Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jun 2013
Review[Usefulness of haemoperfusion in the treatment of the severe septic patient: an update].
Haemoperfusion is an extracorporeal technique that removes endotoxin and/or inflammatory mediators by means of an adsorptive mechanism during the passage of the blood through a porous filter. Most of the studies in the literature use polymyxin B as the adsorptive agent. This treatment is based on the assumption that the removal of endotoxin and inflammatory mediators from the circulation attenuates the inflammatory response in sepsis. ⋯ Although most of the studies show positive results, some doubts have arisen about the suitability of the methods described (small number of cases, low quality of the experimental design, and excessive mortality in the control groups). There are also some inconsistencies regarding the theoretical basis of its use (lack of positive effects after the removal of endotoxin from the circulation using alternative mechanisms, discrepancies regarding the best moment to initiate the therapy, unexplained beneficial effects in the absence of increased endotoxin levels). It is the opinion of the authors that haemoperfusion represents a promising therapy for the treatment of sepsis, but consider that its usefulness requires confirmation in well designed studies before being included in protocols.
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Rev Esp Anestesiol Reanim · Jun 2013
Review[Total intravenous anaesthesia in geriatrics: the example of propofol].
The aim of this review is to analyse the changes in the pharmacology of the elderly patient using, as examples, the existing pharmacokinetics and pharmacodynamics models of propofol and data provided in the literature.
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Rev Esp Anestesiol Reanim · Jun 2013
Randomized Controlled Trial Comparative Study[Ultrasound-guided axillary block versus ultrasound-guided infraclavicular block for upper extremity surgery].
Most upper limb regional anaesthesia techniques are successful, and differences in efficacy should dictate the choice of technique. ⋯ We can conclude that compared to ultrasound-guided AB, ultrasound-guided IB provides a similar efficacy, a shorter onset time and longer lasting analgesia.
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Rev Esp Anestesiol Reanim · Jun 2013
[Bringing clinical simulation into an Anesthesia residency training program in a university hospital. Participants' acceptability assessment].
Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. ⋯ The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.
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Rev Esp Anestesiol Reanim · Jun 2013
[Description of the hemodynamic and respiratory effects of hemoperfusion treatment with polymyxin B in patients with abdominal septic shock].
The objective of this study is to describe the hemodynamic effects, inotropic and vasoactive drug dependence, and to analyze the PO2/FiO2 ratio in 13 patients with septic shock of abdominal origin after hemoperfusion treatment with polymyxin-B. Treatment with polymyxin hemoperfusion therapy is indicated for patients with severe sepsis/septic shock of abdominal origin who do not respond adequately to conventional therapy. ⋯ After treatment, the mean airway pressure (MAP) was increased (P=.003), the need for norepinephrine decreased (P=.003), and the PO2/FiO2 ratio increased (P=.02). The use of polymyxin hemoperfusion in patients with septic shock of intra-abdominal origin can significantly improve hemodynamic and respiratory functions.