Bataller, A.; Gomez, E. L.; Benet, J.; Roigé, J.; Bisbe, E.; Arimany, J. Author Information

BACKGROUND:Nonagenarian population is growing, and so is the number of them needing emergency surgery. Yet, their treatment is often based on the outcomes of younger patients: although old age is known to be a risk factor for surgery, its level is not clear. This is a prospective, observational study to describe the population. It is aimed at providing quantified scientific evidence of the current procedures and their outcomes.METHODS:All non-traumatic nonagenarians who underwent surgery between July 2006 and September 2010 in our University Hospital were recruited and followed up over a month after discharge. A descriptive statistical analysis was performed.RESULTS:Of the approximately 12 660 surgical emergencies, 102 were nonagenarians: 69.6% were women, who mostly had an ASA score III (62.7%). Perioperative morbidity and mortality rates of 61.6% [95% confidence interval (CI): 52.33-71.19%] and 35.3% (95% CI: 26.01-44.57%), respectively, were found statistically associated with preoperative neoplasms. The most frequent causes of surgery were acute limb arterial thrombosis (20), incarcerated hernia (17), and bowel occlusion (14). Confusion, renal failure, and abdominal problems accounted for the most frequent causes of morbidity. Among them, abdominal complications, cardiogenic pulmonary oedema, aspiration, stroke, and renal failure were associated with mortality.CONCLUSIONS:The study gave scientific support and actual figures to many intuitive beliefs: morbidity and mortality are high and are associated with many preoperative comorbidities. All this, combined with an already reduced life expectancy, and a presumably low physiological reserve makes these patients particularly vulnerable to emergency surgery.

s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Transfusion and Haemostasis

BACKGROUND AND OBJECTIVE: Neuromuscular blockers (NMBs) have traditionally been thought to increase the risk of respiratory complications, although drawing conclusions in this respect would require complex studies in large patient samples. The aim of this study was to analyze data from the ARISCAT study to obtain an overall picture of how NMBs are being used and blocks are reversed in Catalonia, Spain.MATERIAL AND METHODS: NMB use as reflected in data from the ARISCAT study was analyzed. Case information from the database was organized into 4 groups: for patients not receiving a NMB (No-NMB), patients whose NMB block was performed with succinylcholine alone (SC), patients who received a single dose of a nondepolarizing NMB (SD-NMB), and patients who received additional doses of a nondepolarizing NMB or a continuous perfusion (AD-NMB). We analyzed patient characteristics, clinical and surgical characteristics, and complications during and after surgery in each of the groups. Variables were also analyzed according to whether the NMB effect had to be reversed.RESULTS: Of the 2991 patients included in the ARISCAT study, 1545 received general or combined anesthesia. Of the 1545 patients, 1267 (89%) received a NMB and the block was reversed with an anticholinesterase agent in 54%. The group distribution was as follows: No-NMB, 103 patients; SC, 31; SD-NMB, 527; and AD-NMB, 709. The highest rate of comorbidity, longest duration of surgery, highest rate of complications during and after surgery, and the longest hospital stays were observed in the last of the 4 groups (AD-NMB). Reversion was required significantly more often after cardiothoracic and upper abdominal surgical procedures; the complication rates after those 2 types of surgery were statistically similar.CONCLUSIONS: Nondepolarizing NMBs are used in combination with general anesthesia often in Catalonia; their use is associated with duration and type of surgery. A reversal drug is administered relatively more often in Catalonia than in other geographic areas.

BACKGROUND AND OBJECTIVE:Neuromuscular blockers (NMBs) have traditionally been thought to increase the risk of respiratory complications, although drawing conclusions in this respect would require complex studies in large patient samples. The aim of this study was to analyze data from the ARISCAT study to obtain an overall picture of how NMBs are being used and blocks are reversed in Catalonia, Spain.MATERIAL AND METHODS:NMB use as reflected in data from the ARISCAT study was analyzed. Case information from the database was organized into 4 groups: for patients not receiving a NMB (No-NMB), patients whose NMB block was performed with succinylcholine alone (SC), patients who received a single dose of a nondepolarizing NMB (SD-NMB), and patients who received additional doses of a nondepolarizing NMB or a continuous perfusion (AD-NMB). We analyzed patient characteristics, clinical and surgical characteristics, and complications during and after surgery in each of the groups. Variables were also analyzed according to whether the NMB effect had to be reversed.RESULTS:Of the 2991 patients included in the ARISCAT study, 1545 received general or combined anesthesia. Of the 1545 patients, 1267 (89%) received a NMB and the block was reversed with an anticholinesterase agent in 54%. The group distribution was as follows: No-NMB, 103 patients; SC, 31; SD-NMB, 527; and AD-NMB, 709. The highest rate of comorbidity, longest duration of surgery, highest rate of complications during and after surgery, and the longest hospital stays were observed in the last of the 4 groups (AD-NMB). Reversion was required significantly more often after cardiothoracic and upper abdominal surgical procedures; the complication rates after those 2 types of surgery were statistically similar.CONCLUSIONS:Nondepolarizing NMBs are used in combination with general anesthesia often in Catalonia; their use is associated with duration and type of surgery. A reversal drug is administered relatively more often in Catalonia than in other geographic areas.

Advances in prenatal diagnosis and surgical techniques have resulted in an increasing number of fetal interventions. 1 Sydorak R.M. Hedrick M.H. Longaker M.T. Albanese C.T. Pathophysiologic patterns influencing fetal surgery. World J Surg. 2003; 27: 45-53 Crossref PubMed Scopus (4) Google Scholar We describe a fetoscopic cord occlusion procedure performed in a twin pregnancy that resulted in acute hemorrhage and the need for intrauterine fetal resuscitation.

Bone echinococcosis affects the spine and pelvis in 60% of cases. Bone lesions may be silent for between 10 and 20 years. The capsules progress aggressively through the medullary canal and replace the trabecular bone without forming cysts, as occurs in the organs, thus making anaplylaxis rare. The combination of chemotherapy and surgery facilitates anesthetic management and reduces the incidence of anaphylactic events and disease recurrence.

Bone echinococcosis affects the spine and pelvis in 60% of cases. Bone lesions may be silent for between 10 and 20 years. The capsules progress aggressively through the medullary canal and replace the trabecular bone without forming cysts, as occurs in the organs, thus making anaplylaxis rare. The combination of chemotherapy and surgery facilitates anesthetic management and reduces the incidence of anaphylactic events and disease recurrence.

OBJECTIVES To evaluate survival and lung growth in fetuses with severe congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO) compared with control fetuses and to analyze possible complications of the anesthetic techniques used. PATIENTS AND METHODS This prospective study was performed on fetuses with CDH. FETO was undertaken before the 29th week of gestation on fetuses with a lung-to-head ratio (LHR) less than 1. FETO was not performed on fetuses with an LHR between 1.0 and 1.5 or those with an LHR less than 1 where consent was not given. Lung growth was monitored by means of LHR. FETO was performed under fetal intramuscular anesthesia and maternal epidural anesthesia and sedation with remifentanil. RESULTS Seventeen fetuses were included in the study. FETO was performed on 11 fetuses and was effective in 9. The median percentage difference between LHR at diagnosis and prior to FETO was 1.15% (P=.183); between diagnosis and before removing the balloon, the difference was 130.5% (P=.003); and between diagnosis and before delivery, 90.18% (P=.003). In the control group (n=6), the median percentage difference between LHR at diagnosis and before delivery was 49.25% (P=.028). No significant hemodynamic or respiratory changes occurred in either mother or fetus during fetoscopy. All the fetuses in the control group died; 45.5% of those in the FETO group survived. CONCLUSIONS The use of FETO in cases of CDH appears to increase survival and lung growth. Fetal anesthesia in association with maternal epidural anesthesia and sedation makes it possible to place and remove the endotracheal balloon via fetoscopy with acceptable maternal comfort and without notable complications.

preanesthesia (the only -2 agonist locally available at the moment) was compared to placebo. Materials and Methods: Two equivalent groups of 40 patients (ASA I–III) were randomised to receive Diazepam in the evening before and oral Clonidine 150 g or placebo in the morning of the surgery. They have received equivalent ballanced general anesthesia for medium amplitude abdominal procedures. Intraand postoperative haemodynamic was assesed, as well as opiod consumption during surgery, opioid antagonisation at emergence. Anxiety, sedation, postoperatory respiratory depression and analgesia were quantified at 5 min postoperatory, at 1 h, then each 3 h until 24 h. Patients’ satisfaction (pain control, side effects) was assesed by a self-administred questionnaire in day 4. The statistic significance of the differences observed in the evolution of these parameters was tested by T Student test. Results and Discussions: Haemodynamic was better in the Clonidine group (variation greater than 20% for arterial pressure and heart rate at induction and during surgery for placebo group, p 0.05). This was even stronger for hypertensive patients. Opioid consumption reported to the duration of the intervention was comparable in the two groups Sedation and respiratory depression was slightly higher in the Clonidine group during the first 12 hours (p 0.05), Analgetic consumption was not statistically different in the two groups, as well as the pain control, Postoperative satisfaction (pain control, sedation, other side effects) was equivalent in the two groups. Conclusion(s): Clonidine premedication for moderate amplitude abdominal surgery ensures a better haemodynamic both intraand postoperatively, with minor side effects concearning sedation and respiratory depression. References: Bonnet F, Houhou A, Aveline C, ESA Refresher Courses 2000. Foëx P, Sear JW Continuing Education in Anaesthesia, Critical Care & Pain 2004 4(5): 139–143. 182 Education, research and presentation

Manrique, S.; Munar, F.; Andreu, E.; Paños, M. L.; Peiró, J. L.; Montferrer, N.; Hervás, C.; Roigé, J. Author Information

Fundamento y objetivo Analizar las caracteristicas de los pacientes que recibieron anestesia para intervenciones quirurgicas en el ano 2003 en Cataluna (Espana). Pacientes y metodo De los datos obtenidos en la encuesta ANESCAT, realizada en 131 hospitales de Cataluna en el ano 2003, describimos la actividad anestesica para especialidades quirurgicas, excluyendo la realizada para obstetricia y procedimientos no quirurgicos. Se describen los datos globales de todas las anestesias y las realizadas para cada especialidad quirurgica. Los resultados se expresan en mediana y percentiles del 10-90%. Resultados La anestesia quirurgica represento el 78,4% de toda la actividad anestesica, con una estimacion anual de 472.857 anestesias. Las especialidades quirurgicas con mayor frecuencia fueron la cirugia ortopedica y traumatologia (23,8%), la oftalmologia (20,2%), la cirugia general y digestiva (18,9%) y la ginecologia (9,7%). La duracion mediana (percentiles 10-90) de las intervenciones quirurgicas fue de 60 (25-165) min. El estado fisico de los pacientes, segun la clasificacion de la American Society of Anesthesiologists (ASA) fue: ASA 1 el 37,9%, ASA 2 el 32,5%, ASA 3 el 23,9% y ASA 4 o superior el 5,7%. La edad mediana de los pacientes fue de 52 (21-78) anos. El 33,6% de estos procedimientos fueron ambulatorios y el 9,2% ingreso en unidades de cuidados criticos postoperatorios. El procedimiento mas frecuente fue la cirugia de cataratas (estimacion de 76.963 casos), seguida por la herniorrafia inguinal (23.315). Los centros publicos realizaron el 74,4% del total de las anestesias, y la oftalmologia y la cirugia plastica fueron las mas frecuentes en los centros privados. Conclusiones Tres de cada 4 anestesias administradas en Cataluna en 2003 fue para procedimientos quirurgicos, una de cada 3 se realize en regimen ambulatorio y casi uno de cada 10 pacientes requirio cuidados criticos postoperatorios.

de Nadal, M.; Mateu, I.; Ruiz, J C.; Bonet, M.; Bóveda, J L.; de Latorre, F J.; Roigé, J. Author Information

Lacasta, A.; Coll, I.; Rochera, M. I.; Gonzalez, A.; Martinez, O.; Fabregas, I.; Roigé, J. Author Information