Evaluación in vitro de la eficacia de plaquetas convencionales, atemperadas y congeladas. Posible empleo en el medio militar / In vitro evaluation of the efficacy of fresh, temperatured and frozen platelets. Possible employment in the military environment

Introducción: La hemorragia exanguinante es la primera causa de muerte prevenible del combatiente en los conflictos armados, convirtiendo así la posibilidad de transfundir hemocomponentes de manera precoz en una prestación absolutamente fundamental durante la asistencia sanitaria a las bajas generadas en las operaciones militares. A lo largo de los numerosos conflictos acontecidos durante el pasado siglo, se han producido importantes cambios en el tratamiento hemoterápico a las bajas junto con una evolución de la doctrina sanitaria respecto a este tema. En algunos protocolos de transfusión masiva se ha empleado la técnica diagnóstica de la tromboelastometría (TE). La TE es una prueba que muestra las propiedades viscoelásticas de la sangre desde la formación del coágulo hasta su fibrinólisis, evalúa la función plaquetaria y se correlaciona con el proceso fisiológico de la hemostasia de una forma rápida. El objetivo principal de este estudio es evaluar in vitro la capacidad hemostática de los diversos concentrados de plaquetas frías, congeladas y frescas mediante pruebas de coagulación estandarizadas y tromboelastometría, esclareciendo si se mejora significativamente la contribución al coágulo con los pool de plaquetas frías (conservadas a 4ºC), en comparación con las plaquetas frescas y congeladas. También se pretende determinar qué ventajas supondría la incorporación de las plaquetas frías en la medicina transfusional realizada en el medio militar. Material y método: Se diseñó un estudio experimental para comparar in vitro plaquetas frías (refrigeradas), congeladas y frescas (convencionales), analizando su rendimiento y efectividad mediante análisis sistemático de sangre, mecanismos de laboratorio de coagulación rutinarios (Tiempo de Protrombina, Actividad de Protrombina, Tiempo de Cefalina y Fibrinógeno) y Tromboelastometría rotacional (ROTEM)...(AU)

Introduction: Exsanguinating hemorrhage is the first preventable cause of death for combatants in armed conflicts, thus making the possibility of transfusing blood components early an absolutely essential benefit during health care for casualties generated in military operations. Throughout the numerous conflicts that have occurred during the past century, there have been important changes in the hemotherapy treatment of casualties along with an evolution of the health doctrine regarding this issue. In some massive transfusion protocols, the diagnostic technique of thromboelastometry (TE) has been used. TE is a test that shows the viscoelastic properties of blood from clot formation to fibrinolysis, evaluates platelet function and correlates quickly with the physiological process of hemostasis. The main objective of this study is the evaluation in vitro of the hemostatic capacity of the various cold, frozen and fresh platelet concentrates through standardized coagulation tests and thromboelastometry, clarifying whether the contribution to the clot is significantly improved with cold platelet pools (preserved at 4ºC), compared to fresh and frozen platelets. It is also intended to determine what advantages would be the incorporation of cold platelets in transfusion medicine performed in the military environment. Material and methods: An experimental study was designed to compare cold (refrigerated), frozen and fresh (conventional) platelets in vitro, analyzing their performance and effectiveness through systematic blood analysis, routine laboratory coagulation mechanisms (Prothrombin Time, Prothrombin Activity, Cephalin and Fibrinogen) and Rotational Thromboelastometry (ROTEM).A sample of 20 healthy patients was recruited, after informing them in writing and obtaining the mandatory informed consent, they donated 6 tubes with 10 ml citrate. of blood per patient...(AU)

Guía de práctica clínica de hipotermia perioperatoria no intencionada / Clinical practice guideline. Unintentional perioperative hypothermia

La importancia de la seguridad de nuestros pacientes en el entorno quirúrgico ha impulsado multitud de proyectos dirigidos al mejor control y actuación clínica de las variables que intervienen o modulan los resultados de los procesos quirúrgicos y que tienen relación directa sobre los mismos. La Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor -SEDAR- mantiene una constante preocupación por una variable que determina claramente los resultados de nuestros procesos clínicos, la hipotermia no intencionada que se desarrolla en todos los pacientes sometidos a un procedimiento anestésico-quirúrgico. SEDAR ha promovido, en colaboración con otras sociedades científicas y asociaciones de pacientes, la elaboración de esta guía de práctica clínica, que pretende dar respuesta a cuestiones clínicas no resueltas aun y para las cuales no existen hasta ahora documentos basados en la mejor evidencia científica disponible. Con metodología GRADE y la asistencia técnica de la oficina de Colaboración Cochrane Iberoamericana, esta guía de práctica clínica presenta 3 recomendaciones (débil a favor) para los métodos activos de calentamiento para la prevención de la hipotermia (cutáneos, de líquidos o gases); 3 para la priorización de las estrategias de prevención de la hipotermia (2 débil a favor y una fuerte a favor); 2 para las estrategias de precalentamiento previas a la inducción anestésica (2 débil a favor); y 2 para investigación

The importance of the safety of our patients in the surgical theatre, has driven many projects. The majority of them aimed at better control and clinical performance; mainly of the variables that intervene or modulate the results of surgical procedures, and have a direct relationship with them. The Spanish Society of Anesthesiology, Critical Care and Therapeutic Pain (SEDAR), maintains a constant concern for a variable that clearly determines the outcomes of our clinical processes, "unintentional hypothermia" that develops in all patients undergoing an anesthetic or surgical procedure. SEDAR has promoted, in collaboration with other scientific Societies and patient Associations, the elaboration of this clinical practice guideline, which aims to answer clinical questions not yet resolved and for which, up to now, there are no documents based in the best scientific evidence available. With GRADE methodology and technical assistance from the Ibero-American Cochrane Collaboration office, this clinical practice guideline presents three recommendations (weak in favor) for active heating methods for the prevention of hypothermia (skin, fluid or gas); three for the prioritization of strategies for the prevention of hypothermia (too weak in favor and one strongly in favor); two of preheating strategies prior to anesthetic induction (both weak in favor); and two for research

Clinical practice guideline. Unintentional perioperative hypothermia. / Guía de práctica clínica de hipotermia perioperatoria no intencionada.

The importance of the safety of our patients in the surgical theatre, has driven many projects. The majority of them aimed at better control and clinical performance; mainly of the variables that intervene or modulate the results of surgical procedures, and have a direct relationship with them. The Spanish Society of Anesthesiology, Critical Care and Therapeutic Pain (SEDAR), maintains a constant concern for a variable that clearly determines the outcomes of our clinical processes, "unintentional hypothermia" that develops in all patients undergoing an anesthetic or surgical procedure. SEDAR has promoted, in collaboration with other scientific Societies and patient Associations, the elaboration of this clinical practice guideline, which aims to answer clinical questions not yet resolved and for which, up to now, there are no documents based in the best scientific evidence available. With GRADE methodology and technical assistance from the Ibero-American Cochrane Collaboration office, this clinical practice guideline presents three recommendations (weak in favor) for active heating methods for the prevention of hypothermia (skin, fluid or gas); three for the prioritization of strategies for the prevention of hypothermia (too weak in favor and one strongly in favor); two of preheating strategies prior to anesthetic induction (both weak in favor); and two for research.

Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana / Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination

Objetivos. Comprobar si la adición de bajas dosis de antibiótico (vancomicina) al suero de lavado del recuperador celular reduce la incidencia de contaminación bacteriana del concentrado de hematíes (CH) autógeno recuperado. Material y método. Estudio experimental, aleatorizado, doble ciego, en forma de grupos paralelos, sobre 20 pacientes consecutivos, programados para cirugía de artrodesis vertebral posterior. La hemorragia intraoperatoria se procesó mediante un recuperador de sangre modelo HaemoLite® 2+, en cuyo proceso los hematíes se lavaron según grupo de aleatorización, con suero fisiológico (grupo control) o con suero fisiológico+10μg/ml−1 de vancomicina (grupo vanco). Se recogieron los datos referentes a edad, peso, volumen procesado y recuperado, hemograma, hemocultivo y concentración de vancomicina del CH obtenido e incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue 843±403ml y el volumen recuperado 121±29ml, con hemoglobina 10,4±5,0g/dl−1 y hematocrito 29,1±15,9% (media±DE). El hemocultivo del CH recuperado fue positivo a Staphylococcus coagulasa negativo en 5 casos (50%) en el grupo control mientras que fue estéril en todos los casos en el grupo vanco (p=0,016). La diferencia entre la concentración teórica de vancomicina administrada y la determinada en CH recuperado fue de 1,31μg/ml−1 (IC 95% 1,19-1,43; p=0,074). Conclusiones. La adición de vancomicina a una concentración de 10μg/ml−1 en el suero de lavado del recuperador consigue concentraciones similares en la sangre autógena recuperada y permite la eliminación de las bacterias, obteniéndose hemocultivos negativos en todos los casos (AU)

Objectives. The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. Material and method. Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml−1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. Results. Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl−1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml−1 (95% CI 1.19 to 1.43; P=.074). Conclusions. The addition of vancomycin at a concentration of 10ug/ml−1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases (AU)

Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination. / Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana.

OBJECTIVES: The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD: Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10µg/ml-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. RESULTS: Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31µg/ml-1 (95% CI 1.19 to 1.43; P=.074). CONCLUSIONS: The addition of vancomycin at a concentration of 10ug/ml-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.

Ventilación con mascarilla facial en decúbito prono para tratamiento radioterápico en niños / Ventilation with facial mask in the prone position for radiotherapy procedures in children

Objetivos. La ventilación de los pacientes para procedimientos en decúbito prono representa un reto para el anestesiólogo, especialmente cuando se intenta evitar la intubación endotraqueal. Presentamos un estudio concebido para comprobar la efectividad y la seguridad de un prototipo diseñado para ventilación con mascarilla facial en decúbito prono en niños. Material y métodos. Estudio descriptivo prospectivo de 105 sedaciones realizadas en 3 niños programados para tratamiento radioterápico en decúbito prono por meduloblastoma desmoplásico de fosa posterior (2 pacientes de 4 y 6 años de edad) y neuroblastoma en área temporal (un paciente de 4 años). La inducción y el mantenimiento de la sedación se realizaron con sevoflurano en oxígeno, manteniendo ventilación espontánea. Tras la pérdida de consciencia e inmovilidad del paciente se procedía a colocarlo en decúbito prono y a fijar su cabeza con frente y cara apoyadas en un prototipo creado con un molde de poliexpan que contenía la mascarilla facial (conectada a un circuito Mapleson D,) y la parte posterior de la cabeza inmovilizada con una capa de material termoplástico. Se recogieron variables de tiempo y posibles complicaciones. Resultados. Las 105 sedaciones se realizaron según el protocolo previsto. No se produjeron desaturaciones por debajo del 95%, movimientos durante el procedimiento ni otras complicaciones. El tiempo de estancia en el hospital incluyendo procedimiento y recuperación postanestésica fue de 54,4 ± 7,9 min (media ± DE). Conclusiones. El prototipo y técnica de sedación con mascarilla facial en decúbito prono empleados fueron efectivos y seguros permitiendo la realización del tratamiento radioterápico, asegurando la vía aérea de forma mínimamente invasiva, manteniendo la ventilación adecuada, una sedación superficial y posibilitando un alta a domicilio precoz (AU)

Objectives. Ventilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. Material and methods. A prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. Results. All sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9 min (mean ± SD). Conclusions. The prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge (AU)

Implementación de un programa de alternativas a la transfusión sanguínea en cirugía de escoliosis en pediatría / Implementation of a patient blood management program in pediatric scoliosis surgery

Objetivos. Determinar si la puesta en marcha de un programa de ahorro de sangre y la adopción y asociación progresiva de diferentes métodos reducen las necesidades transfusionales en pacientes pediátricos intervenidos de escoliosis de múltiples etiologías. Material y método. Estudio cuasiexperimental, no aleatorizado y descriptivo, aprobado por el Comité de Ética para la Investigación de nuestra institución. Se incluyeron 50 pacientes pediátricos (ASA I-III) de edades comprendidas entre los 5 y los 18 años, intervenidos de cirugía de escoliosis de cualquier etiología mediante un único tiempo posterior o doble abordaje, anterior y posterior. Se compararon un grupo histórico (recogida retrospectiva de datos), sin alternativas a la transfusión (Grupo No ahorro = 15 pacientes), y otros 3 grupos prospectivamente: Grupo HNA (hemodilución normovolémica aguda) = 9 pacientes, Grupo HNA + Rec (recuperación intraoperatoria) = 14 pacientes, Grupo EPO (HNA + Rec + eritropoyetina ± donación preoperatoria) = 12 pacientes, conforme se implementaron las diferentes alternativas a la transfusión en nuestra institución. Resultados. La tasa de transfusión en los diferentes grupos (No ahorro, HNA, HNA + Rec, EPO) fue del 100, 66, 57 y 0% de los pacientes, con una media ± DE de 3,40 ± 1,59; 1,33 ± 1,41; 1,43 ± 1,50; 0 ± 0 unidades de CH transfundidas por paciente, respectivamente, con diferencias estadísticamente significativas (p < 0,001) tanto en la tasa de transfusión como en el número de unidades. Conclusiones. La aplicación de un programa multimodal de alternativas a la transfusión sanguínea en cirugía de escoliosis pediátrica, individualizado para cada paciente, puede evitar la transfusión en la práctica totalidad de los casos (AU)

Objectives. To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. Material and method. Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro = 15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution) = 9 patients; Group HNA + Rec (intraoperative blood salvage) = 14 patients, and Group EPO (HNA + Rec + erythropoietin ± preoperative donation) = 12 patients; according with the implementation schedule of the transfusion alternatives in our institution. Results. The rate of transfusion in different groups (No ahorro, HNA, HNA + Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean ± SD of 3.40 ± 1.59; 1.33 ± 1.41; 1.43 ± 1.50; 0 ± 0 RBC units transfused per patient, respectively. Statistically significant differences (P < .001) were found in both the transfusion rate and number of RBC units. Conclusions. The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases (AU)

Características y calidad de la sangre autóloga recuperada del campo quirúrgico durante cirugía de escoliosis en pediatría / Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery

Objetivos. Determinar las características hematológicas y microbiológicas de la sangre recuperada mediante el uso de un recuperador celular con campana centrifugadora pediátrica rígida (100 ml) en cirugía de escoliosis en pediatría y comprobar si se ajusta al estándar esperado en el paciente adulto. Material y método. Estudio de cohorte transversal, descriptivo, sobre 24 unidades consecutivas de sangre recuperada del campo quirúrgico procesadas mediante un recuperador de sangre modelo Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.). Se recogieron los datos referentes a edad, peso, abordaje (anterior o posterior) de la cirugía de escoliosis, volumen procesado y volumen de concentrado de hematíes (CH) autógeno recuperado, hemograma y hemocultivo del concentrado obtenido y la incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue muy escaso (939 ± 569 ml) con gran variabilidad (coeficiente de variación = 0,6), a diferencia del volumen recuperado 129 ± 50 ml (coeficiente de variación = 0,38). Se estableció correlación estadísticamente significativa entre el volumen procesado y el hematocrito del CH recuperado (Pearson, r = 0,659; p = 0,001) que fue menor del esperado. Los parámetros hematológicos más relevantes de los concentrados recuperados fueron: Hb 11 ± 5,3 g dl−1; HTO: 32,1 ± 15,4%; leucocitos 5,34 ± 4,22 × 103 μl−1; plaquetas 37,88 ± 23,5 × 103 μl−1 (media ± DE). El hemocultivo del CH recuperado fue positivo en 13 casos (54,2%) en los que se aisló Staphylococcus coagulasa (−). Conclusiones. Los recuperadores celulares con campana centrifugadora de volumen fijo (incluso pediátrica) no obtienen la concentración esperada si se procesan bajos volúmenes, por lo que no son la mejor opción en el niño (AU)

Objective. To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100 ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. Material and methods. A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. Results. The processed shed volume was very low (939 ± 569 ml) with high variability (coefficient of variation = 0.6), unlike the recovered volume 129 ± 50 ml (coefficient of variation = 0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11 ± 5.3 g dl−1; haematocrit: 32.1 ± 15.4% (lower than expected); white cells 5.34 ± 4.22 × 103 ul−1; platelets 37.88 ± 23.5 × 103 ul−1 (mean ± SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (−) was isolated. Conclusions. Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery (AU)

Ventilation with facial mask in the prone position for radiotherapy procedures in children.

OBJECTIVES: Ventilation of patients undergoing procedures in the prone position represents a challenge for the anesthesiologist, especially when trying to avoid tracheal intubation. This study aimed to test the effectiveness and safety of a prototype designed for pediatric facial mask ventilation in the prone position. MATERIAL AND METHODS: A prospective descriptive study was conducted on 105 sedations performed in 3 children scheduled for radiotherapy treatment of posterior fossa desmoplastic medulloblastoma (6 and 4 y.o. males), and neuroblastoma in temporal area (4 y.o. male). Induction and maintenance of sedation were conducted with sevoflurane in oxygen, maintaining spontaneous ventilation. After achieving loss of consciousness and immobility, the patients were placed in the prone position. Their heads were fixed with the forehead and face supported by a prototype made with a cast of expanded polystyrene (EPS), which held the facial mask (connected to a Mapleson D circuit), and the back of the head immobilized with a layer of thermoplastic material. Time variables and complications were recorded. RESULTS: All sedations were performed according to the planned protocol. All patients maintained oxygen saturation levels above 95%, and no complications were reported. Daily hospital length of stay including the procedure and post anesthetic recovery was 54.4±7.9 min (mean±SD). CONCLUSIONS: The prototype and the sedation technique with face mask in the prone position employed were effective and safe, allowing the completion of the radiotherapy sessions and securing the airway in a minimally invasive way, maintaining adequate ventilation, light sedation and enabling early hospital discharge.

Implementation of a patient blood management program in pediatric scoliosis surgery.

OBJECTIVES: To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. MATERIAL AND METHOD: Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. RESULTS: The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. CONCLUSIONS: The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.

Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery.

OBJECTIVE: To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS: A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS: The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS: Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.

Early thromboelastometry variables predict maximum clot firmness in children undergoing cardiac and non-cardiac surgery.

BACKGROUND: Early clot amplitudes measured on thromboelastometry (ROTEM®) predict maximum clot firmness (MCF) in adults. In this multicentre, retrospective study, we aimed to confirm the suspected relationship between early ROTEM® variables and MCF, in children undergoing cardiac or non-cardiac surgery. METHODS: 4762 ROTEM® tests (e.g. EXTEM, INTEM, FIBTEM, APTEM, and HEPTEM) performed in children undergoing cardiac or non-cardiac surgery at three University hospitals between January 2011 and June 2014 were reviewed. To assess the correlation between clot amplitudes measured after 5, 10 and 15 min and MCF, each variable was compared with the corresponding MCF by calculating Spearman's correlation coefficient. RESULTS: For the EXTEM® test, we observed that amplitude measured after 5 min (A5: r=0.91, P<0.001), 10 min (A10: r=0.95, P<0.001) and 15 min (A15: r=0.96, P<0.001) were strongly correlated to MCF. The same correlations were observed for INTEM® test (A5: r=0.93, P<0.001; A10: r=0.97, P<0.001; A15: r=0.97, P<0.001), and FIBTEM® test (A5: r=0.93, P<0.001; A10: r=0.94, P<0.001; A15: r=0.96, P<0.001). In addition, the amplitudes measured after five, 10 and 15 min were also strongly correlated with MCF in the APTEM® and the HEPTEM® tests. Receiver operating characteristics (ROC) analysis confirmed that A5, A10, A15 strongly predicted decreased MCF on all ROTEM® tests. CONCLUSIONS: This study confirmed that early values of clot amplitudes measured as soon as five, 10 or 15 min after clotting time could be used to predict maximum clot firmness in all ROTEM® tests.

Empleo de plaquetas congeladas en trauma masivo de extremidades / Use of frozen platelets in massive limb trauma

No disponible

Control de la hemorragia en el ámbito militar / Control of bleeding in the military environment

Uno de los pilares de la medicina militar es el control del shock hemorrágico. La hemorragia es la primera causa de muerte prevenible en combate, el control adecuado del sangrado se considera primordial para estimar la supervivencia del combatiente y, el apoyo terapéutico encaminado a minimizar la pérdida sanguínea supone un reto dentro la logística sanitaria militar. El objetivo del trabajo es revisar los avances médicos y logísticos en el tratamiento de la hemorragia en el ambiente militar a lo largo de los últimos conflictos, describir cuál está siendo la aportación de las Fuerzas Armadas Españolas y perfilar futuras líneas de investigación(AU)

One of the basics of military medicine is the control of haemorrhagic shock. Haemorrhage is the first cause of preventable death in combat, with the adequate control of bleeding being considered as fundamental to estimate the survival of the combatant as well as therapeutic support aimed at minimising blood loss being a challenge within military health logistics. The aim of this work is to review the medical and logistics advances in the treatment of bleeding in the military environment and combat during the latest conflicts, and to describe what is the current contribution of the Spanish Armed Forces and to profile future lines of investigation(AU)

[Control of bleeding in the military environment]. / Control de la hemorragia en el ámbito militar.

One of the basics of military medicine is the control of haemorrhagic shock. Haemorrhage is the first cause of preventable death in combat, with the adequate control of bleeding being considered as fundamental to estimate the survival of the combatant as well as therapeutic support aimed at minimising blood loss being a challenge within military health logistics. The aim of this work is to review the medical and logistics advances in the treatment of bleeding in the military environment and combat during the latest conflicts, and to describe what is the current contribution of the Spanish Armed Forces and to profile future lines of investigation.

Colocación de filtro de cava por trombosis venosa profunda durante el embarazo / No disponible

No disponible

Difficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.

Klippel-Feil Syndrome (KFS) is a congenital defect characterized by the fusion of at least two cervical vertebrae. This article presents the case of a 12-year-old girl with KFS planned for scoliosis surgery. A short, rigid neck and limited mouth opening were predictors of difficult airway access. After failing multiple intubation attempts employing several devices, the case was postponed. Imaging tests showed lingual tonsil hypertrophy and a deviation of the tracheal axis, clarifying the causes of the failed intubation and suggesting new approaches for airway management. As far as we know, the association of KFS and lingual tonsil hypertrophy has not been reported before in the literature.