docente de los hospitales españoles acreditadospara la formación de residentes de Anestesiología.MÉTODOS: Encuesta a los tutores de residentes de loshospitales acreditados en 2008, recabando datos de actividadquirúrgica, obstétrica, dolor, procedimientos ydotación de camas de cuidados intensivos. Se describenlos resultados agrupados por comunidades autónomas yse calcula la capacidad docente máxima teórica según lasrecomendaciones europeas.RESULTADOS: Los 100 hospitales encuestados forman a325 residentes al año y podrían teóricamente ampliar suoferta docente, con ciertas limitaciones en las especialidadesde cirugía pediátrica, que con 3 meses de rotaciónsólo permite formar a 397 residentes al año con una distribuciónóptima de recursos; neurocirugía que con 2meses podría formar a 442 residentes y cirugía torácicacon 1 mes a 479 residentes. En la actualidad hay problemasen algunas comunidades autónomas sólo para anestesiaen cirugía pediátrica, cirugía torácica y cirugíamayor ambulatoria. En medicina de cuidados intensivos,aunque la especialidad de Anestesiología tiene 41,6% detodas las camas de críticos, preocupa la existencia de 46hospitales sin dotación adecuada. Este hecho influyenegativamente en la posible acreditación de unidadesdocentes.CONCLUSIONES: A pesar de las limitaciones encontradas,la encuesta muestra que la capacidad docente essuperior a la acreditada y por tanto sería posible aumentarel número de residentes(AU)

OBJECTIVES: To describe the health-care workloadand instructional capacity of Spanish hospitalsaccredited to train anesthesiology residents.METHODS: Survey of supervisors of anesthesiologyresidents in 2008 to determine caseloads in surgery andobstetrics as well as in pain clinics and critical careunits. The results are presented for different Spanishautonomous communities. The maximum theoreticalcapacity for instruction in accordance with Europeanguidelines is calculated.RESULTS: The 100 hospitals surveyed train 325residents per year and could theoretically increase thetraining opportunities they offer, within certain limits.Given optimal distribution of resources, the systemcould train 397 residents per year in pediatric surgery in3-month rotations, 442 residents in neurosurgery in 2-month rotations, and 479 residents in thoracic surgery in1-month rotations. Some Spanish communities presentlyhave problems giving training in the settings ofpediatric, thoracic, and major outpatient surgery.Furthermore, even though anesthesiologists arepresently responsible for 41.6% of available critical carebeds, 46 hospitals do not have a sufficient number ofbeds to give training in this setting. This shortage mayhave negative repercussions on the accreditation oftraining programs.CONCLUSIONS: Although certain limitations werefound, the survey showed that the training capacity ofthe system is greater than accreditation suggests. Itwould therefore be possible to increase the number ofresidents(AU)

Unificación de "Anestesiología y Reanimación" con "Medicina Intensiva" / No disponible

No disponible

The inflammatory response to colloids and crystalloids used for pump priming during cardiopulmonary bypass.

BACKGROUND: Systemic inflammatory response frequently occurs after coronary artery bypass surgery and is strongly correlated with the risk of postoperative morbidity and mortality. This study tests the hypothesis that the priming of the extracorporeal circuit with colloid solutions results in less inflammation in patients undergoing cardiac surgery than priming with crystalloid solutions. METHODS: A prospective, randomized study was designed. Forty-four patients undergoing elective coronary artery bypass grafting were randomly allocated to one of two groups: 22 patients primed with Ringer's lactate (RL) solution and 22 patients primed with gelatin-containing solution during the surgery. Plasma levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP) and, complement 4 were measured during the surgical intervention and over the following 48 postoperative hours. Cytokine levels were measured by enzyme-linked assays from plasma samples obtained at specific time points pre- and post-operatively. RESULTS: In both groups the serum levels of the pro-inflammatory cytokines (IL-6, IL-8, TNF-alpha), CRP, complement 4, and leukocytes increased significantly over the baseline, although no significant differences were observed between the two groups. The operation time, blood loss, need for inotropic support, extubation time, and length of intensive care unit stay did not differ significantly between the two groups. CONCLUSION: Priming with gelatin vs. RL produces no significant differences in the inflammatory response in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Anestesia epidural en paciente con atrofia muscular espinal tipo Kugelber-Welander / No disponible

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Prick-test evaluation to anaesthetics in patients attending a general allergy clinic.

BACKGROUND AND OBJECTIVES: To analyse the prevalence of positive prick-tests to all medicaments normally checked in allergy units when a patient is suspected of being allergic to anaesthetics. To establish the degree of agreement between the antecedents of a previous history of an allergic reaction to a medicament and the positive result, or not, to the specific prick-test for the said medicament. METHODS: This was a prospective study, during 2003 and 2004, which analysed 473 patients referred by their doctors to allergy units to make retrospective diagnoses of an allergy to a drug. The prick-test was done using the undiluted drug. All patients were tested for 41 drugs. These include antibiotics, trimethoprim-sulphamethoxazole, non-steroidal anti-inflammatory drugs (NSAIDs) and perioperative drugs (PD): neuromuscular blocking drugs, latex, iodine, local anaesthetics, hypnotics, opioids and coadjuvants. Cohen's Kappa Index was used to determine the degree of agreement. RESULTS: 71.5% of patients studied presented a positive prick-test. The largest number of positive cases was found in antibiotics (56.4%), followed by PD (15.6%), NSAIDs (14.4%) and trimethoprim-sulphamethoxazole (12.7%). Among PD, the highest prevalence of positive prick-tests was found for neuromuscular blocking drugs (5.3%). Agreement between the substance suspected of causing the allergic reaction and the positive prick-test was excellent for penicillin (Kappa = 0.74) and other antibiotics (Kappa = 0.721) and good for NSAIDs (Kappa = 0.47) and iodine (Kappa = 0.54). CONCLUSIONS: The prevalence of patients with positive prick-tests to PD occurred in 15.6% in this prospective cohort. Neuromuscular blocking drugs were found to have the highest prevalence of positive prick-tests. There is positive agreement when the substance responsible for the allergic reaction is suspected, otherwise agreement is low.

Prevalence of positive prick test to anaesthetic drugs in the surgical population.

Prevalence of patients with positive prick tests to anaesthetics occurred in 4.7% of the surgical population.

Desintoxicación ultrarrápida bajo anestesia:evolución clínica y percepciónde la desintoxicación / Ultrarapid opiate detoxification under anaesthesia: clinical evaluation and perception of the detoxification process

Objetivo: se analiza la evolución clínica y la seguridad de una pauta de desintoxicación ultrarrápida a opiáceos bajo anestesia. Materiales y Método: se ha realizado un estudio observacional en pacientes sometidos a desintoxicación ultrarrápida a opiáceos bajo anestesia. El estudio se ha realizado en 15 pacientes dependientes a opiáceos (criterios DSM IV). Se ha valorado el síndrome de abstinencia a opiáceos de manera regular mediante el empleo de la escala elaborada para el estudio, así como la percepción referida del proceso de desintoxicación por parte del paciente. Resultados: el 100 por ciento de los pacientes se han desintoxicado de manera satisfactoria. En un período de 24 horas desde el inicio del proceso los pacientes han podido ser dados de alta. En todos los pacientes la intensidad del síndrome de abstinencia a opiáceos fue siempre leve. Las manifestaciones peor percibidas por los pacientes han correspondido a la extubación, el cansancio intenso y la aparición de diarreas. Conclusiones: la desintoxicación ultrarrápida bajo anestesia se muestra como un proceso eficaz y seguro (AU)