Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Dec 2010
Practice Guideline[Neuroanesthesia for embolization of a ruptured cerebral aneurysm: clinical practice guidelines].
When the neuroanesthesia working group of the Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor surveyed Spanish anesthesiologists to learn the degree of their involvement in the diagnosis and treatment of spontaneous subarachnoid hemorrhage, a surprising finding was that anesthetists did not participate in endovascular repair of intracranial aneurysms when the procedure was carried out in an interventional radiology department. These interventions, which are considered minimally invasive and are performed outside the operating room, are not risk-free. Based on the survey results and a systematic review of the literature, the working group has provided practice guidelines for the perioperative management of anesthesia for endovascular repair of ruptured cerebral aneurysms. In our opinion, the diversity of practice in the hospitals surveyed calls for the application of practice guidelines based on consensus if we are to reduce variability in clinical and anesthetic approaches as well as lower the rates of morbidity and mortality and shorten the hospital stay of patients undergoing exclusion of an aneurysm.
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Rev Esp Anestesiol Reanim · Dec 2010
[Transcranial Doppler ultrasound, bispectral index, and electroencephalographic monitoring of entropy during sevoflurane anesthesia in children].
Transcranial Doppler ultrasound is a noninvasive technique for monitoring the velocity of blood flow in the main intracranial arteries, particularly those in the circle of Willis. Our aim was to assess whether changes in cerebral arterial blood flow in pediatric patients under sevoflurane anesthesia demonstrated by pulsed Doppler ultrasound correlate with changes in the bispectral (BIS) index and electroencephalographic state and response entropy (ES and ER, respectively). ⋯ We show Doppler ultrasound patterns during anesthetic induction with sevoflurane. Systems for monitoring hypnosis could be considered indirect measurements of cerebral blood flow; BIS measurements are more sensitive to change. Transcranial Doppler ultrasound facilitates the observation of changes in blood flow that occur at different levels of hypnosis during anesthesia.
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Rev Esp Anestesiol Reanim · Dec 2010
Review[Hypotensive resuscitation of the polytrauma patient with hemorrhagic shock].
Hemorrhagic shock is a significant cause of death in hospital practice, yet the management of this event in the period prior to definitive surgical hemostasis has changed little in 40 years. Currently, the standard treatment of resuscitation by means of fluid therapy to re-establish normal pressure and volume is based on animal models from the 1950s and 1960s; these studies will be reviewed in this article. ⋯ Finally, we review clinical trials of hypotensive resuscitation in hemorrhagic shock as well as studies indirectly related to this management approach. We conclude that hypotensive resuscitation is a promising treatment for use in cases of hemorrhagic shock that occur either in or out of hospital; however, we believe that more trials should be done before it can be considered a standard treatment.
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Rev Esp Anestesiol Reanim · Dec 2010
Practice Guideline[Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].
The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. ⋯ Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.