Carbon Monoxide poisoning and Air Embolism following Hysteroscopic Myomectomy: a case report.

INTRODUCTION: Uterine myomas are the most common benign uterine tumors. Hysteroscopic myomectomy has grown as a standard minimally invasive surgical procedure, but this technique is not free from complications. CASE: An hysteroscopic myomectomy was performed on a 38 years-old woman. During the awakening after the procedure, she presented focal neurological deficits, thus arterial blood gas test and total body computerized tomography (CT) scan were urgently carried out. They revealed a very high carboxyhemoglobin level and abdominal venous air embolism. The patient stayed in Trendelenburg position and under mechanical ventilation with 100% oxygen concentration. Fortunately, a few hours later she was fully awake and was able to be successfully extubated, being discharged to the surgical ward three days later fully recovered. CONCLUSION: Carbon monoxide poisoning during hysteroscopic resection is a rare but potentially fatal complication that anesthetists, gynecologists, and critical care physicians should be aware of.

[Monitoring of deep sedation. The BIS(R) monitor]. / Monitorización de la sedación profunda. El monitor BIS(R).

Adequate monitoring of analgesia and sedation should be one of the main goals in the Intensive Care Units. Once the analgesia is assured, the correct dosage of the sedatives will depend on the correct monitoring of the sedation level. For years, clinical scales have been used to evaluate the sedation level. These scales are appropriate for the evaluation of mild sedation but they cannot correctly evaluate deeply sedated patients or those patients who require continuous intravenous administration of neuromuscular blockade agents. In this chapter, we review the most used monitor to control the adequate level of sedation in the Intensive Care Units as well as the BIS(R) Monitor, which is the one recommended by the Analgesia and Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC).

Monitorización de la sedación profunda. El monitor BIS® / Monitoring of deep sedation. The BIS® monitor

La correcta monitorización de la analgesia y la sedación debe ser uno de los objetivosprincipales en las Unidades de Cuidados Intensivos. Una vez asegurada la analgesia, lacorrecta dosificación de los sedantes va a depender de la monitorización correcta delnivel de sedación. Desde hace años se han utilizado sistemas de monitorización basadosen escalas. Estas escalas son adecuadas para la monitorización de la sedación superficial,pero no son capaces de evaluar el grado de sedación en pacientes profundamente sedadoso con bloqueantes neuromusculares en perfusión continua. Actualmente disponemosde diferentes sistemas de monitorización que nos facilitan llegar donde las escalas noalcanzan. En este capítulo revisaremos el monitor más empleado en la actualidad en lasUnidades de Cuidados Intensivos, y el recomendado por el grupo de trabajo de Sedacióny Analgesia de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias(SEMICYUC) para la monitorización de la sedación profunda, el Monitor BIS® (AU)

Adequate monitoring of analgesia and sedation should be one of the main goals in the IntensiveCare Units. Once the analgesia is assured, the correct dosage of the sedatives will dependon the correct monitoring of the sedation level. For years, clinical scales have beenused to evaluate the sedation level. These scales are appropriate for the evaluation of mildsedation but they cannot correctly evaluate deeply sedated patients or those patients whorequire continuous intravenous administration of neuromuscular blockade agents. In thischapter, we review the most used monitor to control the adequate level of sedation in theIntensive Care Units as well as the BIS® Monitor, which is the one recommended by the Analgesiaand Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC) (AU)

[Hemodynamic monitoring: PiCCO system]. / Monitorización hemodinámica: sistema PiCCO.

Cardiac output (CO) is monitored in critically ill patients to maintain and improve cardiac function with the primary goal of adequate tissue perfusion. For a long time, this monitoring has been done using the pulmonary arterial catheter, which has been provoking increasing controversy. For some years, monitoring of CO has been evolving with the appearance of new invasive and non-invasive monitoring systems. In this chapter we review some aspects of CO monitoring with the PiCCO system based on transpulmonary thermodilution. This system is based on the injection of a cold fluid bolus centrally in the vein. A thermistor located in the tip of the arterial catheter, usually femoral, is used to measure blood temperature changes. A thermodilution curve is created and the hemodynamic parameters obtained after its analysis.

Monitorización hemodinámica: sistema PiCCO(R) / Hemodynamic monitoring: PiCCO(R) system

La monitorización del gasto cardíaco (GC) en lospacientes críticos tiene como objetivo el mantener yoptimizar la función cardíaca con el objetivoprimordial de obtener una adecuada perfusión tisular.Dicha monitorización se ha realizado, desde haceaños, mediante el empleo del catéter de arteriapulmonar, el cual, cada vez suscita mayorcontroversia. Desde hace algunos años lamonitorización del GC ha ido evolucionando con laaparición de nuevos sistemas de monitorización tantode manera invasiva como no invasiva. En estecapítulo repasamos algunos aspectos de lamonitorización del GC mediante el empleode termodilución transpulmonar con el sistemaPiCCO®. Dicho sistema se basa en la inyecciónde un bolo de suero salino por vía central. Untermistor situado en la punta de un catéter arterial,normalmente femoral, mide los cambios detemperatura sanguíneos creando una curvade termodilución, que tras su análisis nos informará delos parámetros hemodinámicos

Cardiac output (CO) is monitored in critically illpatients to maintain and improve cardiac functionwith the primary goal of adequate tissue perfusion.For a long time, this monitoring has been doneusing the pulmonary arterial catheter, which hasbeen provoking increasing controversy. For someyears, monitoring of CO has been evolving with theappearance of new invasive and non-invasivemonitoring systems. In this chapter we review someaspects of CO monitoring with the PiCCO® systembased on transpulmonary thermodilution. Thissystem is based on the injection of a cold fluidbolus centrally in the vein. A thermistor located inthe tip of the arterial catheter, usually femoral, isused to measure blood temperature changes.A thermodilution curve is created and the hemodynamic parameters obtained after itsanalysis

[Sedation in special procedures and situations]. / Sedación en procedimientos y situaciones especiales.

Numerous diagnostic techniques require sedation and analgesia in order to be performed in a safe and comfortable way for the patient. Several of the most notable points of interest for the critical care specialist are the electrical cardioversion, the placing of implantable cardiac stimulation devices, the endoscopic techniques and the performing of bedside surgical procedures. In this current revision, the SEMICYUC Task Force for Sedation and Analgesia describes recommendations and best practices for administering sedation and analgesia in these situations.

Control del coma barbitúrico / Control of barbiturate coma

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