J.M. Calvo Vecino

Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca

The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologists experience.

Is it time to integrate patient blood management in ERAS guidelines

i i R a The multidisciplinary perioperative approach as well as the anaesthetist role as a perioperative physician, has recently focused on the management of surgical patients in order to reduce post-operative complications and the hospital length of stay. The concept of Enhanced Recovery After Surgery (ERAS)1, or multimodal surgery, involves on the one hand the use of different strategies to reduce the psychological and physiological stress in order to reduce catabolism and, on the other hand, a set of measures to provide a more rapid and stress-free recovery free of complications, which in turn leads to a reduction in the length of stay. Preoperative anaemia is currently considered as a surrogate marker for any poor clinical basal conditions in surgical patients requiring correction, as far as possible, especially in scheduled surgical patients. In cancer patients, anaemia, often associated with hypoalbuminemia, subjects the patient to excessive surgical stress and an increase in negative immunological consequences involving transfusion2. Optimizing preoperative anaemia takes up minimal place in ERAS Guidelines1 with a moderate

Abstract PR617: Parameter Calculation Based On the Analysis of Plethismography Waveform

Background & Objectives: The main objective of this work was to develop a parameter able to predict the fluid responsiveness of a patients. The photoplethismographic (PPG) waveform was studied. This parameter would allow the early identification of alterations in the state of the patient that could result in severe injuries. Similarly to the Pleth Variability Index (1) (PVI), our gold standard, two new indexes were computed from the PPG waveform. These indexes were expected to be able to specify the degree of fluid responsiveness in mechanically ventilated patients.

Monitorización del consumo metabólico de oxígeno en anestesia pediátrica. Utilidad clínica

OBJECTIVES: To determine changes in oxygen consumption as a marker of energy metabolism during general inhaled anesthesia in pediatric patients and to identify factors that might influence consumption. MATERIAL AND METHODS: Prospective, observational, double-blind study in children under inhaled anesthesia in spontaneous ventilation. We monitored heart rate electrocardiogram, noninvasive blood pressure, respiratory frequency, carbon dioxide (CO2) end-expiratory pressure, oxygen saturation by pulse oximetry, state entropy, response entropy, esophageal temperature, and (by indirect calorimetry) oxygen consumption and the respiratory quotient. Capillary blood was extracted every 5 minutes to determine lactate concentration. RESULTS: Thirty-six patients (ASA 1-2) between 5 and 11 years old were included. Mean (SD) oxygen consumption was 0.6 (0.12) mL x kg(-1)min(-1) at baseline, 5.3 (03) mL x kg(-1) min(-1) during maintenance of anesthesia, and 8.1 (1.1) mL x kg(-1) min(-1) on awakening. A progressive increase was detected in lactic acid concentration, from a baseline mean of 0.8 (0.1) mmol/L to 2.2 (0.9) mmol/L half an hour later; the change was unrelated to oxygen consumption. After correcting the flow of normal saline solution to 0.9%, a significant increase in oxygen consumption (P 10% for each degree centigrade decrease), inspired oxygen fraction > 0.8; sharp changes in the expired CO2 fraction exceeding 2 standard deviations (+/- 6), use of nitrous oxide in the gas mix (inspired nitrous oxide fraction > 20%), the length of the sampling line, and increased respiratory frequency. A model with 3 factors was constructed to explain the kinetics of oxygen consumption during anesthesia. CONCLUSIONS: Oxygen consumption monitoring may provide an indirect indicator of homeostatic changes during surgery. The ideal system for carrying out such monitoring during anesthesia remains to be found, and the values to guide the anesthesiologist in deciding whether or not to intervene immediately still need to be determined.