Revista española de anestesiología y reanimación
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The treatment of thoracic or abdominal aorta aneurysms with endoprostheses or aortic stents consists of placing the stents within the aorta to exclude the aneurysm, followed by inflation of a balloon inserted through the vessel in order to fix the stent to the vascular walls. The procedure is minimally invasive, causes little pain, and is performed by femoral arteriotomy or puncture. Absolute immobility of the lower limbs is required if lesions are to be avoided and the duration can not be foreseen. ⋯ Postoperative recovery occurs in a special observation ward in the first few hours after surgery, with strict monitoring of diuresis and hydration. Analgesic requirements are minimal and intravenous metamizol or ketorolac are adequate. In conclusion, stent implant is a complex procedure in patients with severe associated disease who require strict and full monitoring during surgery and in the first few hours afterwards.
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The prevention of perioperative myocardial ischemia is one of the cornerstones of anesthetic techniques. From the perspective of anesthesiologists, the traditional relation between oxygen supply and demand is improved mainly by reducing demand. Cardiologists, however, look at the problem from the other side of the equation. ⋯ On the contrary, evidence suggests that infarction depends on changes in oxygen supply secondary to transient or permanent episodes of thrombotic vascular occlusion. Our data suggest that these thrombotic events are dependent on hypercoagulability. It may be that anesthesiologists should focus on preventing rupture of the atherosclerotic plaque or on examining changes in coagulation, given that such events might facilitate the appearance of thrombosis in coronary arteries with unstable plaques.
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The pathophysiology of acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema due to extravasation from capillary lesions in the endothelium. A clinical diagnosis is made when there is a predisposing cause (sepsis and pneumonia being the most common) that gives rise to acute respiratory insufficiency (PaO2/FiO2 ratio (3/4) 200 mmHg, bilateral infiltrates visible on a chest film and hemodynamic or other clinical signs of left cardiac insufficiency). Most patients require invasive support ventilation at a high FiO2 and positive end-expiratory pressure (PEEP). The only therapeutic approach available at this time associated with a highly significant decrease in mortality in patients with ARDS is ventilation at low flow volumes (6 ml/kg) and moderate levels of PEEP (approximately 10 cmH2O).
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Carotid endarterectomy can be performed under general or locoregional anesthesia. If locoregional anesthesia is chosen, the state of awareness of the patient allows for direct viewing of the effect of vascular clamping of the corresponding neurological territory. We present the results of an anesthetic procedure using only an analgesic in patients who were intubated and ventilated but with a level of consciousness that allowed us to view the effect of carotid clamping on motor functions. ⋯ An advantage of this technique is that the duration of anesthesia is not limited, with adequate ventilation and maintenance of an adequate state of consciousness for clinical evaluation of the repercussions of carotid clamping. Hemodynamic monitoring detected the appearance of imbalances requiring therapeutic intervention. The procedure is interesting provided it is performed according to a strict protocol, with continuous clinical and instrumental monitoring of the patient's status.