Veno-arterial extracorporeal membrane oxygenation (ECMO VA) as part of a multimodal approach for the protection of spinal cord ischemia in surgical repair of a thoracoabdominal aneurysm.

Spinal cord ischaemia leading to paraplegia or paraparesis is one of the most devastating complications of aortic surgery. The risk of ischaemia is particularly high in repairs involving both the thoracic and abdominal segments, because in these cases blood flow to the spinal arteries can be interrupted. Multimodal protocols have now been developed to reduce the incidence of this complication, and include measures such as cerebrospinal fluid (CSF) drainage, avoidance of hypotension and anaemia, systemic hypothermia, neuromonitoring, maintaining distal perfusion during proximal clamping of the aorta, and reimplantation of intercostal or lumbar arteries, whenever feasible. We describe a case in which, due to the special characteristics of the surgery, veno-arterial extracorporeal membrane oxygenation (VA ECMO) was used to maintain distal blood flow in the lumbar, inferior mesenteric, and hypogastric arteries during aortic clamping. This approach reduced the risk of spinal cord and visceral ischaemia, and also eliminated the need for thoracotomy because partial left bypass was not required.

Ultrasound-guided piriformis muscle injection. A new approach. / Inyección ecoguiada del músculo piriforme. Un nuevo abordaje.

Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. Ultrasound allows direct visualization and real time injection of the piriformis muscle. We describe 5 consecutive patients, diagnosed of piriformis syndrome with no improvement after pharmacological treatment. Piriformis muscle injection with local anesthetics and steroids was performed using an ultrasound technique based on a standard technique. All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe.

Ultrasound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair. / Bloqueo de la fascia transversalis versus bloqueo plano transverso del abdomen anterior ecoguiados en cirugía ambulatoria de hernia inguinal.

INTRODUCTION: The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair. MATERIALS AND METHODS: Retrospective observational study conducted on ASA I-II patients. Two groups (TAP-A and TFP), which were given 30ml of 0.25% levobupivacaine prior to surgical incision. The primary endpoint was the post-operative pain evaluated by verbal numerical scale (VRN at rest and movement) at 10, 30, 60, 90min, coinciding with ambulation, and 24hours by telephone. An evaluation was also made of the sensory block level reached prior to surgery, the need for additional analgesia, side effects, ease of performing the technique, and the level of satisfaction of patients with the anaesthetic-analgesic technique. RESULTS: A total of 61 patients were included, 30 patients in the TAP-A group and 31 in the TFP group. The analgesic efficacy obtained in both groups was similar, although some higher values were found in the VNR on moving in the TAP-A group, reaching statistical difference at 10minutes (P=.014) and 30minutes (P=.013) post-operatively. A higher level of sensory block was achieved in the TFP group than in the TAP-A group (P<.01). There were no significant differences in additional analgesia requirements, and the cumulative dose of morphine was similar in both groups in the post-operative period. There were no differences in side effects or complications. The technical ease of the block was similar in both groups and the level of satisfaction of patients very high. CONCLUSIONS: Both blocks with a multimodal approach achieve good post-operative analgesia of inguinal hernia repair, are easy to perform and have few complications. TFP achieves the highest sensory level, but there are no differences in the requirements for additional analgesia.

Infecciones relacionadas con catéteres vasculares de corta permanencia en cuidados críticos / Short term catheter related infections in critical care

Las infecciones por catéter son la tercera causa de infección nosocomial en UCI. El riesgo de infección depende del tipo de dispositivo, el sitio de inserción y las adecuadas medidas de prevención. Su manejo implica la decisión de retirar el catéter y la terapia antimicrobiana sistémica. Esta revisión se centra en la epidemiología, patogénesis, diagnóstico y manejo de las infecciones relacionadas con catéter, centrándose en el manejo de acorde con el patógeno (AU)

Catheter related infections are third cause of nosocomial infections in the ICU. The risk of infection depends on the tapy of device, the site of insertion and the appropriate prevention measures. Management involves deciding on catheter removal and systemic antimicrobial therapy. This review outlines the epidemiology, pathogenesis, diagnosis and management of catheter related infections, mainly focusing on the management according to the patogen (AU)

Anafilaxia perioperatoria / Perioperative anaphylaxis

La anafilaxia perioperatoria es un cuadro clínico que puede amenazar la vida del paciente, producido por fármacos o sustancias usados durante la anestesia. Después de una anafilaxia debe realizarse un estudio alergológico para identificar el agente responsable y prevenir recurrencias. La incidencia global se estima de 1 entre 10.000-20.000 anestesias. Los agentes más frecuentemente implicados son los bloqueantes neuromusculares, látex y antibióticos. El diagnóstico inicial es clínico y en el tratamiento es esencial la adrenalina. En este artículo se describe la clínica, pruebas diagnósticas, así como protocolos de prevención y tratamiento del cuadro de anafilaxia perioperatoria. Será importante desarrollar protocolos de detección y manejo precoz de estas reacciones en circuitos de cirugía ambulatoria y establecer un adecuado seguimiento posterior (AU)

Perioperative anaphylaxis may be a life threatening clinical condition and is typically due to the results of drugs used for anesthesia. Once anaphylaxis occurs, allergy studies are essential to identify the responsible agent so to prevent recurrences. The overall incidence is estimated at 1 in 10,000-20,000 anesthetic procedures. The most commonly involved agents are neuromuscular blocking agents, latex and antibiotics. The initial diagnosis is presumptive; including clinical signs and adrenalin is the treatment of choice. The aim of this article is to review etiology, diagnosis, prevention and treatment of perioperative anaphylaxis. It will be important to produce action protocols to ensure the detection of these reactions of anaphylaxis in outpatient surgery and to establish the correct follow-up (AU)

Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo / Ultrasound-guided block at the antecubital fossa for carpal tunnel syndrome surgery

Introducción. Existen diferentes técnicas anestésicas para la cirugía ambulatoria del síndrome del túnel del carpo. Los bloqueos nerviosos ecoguiados brindan ventajas frente a otras técnicas. El objetivo del estudio fue determinar la eficacia del bloqueo ecoguiado a nivel de la fosa antecubital, así como la evaluación de las complicaciones, la satisfacción del paciente y del cirujano. Material y métodos. Estudio observacional prospectivo en 32 pacientes programados para cirugía del síndrome del túnel del carpo, en régimen ambulatorio. Se realizó un bloqueo nervioso ecoguiado a nivel de la fosa antecubital, de los nervios mediano, cubital y cutáneos medial y lateral del antebrazo con mepivacaína 1%. Se registraron las mediciones de los diámetros anteroposterior y laterolateral de los nervios mediano y cubital, antes y después de la inyección. Se evaluó el inicio del bloqueo sensitivo y motor en los territorios de los nervios mediano y cubital cada 5 min, hasta 30 min después de la administración del anestésico local, con respecto a la mano contralateral. Se registró la presencia de dolor durante la incisión quirúrgica, en el postoperatorio, las complicaciones y la satisfacción del paciente y del cirujano con la técnica anestésica realizada. Resultados. El bloqueo nervioso ecoguiado a nivel de la fosa antecubital fue eficaz en un 93,7% de los pacientes. Ningún paciente requirió rescate analgésico, no se produjeron efectos adversos reseñables ni complicaciones. La satisfacción con respecto a la técnica anestésica elegida fue valorada como «muy buena» por el 93,7% de los pacientes y por el 97% de los cirujanos. Conclusiones. El bloqueo nervioso ecoguiado de los nervios mediano, cubital y cutáneos medial y lateral del antebrazo a nivel de la fosa antecubital es una técnica anestésica eficaz y satisfactoria para la cirugía ambulatoria del síndrome del túnel del carpo, permite la movilización del brazo por parte del paciente, minimiza los riesgos y disminuye la dosis de anestésico local empleada(AU)

Introduction. There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. Materials and methods. Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. Results. The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. Conclusions. A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used(AU)

Bloqueo transverso abdominal ecoguiado vs. infiltración de herida quirúrgica en cirugía ambulatoria de hernia inguinal / Transversus abdominis plane block ultrasound-guided vs. surgical wound infiltration in outpatient inguinal hernia repair

Introducción: recientemente se han descrito numerosos bloqueos periféricos a nivel abdominal. El bloqueo del plano transverso abdominal (TAP) ha mostrado su utilidad para reducir el dolor y los requerimientos analgésicos en cirugía de pared abdominal. El objetivo de nuestro estudio fue valorar la eficacia y seguridad del bloqueo TAP ecoguiado en comparación con la infiltración de la herida quirúrgica en pacientes programados para cirugía de hernia inguinal unilateral en régimen ambulatorio. Material y métodos: estudio prospectivo, aleatorizado, simple ciego, en pacientes ASA I y II, divididos en dos grupos: grupo TAP a los que se les realizó un bloqueo TAP ecoguiado con 30 ml levobupivacaína 0,25 %, previo a la cirugía; grupo IH con infiltración de la herida quirúrgica con levobupivacaína 0,25 %. Se evaluó la eficacia analgésica mediante la escala verbal numérica (en reposo y movimiento) a los 10, 30, 60 y 90 min del postoperatorio, coincidiendo con la deambulación y en domicilio a las 24 h mediante llamada telefónica. Se registró la analgesia de rescate administrada, los efectos secundarios y el grado de satisfacción de los pacientes con la técnica anestésica. Resultados: se incluyeron 41 pacientes, 20 en el grupo TAP y 21 en el grupo IH. La eficacia analgésica obtenida en ambos grupos fue similar, con mayor demanda de analgesia adicional en postoperatorio en el grupo IH a los 10, 30 y 60 min, llegando a ser estadísticamente significativo a los 60 min. Mediante llamada telefónica a domicilio, a las 24 h se encontró un mayor consumo deo (..) (AU)

Introduction: Recently numerous peripheral blocks have been described at abdominal wall. The transversus abdominis plane block (TAP), has proven useful in reducing pain and analgesic requirements in abdominal wall surgery. The aim of our study was to evaluate the efficiency and safety of ultrasound-guided TAP block compared to surgical wound infiltration in patients scheduled for unilateral inguinal hernia surgery in outpatients. Materials and methods: A prospective, randomized, single-blind, ASA I and II patients, divided into two groups: the TAP group who underwent ultrasound guided TAP block with 30 ml levobupivacaine 0.25% prior to surgery; and a IH group with surgical wound infiltration with levobupivacaine 0.25%. Analgesic efficacy was evaluated by a numerical verbal scale (at rest and in movement) in 10, 30, 60, 90 minutes post surgery, coinciding with ambulation and through (..) (AU)

[Ultrasound-guided block at the antecubital fossa for carpal tunnel syndrome surgery]. / Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo.

INTRODUCTION: There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. MATERIALS AND METHODS: Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30 min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. RESULTS: The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. CONCLUSIONS: A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used.

Alergia al látex (I): implicaciones para el anestesiólogo / No disponible

La alergia al látex es una patología importante en el ámbito sanitario. Son grupos de riesgo para desarrollar alergia al látex los pacientes multioperados y los profesionales sanitarios. La prevalencia en la población general es calcula en un 1%, mientras que en los trabajadores sanitarios es del 2,6 al 19,6%, siendo mayor en los trabajadores de las áreas quirúrgicas. La clínica varía desde rinitis hasta shock anafiláctico, pudiendo ser causa de muerte. El diagnóstico se basa en una buena historia clínica, test cutáneos y, si es necesario, pruebas de provocación controlada. Existen protocolos para prevenir el desarrollo de síntomas en los pacientes alérgicos, cuando van a ser intervenidos quirúrgicamente. El tratamiento etiológico se basa en la inmunoterapia yen nuevas técnicas de ADN recombinante. En este artículo, se describe la clínica, protocolos diagnósticos, así como protocolos de prevención y tratamientos etiológicos de la alergia al látex (AU)

Hypersensitivity to natural rubber latex has been recognized as an important health problem. Risks groups for natural rubber latex allergy included health workers and patients who have under gone multiple surgical procedures. The prevalence of latex allergy among general population is probably 1%, in heath workers the estimated prevalence is between 2.6 to 19.6% and tends to be higher in surgical settings. Symptoms vary between rhinitis to anaphylaxis, even death. Diagnosis of latex allergy is based in clinical history, skin test and provocation test. Several protocol shave been described to avoid symptoms in allergy patients when they undergo surgical procedures. Etiological treatment is based on specific immunotherapy and recombinant allergens techniques. The aim of this article was to review etiology, diagnosis, prevention and treatment of latex allergy (AU)