Revista española de anestesiología y reanimación
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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.
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Rev Esp Anestesiol Reanim · Dec 2010
[Transcranial Doppler ultrasound, bispectral index, and electroencephalographic monitoring of entropy during pediatric total intravenous anesthesia].
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 anesthetized pediatric patients detected by pulsed Doppler ultrasound correlate with changes in the bispectral (BIS) index and electroencephalographic state and response entropy (ES and ER, respectively). ⋯ We report Doppler ultrasound patterns during anesthesia with propofol. Systems for monitoring hypnosis could be considered indirect measurements of cerebral blood flow; BIS measurements are more sensitive to flow 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
[Bringing clinical simulation into anesthesiology and postoperative recovery care residency training].
This article describes the use of clinical simulations for training residents in anesthesiology and postoperative recovery care at Hospital Universitario Marqués de Valdecilla. A working group defined criteria for the competencies residents would acquire by means of simulation training, designed the scenarios to be used, and took responsibility for coordinating and funding the program. We used the platform of the Critical Events Training Center of the Marcelino Botin Foundation, now part of our center's virtual hospital. ⋯ More studies are required to establish criteria to guide the integration of this tool into the curriculum in those areas of the specialty where it can work most efficiently; the effectiveness of the approach also needs to be assessed. Simulations facilitate training without putting patients at risk and provide residents with early exposure to situations that might otherwise be difficult to observe. This tool also encourages the practice of reflective clinical decision-making.