J. Álvarez Escudero

Utilidad del heliox en la obstrucción de vía aérea superior secundaria a disfunción bilateral de cuerdas vocales postiroidectomía

Resumen El helio es un gas noble que por su baja densidad disminuye la resistencia de la via aerea. Esta propiedad, empleando una mezcla de helio y oxigeno (heliox), permite que sea util en determinadas situaciones clinicas, especialmente en las obstrucciones de via aerea. Describimos el caso de una paciente que presento un cuadro de obstruccion grave de la via aerea superior debido a la paralisis bilateral de cuerdas vocales despues de una tiroidectomia. El heliox se uso temporalmente para disminuir el esfuerzo respiratorio y evitar la intubacion endotraqueal mientras mejoraba la obstruccion con antiinflamatorios.

Hemotórax masivo derecho por rotura espontánea idiopática de una arteria frénica tras cirugía cardiaca

We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery, from spontaneous rupture of a phrenic artery. A quick diagnosis and immediate intervention is crucial to manage the patient.

Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia

OBJECTIVES To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. MATERIAL AND METHODS Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. RESULTS The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. CONCLUSION Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist.

Análisis prospectivo de las complicaciones, eficacia y grado de satisfacción en la sedación realizada por anestesiólogos en endoscopia digestiva

OBJECTIVE To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. METHODS A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. RESULTS The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. CONCLUSION The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction.

Influencias de la anestesia y antisepsia sobre las primeras laparotomías ginecológicas. Notas históricas a propósito del 2° centenario de la introducción de la ovariectomía

Resumen Con motivo del segundo centenario de la primera ovariectomia, hemos realizado este trabajo con el proposito de revisar los comienzos de la cirugia ginecologica abdominal en Espana, a la vez que se pretende esclarecer algunos aspectos historicos que aparecen en nuestra historiografia medica no perfectamente claros y, muchas veces, tergiversados. Se analiza una importante bibliografia que nos permitio hacer un seguimiento a lo largo del ultimo cuarto del siglo XIX, proporcionandonos datos que consideramos definitivos y que confirmarian nuestras suposiciones iniciales. Se hace hincapie en la labor del Dr. Federico Rubio como iniciador en Espana de la operacion de la ovariectomia, asi como de las experiencias primeras de nuestros cirujanos; destacando la gran mortalidad de esta operacion durante estos primeros ensayos. Tambien se analizo el problema de la anestesia y de la antisepsia, y la influencia que ambas tuvieron sobre esta cirugia, resaltando la labor de un grupo de cirujanos de nueva mentalidad que con el auxilio de estos medios, lograron exitos notables en contraposicion a otros, que anclados en el pasado, escribian una pagina de mucho menos brillo en nuestra cirugia.