Revista española de anestesiología y reanimación
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Postoperative hypertension (HT) is defined as a significant rise in blood pressure (BP) during the immediate postoperative period that can lead to serious neurological, cardiovascular or surgical complications requiring urgent management. In non-cardiac surgery, HT is common and leads to an increase in adverse events, including stroke, injury and myocardial infarction, and bleeding. In certain procedures, such as carotid endarterectomy, aortic aneurysm surgery or intracranial surgery, postoperative HT has specific considerations not present in other surgeries and may be associated with worse neurological outcomes. ⋯ The use of oral medication in the postoperative period may be limited by the circumstances of the surgery, but also by the slow onset of action of the drugs and the difficulty of controlling the degree of pressure drop. If oral administration of medication is not feasible, we recommend the use of short-acting intravenous drugs. The choice of antihypertensive drug will depend on the clinical situation and conditions of the patient, and should take into account the pharmacokinetic and pharmacodynamic parameters of the different agents available.
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Rev Esp Anestesiol Reanim · Mar 2020
Case ReportsBilateral erector spinae plane block for scoliosis surgery: Case series.
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. ⋯ Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity.
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Rev Esp Anestesiol Reanim · Feb 2020
Comparative Study Observational StudyComparison of peribulbar block and general anaesthesia in mechanical vitrectomy: a prospective observational study.
Vitrectomy surgery is a common procedure for the treatment of several types of ophthalmologic conditions. It can be performed under regional anaesthesia with peribulbar block (PB) or general anaesthesia (GA). There are no evidence-based recommendations on the optimal anaesthesia strategy for this procedure. The aim of this study was to compare the advantages of PB and GA for vitrectomy surgery. ⋯ We included 179 patients submitted for mechanical vitrectomy: 91 (51%) with PB and 88 (49%) under GA. Patients submitted to PB were older (69.0 vs. 64.5 years, p=.006) and presented with higher ASA physical status (p=.001). For haemodynamic outcomes, patients submitted to PB presented with less variation of median arterial pressure (-3.0 vs. -13.5mmHg, p=.000) and with no significant differences in heart rate (-2.0 vs. -3.0 bpm, p=.825). In the postoperative period, the PB group presented with decreased need of postoperative analgesia (0.0 vs. 5.0, p=.026) and a lower incidence of nausea and vomiting (1.0 vs. 12.0, p=.001). Times related to anaesthesia and surgery were better in PB group, with shorter induction time (10.0 vs. 11.0min, p=.000), surgery time (56.5 vs. 62.0min, p=.001), recovery time (10.0 vs. 75.5min, p=.000), and hospital stay (2.0 vs. 3.0 days, p=.000). When analysing costs, PB was less expensive than GA (4.65 vs. 12.09 euros, p=.021) CONCLUSION: PB is a reliable and safe alternative to GA for patients undergoing mechanical vitrectomy, permitting good anaesthesia and akinesia conditions during surgery, better haemodynamic stability, and less postoperative complications, especially in older patients and those with more comorbidities.
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Rev Esp Anestesiol Reanim · Feb 2020
Strong opioids and non-cancer chronic pain in Catalonia. An analysis of the family physicians prescription patterns.
To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. ⋯ Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units.
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Rev Esp Anestesiol Reanim · Dec 2019
Case ReportsL4 erector spinal plane block after lumbar spine arthrodesi: A case-series.
Thoracic erector spinae plane block is now performed in many different surgical procedures, including lumbar spinal fusion. We evaluated the analgesic effect of lumbar ESP performed at L4 after lumbar spinal fusion surgery. ⋯ Lumbar ESP appears to contribute to pain control during the first 48hours after lumbar spinal fusion.