Long-term allergic dermatitis caused by sevoflurane: a clinical report.

BACKGROUND: Allergy to volatile anaesthetics is extremely rare, but capable of damaging the professional career. METHODS: This article presents the case of a 60-year-old surgeon who developed a skin rash on the reverse of hands, which progressively worsened and extended to distant fold areas. Blood tests were normal but for eosinophilia and risen total IgE, with normal specific globulins and skin prick tests for common allergens. After 8 years, a malfunction in the anaesthetic gas scavenging system was found, and symptoms remitted within a week following its replacement. Repeated open application test with sevoflurane led to the appearance of the same lesions in the tested areas and in distant body folds. RESULTS: We hypothesize that the most probable mechanism for the reaction in our patient is systemic allergic contact dermatitis, which is caused by repeated systemic exposure to a hapten that reaches the skin through haematogenous transport in a sensitized patient. CONCLUSIONS: The report aims to warn about the potential aetiological relationship between exposure to inhaled anaesthetics and allergic manifestations with cutaneous symptoms.

Vasopresina y terlipresina en anestesia y reanimación: limitaciones a su uso en España / Vasopressin and terlipressin in anesthesia and postoperative recovery care: limits on use in Spain

No disponible

[Rapid-sequence anesthesia induction]. / Inducción anestésica de secuencia rápida.

Rapid-sequence induction (RSI) techniques are designed to reduce the risk of aspiration in cases where risk is high. ISR is often for surgery, particularly under emergency conditions, but is also found in procedures requiring emergency tracheal intubation inside and outside the hospital. ISR techniques have proven safe for reducing the risk of aspiration and providing good conditions for intubation in such situations. The great variety of clinical situations that can be involved means that the combination of drugs to be used should be individualized for each case. In addition to the two objectives of RSI named and the particular nature of a case, the risk of presenting unforeseen difficult intubation is yet another factor affecting choice of drugs. Precisely because of this last factor and the good results obtained with short-acting opiates, great interest has developed in recent years in RSI that does not use neuromuscular blocking agents. However, conclusive data are unavailable. Studies are often difficult to compare because of small differences in the combination of drugs, the dosing of one or more of them, the route of administration, or because the criteria used to define ideal intubation conditions are different.

Inducción anestésica de secuencia rápida / Rapid-sequence anesthetic induction

Las técnicas de inducción de secuencia rápida (ISR) se diseñan con el objetivo de reducir el riesgo de aspiración en aquellos casos en que éste se halla anormalmente elevado. Su campo de aplicación se halla frecuentemente en el ámbito quirúrgico, especialmente cuando la intervención tiene un carácter urgente, pero también cuando se requiere intubación traqueal en situaciones de urgencia tanto intra como extrahospitalaria. En estas últimas, las técnicas de ISR se han mostrado seguras en su doble objetivo de reducir el riesgo de aspiración y proveer unas condiciones adecuadas de intubación. La multiplicidad de situaciones clínicas en que pueden considerarse indicadas determinan la necesidad de individualizar la combinación de fármacos a utilizar en cada caso. Los condicionantes al realizar esta selección son no sólo los dos objetivos mencionados y las características particulares de cada caso, sino también el riesgo de presentación de una intubación difícil imprevista. Precisamente este último factor y los buenos resultados obtenidos con los opiáceos de efecto breve han generado, en los últimos años, un gran interés por las técnicas de ISR que prescinden de los bloqueantes neuromusculares. No obstante, los datos disponibles no son concluyentes. A menudo los diferentes estudios son difícilmente comparables entre sí, sea porque las pautas utilizadas presentan pequeñas diferencias en la combinación de fármacos, en la dosificación de uno o más de ellos o en la forma de administrarlos, o porque los criterios utilizados para definir la idoneidad de las condiciones de intubación son diferentes. (AU)

[Anesthesia ventilators]. / Ventiladores de anestesia.

New technology has led to improved performance in the latest generation of ventilators for anesthesia. However, the wide variety of designs by different manufacturers means that there are significant differences in how the ventilators work. First, two radically different concepts dominate the market. One is that of anesthesia ventilator, which fits in as a module within an anesthesia system or a workstation. Another concept is that of ventilator adapted for anesthesia, which constitutes in and of itself the anesthesia machine. Second, the differences extend to the systems for generating pressure used by different manufacturers of each model, to the algorithms employed in the software, or the "solutions" proposed by each to compensate for certain deficiencies inherent to the design. Lack of uniformity prevents the anesthesiologist from meeting the ideal objective of working on a daily basis with systems that are sufficiently well understood and that perform predictably, with knowledge following from the study of the functional features of each model before clinical use starts. To this lack of knowledge, we must add the scarcity of information from studies to analyze the performance of each model in the various possible clinical situations involving anesthesia. The present paper aims to develop a systematic classification of anesthesia ventilators and to describe the main parameters that determine the performance of all ventilators.

Ventiladores de anestesia / Anesthesia ventilators

La aplicación de las nuevas tecnologías ha supuesto una mejora en el comportamiento de los ventiladores utilizados en anestesia. No obstante, la amplia diversidad de diseños ofertados por los distintos fabricantes se acompaña de notables diferencias funcionales entre ellos. En primer lugar, predominan dos concepciones radicalmente diferentes de ventiladores de anestesia, según éstos se integren como un módulo más en un sistema anestésico o estación de trabajo (workstation) o, como ventiladores adaptados a la anestesia, constituyan en sí mismos la propia máquina de anestesia. En segundo lugar, las diferencias se extienden a los sistemas generadores de presión utilizados por los distintos fabricantes en cada modelo, así como a los algortimos incorporados en su software o a las "soluciones" propuestas en cada caso para compensar ciertas deficiencias inherentes a los distintos diseños.La falta de uniformidad aleja al anestesiólogo del objetivo ideal de trabajar diariamente con sistemas suficientemente conocidos y de comportamiento predecible, lo que debería seguirse, por su parte, del estudio de las particularidades funcionales de cada modelo antes de iniciar su utilización clínica. A esta dificultad se suma la escasez de información disponible, especialmente en forma de estudios orientados a analizar el comportamiento de cada modelo frente a las diversas condiciones clínicas posibles en anestesia. Este artículo tiene como objetivos desarrollar una clasificación sistemática de los ventiladores anestésicos y describir los principales parámetros determinantes del comportamiento funcional de todo ventilador (AU)

No disponible

[Monitoring of mechanical ventilation during IPPV: implications due to the intrapulmonary entrapment of gas. Study on a physical model of the lung]. / Monitorización de la mecánica ventilatoria durante IPPV: implicaciones debidas al atrapamiento intrapulmonar de gas. Estudio sobre modelo físico de pulmón.

This work was undertaken to determine the possible influence of gas trapping on the values of total respiratory system compliance and on the air flow resistance at the air ways obtained by conventional effects of positive telespiratory alveolar pressure (auto-PEEP) typical of gas trapping on ventilatory dynamics. This study has been carried out in a physical model of the lung. The results support the contention that in the above situation: 1) the total compliance of the respiratory system measured as the quotient between the current volume and the plateau pressure (C.DIN) shows lower values than those of the static compliance (C.EST), and 2) flow resistance at the air ways must be measured as the quotient between the time constant and the plateau pressure. It should not be measured as the quotient between the time constant and the static compliance since in that case the values would be lower than the real ones.