Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · May 2020
Practical recommendations for the perioperative management of the patient with suspection or serious infection by coronavirus SARS-CoV.
In December 2019, the Wuhan Municipal Health and health Commission (Hubei Province, China) reported a series of cases of pneumonia of unknown etiology. On January 7, 2020, the Chinese authorities identified as a causative agent of the outbreak a new type of virus of the Coronaviridiae family, called SARS-CoV-2. ⋯ Infections in humans cause a broad clinical spectrum ranging from mild upper respiratory tract infection, to severe acute respiratory distress syndrome and sepsis. There is not specific treatment for SARS-CoV-2, which is why the fundamental aspects are to establish adequate prevention measures and support treatment and management of complications.
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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 · May 2020
Practice GuidelineClinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. ⋯ This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.