Enucleación prostática con láser holmio y adenomectomía prostática retropúbica: análisis de morbilidad y consideraciones anestésicas / Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations

Objetivo: La enucleación prostática mediante láser de holmio (HoLEP) es una alternativa a la adenomectomía prostática para el tratamiento quirúrgico de la hipertrofia benigna de próstata. Analizamos nuestra curva de aprendizaje de dicha técnica y la comparamos de forma secundaria con las adenomectomías de próstata. Materiales y métodos: Estudio retrospectivo y comparativo donde se incluyeron los 100 primeros casos de HoLEP realizados en nuestro centro y los últimos 50 casos de adenomectomías retropúbicas. Se recogen los datos del paciente, de la intervención, del acto anestésico, de las variables perioperatorias, de las complicaciones anestésicas y de las variables postoperatorias con un seguimiento durante 6 meses. Se analizó la curva de aprendizaje sin mentor del HoLEP y se compararon las características del HoLEP en 2 fases diferenciadas (fase de aprendizaje y fase de estabilización) con las últimas adenomectomías retropúbicas de próstata realizadas. Resultados: La anestesia intradural fue la técnica más frecuente. Las necesidades de transfusión, el tiempo de estancia (p < 0,01) y la morbilidad postoperatoria fueron menores en los HoLEP que en las adenomectomías. Sin embargo, el grupo de las adenomectomías retropúbicas tenía un mayor volumen prostático inicial (p < 0,001) y un menor tiempo quirúrgico (p < 0,001). Se observó un mejor rendimiento quirúrgico (p < 0,001) y una menor incidencia de complicaciones en el Grupo HoLEP-B (superada ya la curva de aprendizaje) frente al grupo HoLEP-A. Conclusión: En nuestro centro el HoLEP se ha introducido como una opción válida frente a las adenomectomías retropúbicas abiertas, con muy buenos resultados en términos de morbilidad y reducción de estancia hospitalaria. Respecto a la curva de aprendizaje consideramos en torno a los 50 pacientes (sin mentor) como un punto de corte adecuado. La anestesia regional es una buena elección como técnica anestésica

Objective: Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. Materials and methods: A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. Results: Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P < .01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P < .001) and shorter surgical times (P < .001). Better surgical performance (P < .001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. Conclusion: In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique

Influencia del tipo de anestesia y del grado de urgencia en el dolor posoperatorio tras una cesárea / Influence of the type of anesthesia and the level of urgency in post-surgical pain after a cesarian

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Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations.

OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. MATERIALS AND METHODS: A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. RESULTS: Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. CONCLUSION: In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.

Herniación en mascarilla laríngea Supreme® (new cuff) / Herniation in Supreme® (new cuff) laryngeal mask

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Anestesia y reanimación en un caso de placenta pércreta / Anaesthesia and recovery in a case of placenta percreta

La placenta pércreta es un subtipo de acretismo placentario, en el que este órgano invade la totalidad de la pared uterina, llegando a afectar a los órganos circundantes. Se trata de una afección de alto riesgo quirúrgico, que por lo general va a requerir una histerectomía obstétrica. Presentamos el caso de una gestante de 36 años, con diagnóstico de placenta pércreta con invasión de vejiga e intestino. Durante la intervención desarrolló un cuadro de shock hipovolémico, que precisó transfusión masiva de hemoderivados y apoyo inotrópico. Fueron necesarias 3 reintervenciones sucesivas debido a la hemorragia, realizándose, en una de ellas, embolización selectiva de las arterias hipogástricas. Precisó 13 días en Cuidados Intensivos. El volumen total de hemoderivados transfundidos fue de 43 concentrados de hematíes, 28 unidades de plasma y 8 pools de plaquetas. Se destaca la importancia del diagnóstico prenatal precoz, para poder llevar a cabo un planteamiento adecuado de la intervención, en la que se cuente con un equipo multidisciplinario (cirujanos generales, urólogos, cirujanos vasculares), además de anestesiólogos y obstetras experimentados(AU)

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians(AU)

Neumotórax bilateral y neumomediastino tras microcirugía transoral con láser y traqueotomía / Bilateral and pneumomediastinal pneumothorax after transoral laser microsurgery and tracheotomy

La microcirugía transoral con láser CO2 se ha convertido en una alternativa cada vez más empleada para el tratamiento del cáncer de laringe y faringe. Entre las ventajas que aporta frente a la cirugía abierta y la radioterapia, se encuentran su menor invasividad, mayor precisión, mejor preservación funcional del órgano y menor morbilidad asociada al procedimiento. No obstante, esta técnica quirúrgica no está exenta de complicaciones, algunas hasta ahora poco frecuentes, pero de gran trascendencia clínica. Presentamos el caso de una paciente que en el contexto de una microcirugía con traqueotomía por cáncer de laringe sufrió un enfisema subcutáneo, neumomediastino y neumotórax bilateral precisando de las medidas pertinentes para su control y estabilización, que se describen. Además, se realiza una revisión actual en la literatura, sobre las consideraciones anestésicas y las principales complicaciones perioperatorias de la microcirugía con láser(AU)

Transoral laser CO2 microsurgery is becoming an increasing used treatment option for cancer of the larynx and the pharynx. Amongst the advantages it has compared to open surgery and radiotherapy are, it less invasiveness, greater precision, better functional preservation of the organ, and less procedure-associated morbidity. However, this surgical technique is not without its complication, some being rare up until now, but with great clinical importance. We present the case of a patient subjected to microsurgery with a tracheotomy due to cancer of the larynx, who suffered a subcutaneous emphysema, and a bilateral and pneumomediastinal pneumothorax, requiring the appropriate measures for its control and stabilisation, which are described. A review was also performed of the current literature as regards anaesthetic considerations and the main peri-operative complications of laser microsurgery(AU)

[Anaesthesia and recovery in a case of placenta percreta]. / Anestesia y reanimación en un caso de placenta pércreta.

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians.

[Bilateral and pneumomediastinal pneumothorax after transoral laser microsurgery and tracheotomy]. / Neumotórax bilateral y neumomediastino tras microcirugía transoral con láser y traqueotomía.

Transoral laser CO2 microsurgery is becoming an increasing used treatment option for cancer of the larynx and the pharynx. Amongst the advantages it has compared to open surgery and radiotherapy are, it less invasiveness, greater precision, better functional preservation of the organ, and less procedure-associated morbidity. However, this surgical technique is not without its complication, some being rare up until now, but with great clinical importance. We present the case of a patient subjected to microsurgery with a tracheotomy due to cancer of the larynx, who suffered a subcutaneous emphysema, and a bilateral and pneumomediastinal pneumothorax, requiring the appropriate measures for its control and stabilisation, which are described. A review was also performed of the current literature as regards anaesthetic considerations and the main peri-operative complications of laser microsurgery.

Bloqueo axilar del plexo braquial en un paciente con síndrome de Bardet-Biedl / Axillary brachial plexus block in a patient with Bardet-Biedl syndrome

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Taponamiento cardiaco como complicación infrecuente en la cateterización venosa central / Cardiac tamponade as a rare complication in central venous catheterisation

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Psoriasis dorsolumbar evolucionada: ¿anestesia regional o general? / Advanced dorsolumbar psoriasis: regional or general anaesthesia?

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[Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block]. / Control del dolor postoperatorio en artroplastia de rodilla: bloqueo del nervio femoral con dosis única frente a bloqueo femoral continuo.

INTRODUCTION: To compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement. MATERIAL AND METHODS: A prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6ml/h for 48h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48h after surgery. RESULTS: A total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose. CONCLUSIONS: The use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48h) compared to isolated femoral block.

Control del dolor postoperatorio en artroplastia de rodilla: bloqueo del nervio femoral con dosis única frente a bloqueo femoral continuo / Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block

Introducción. Comparar la eficacia de un régimen analgésico multimodal con 2 técnicas diferentes (bloqueo del nervio femoral con dosis única y bloqueo continuo del nervio femoral) en el control del dolor, consumo de opioides y efectos secundarios en pacientes intervenidos de artroplastia total de rodilla. Material y métodos. Estudio prospectivo aleatorizado, de pacientes intervenidos de prótesis de rodilla con anestesia subaracnoidea. La analgesia postoperatoria consistió en tramadol, dexketoprofeno y paracetamol, y una de las 2 técnicas siguientes: bloqueo del nervio femoral con dosis única de 30ml de ropivacaína 0,5% o la anterior dosis más perfusión continua por un catéter femoral de ropivacaína 0,375%, 6ml/h durante 48h. Se registraron las variables demográficas, anestésicas y quirúrgicas, intensidad del dolor según escala visual analógica, consumo de opiáceos y complicaciones a las 24 y 48h. Resultados. Se incluyeó a 104 pacientes. No hubo diferencias demográficas entre los grupos. La intensidad del dolor fue menor en el grupo en el que se realizó bloqueo femoral continuo, especialmente a las 48h, frente al bloqueo con dosis única, con menor consumo de analgesia de rescate en el bloqueo femoral continuo. La incidencia de efectos secundarios fue similar, observándose un menor bloqueo sensitivo de larga duración en el bloqueo femoral con dosis única. Conclusiones. El uso de los bloqueos nerviosos periféricos está aceptado para la analgesia postoperatoria de las artroplastias de las rodillas. El bloqueo femoral continuo es una alternativa válida disminuyendo el consumo de opiáceos de rescate y la intensidad del dolor (especialmente a las 48h) respecto al bloqueo femoral aislado(AU)

Introduction. To compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement. Material and methods. A prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6ml/h for 48h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48h after surgery. Results. A total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose. Conclusions. The use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48h) compared to isolated femoral block(AU)

Consideraciones anestésicas en la enfermedad de Charcot-MArie-Tooth / No disponible

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