Actuación de los pacientes ante un síndrome coronario agudo: diferencias desde una perspectiva de género / Patient responses to symptoms of acute coronary syndrome: a gender-perspective study

Objetivos: Conocer las características del entorno, pensamientos, actuaciones y tipo de transporte utilizado en hombres y mujeres con síndrome coronario agudo –SCA– (infarto agudo de miocardio y angina inestable) al inicio de los síntomas. Método: Estudio observacional descriptivo de una muestra representativa de pacientes ingresados en las unidades de cuidados intensivos de 33 hospitales públicos de las 8provincias andaluzas, entre 2007 y 2010, con diagnóstico al alta de SCA. Resultados: Se obtuvieron 1.416 encuestas: 948 hombres y 468 mujeres, con una edad media de 63,0 años y 70,5, respectivamente. Los síntomas se inician mayormente en la vivienda habitual y por la mañana. Menos de una tercera parte de las personas encuestadas supo desde el principio que se trataba de un infarto (hombres 29,9%, mujeres 24,2% p < 0,001). El 26,0% lo primero que hace es telefonear o desplazarse en busca de familiares, amistades o gente vecina, además las personas realizan más de (..) (AU)

Objective: To determine the environmental characteristics and the opinions, behaviors, and types of transfer to hospital of men and women who experience symptoms of acute coronary syndrome (acute myocardial infarct and unstable angina).Methods: Descriptive observational study of a representative sample of patients with a diagnosis of acute coronary syndrome who were admitted to the intensive care units of 33 public health service hospitals in 8 provinces in Andalusia, Spain, between 2007 and 2010.Results: A total of 1416 surveys were completed; 948 were for men and 468 were for women (mean [SD] ages, 63.0and 70.5 years, respectively). Symptoms usually began in the patient’s home. Fewer than a third of the patients surveyed knew they were experiencing a coronary event from the beginning of symptoms (29.9% of men and 24.2% of women;P<.001). The first reaction of 26.0% was to call or try to find a family member, friend, or neighbor. Many (..) (AU)

Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest, head and neck oncoplastic surgery.

BACKGROUND AND OBJECTIVE: The flexible laryngeal mask airway has been mostly used in spontaneous ventilated children during short procedures to avoid the risk of kinking; little information has been reported about its airway morbidity. The aim of the study was to compare this airway device with the reinforced tracheal tube in mechanically ventilated adult patients. METHODS: 120 adult patients undergoing general anaesthesia for breast, head and neck oncoplastic surgery, expected to last up to 3 h, were stratified into two airway groups: flexible laryngeal mask airway (n = 60) or reinforced tracheal tube (n = 60). Within each group, patients were randomly allocated to one of the two maintenance anaesthetic subgroups: propofol (n = 30) or sevoflurane (n = 30). Ease of insertion and haemodynamic stress response to placement, ventilation and postoperative morbidity were studied. RESULTS: Easy insertion rate was greater for the flexible laryngeal mask airway (93% vs. 77%, P = 0.01), and the overall success in insertion rate was 100% for both groups. Haemodynamic changes were significantly higher after inserting reinforced tracheal tube (P < 0.001). Oxygen saturation and capnography were comparable in both groups but airway pressure was lower with flexible laryngeal mask airway (P = 0.002). Sore throat, cough and dysphonia were lest frequent with flexible laryngeal mask airway (P < 0.01); also more patients in this group felt comfortable. Sevoflurane gave better results in emergence time, regardless of the airway device used. CONCLUSION: During anaesthesia in mechanically ventilated adult patients, both devices function adequately, are stable and protect the airway. Flexible laryngeal mask airway results in less postoperative morbidity than reinforced tracheal tube.

[Survival and the quality of life in extrahospital cardiorespiratory arrest]. / Supervivencia y calidad de vida en la parada cardiorrespiratoria extrahospitalaria.

BACKGROUND: There are few data in Spain on out-of-hospital cardiac arrest and the efficacy of emergency systems. The objectives of the present study were to evaluate an emergency system, comparing survival at hospital discharge according to the origin, cardiac or non-cardiac, of cardiac arrest in out-of-hospital critically ill patients, and to describe the quality of life of the survivors. PATIENTS AND METHODS: Prospective study on 282 patients treated during 1995 and 1996 by ICU ambulances units of the Andalusian Public Health Emergency Company (061) in Granada, Almería and El Ejido-Poniente (Spain). The Utstein style was followed, gathering the mortality at different times up to 6 months after hospital discharge and the origin (cardiac/non-cardiac) of the arrest. Quality of life 6 months after discharge was collected among survivors. RESULTS: Advanced cardiopulmonary resuscitation (CPR) was applied to 176 (62.4%) patients. The survival rate to discharge was 4.9% for patients with cardiac etiology (7/142 x 100) and 5.9% for those with non-cardiac etiology (2/34 x 100), with non-significant differences between the two groups. An optimal quality of life in all domains, except for pharmacological dependence in seven, was found in the eight survivors 6 months after hospital discharge. CONCLUSIONS: The origin (cardiac/non-cardiac) of out-of-hospital cardiac arrest is not associated with survival at hospital discharge. The survivors exhibit an optimal quality of life 6 months after discharge.

[Anesthesia techniques in epidermolysis bullosa]. / Técnicas anestésicas en la epidermólisis ampollosa.

Epidermolysis bullosa encompasses a group of rare clinical profiles marked by the formation of bullae on the skin and mucosa as the result of slight mechanical trauma. The anesthesiologist must take certain safety measures to monitor the airway and must expect difficult venous access in patients with this disease. We report our experience in providing anesthesia by various techniques for plastic and maxillofacial surgery. Most anesthetic techniques can be considered safe if they are performed with care and attention to detail.