Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Nov 2010
Comparative Study Clinical Trial[Clinical validation of minimally invasive evaluation of systolic function].
Pulse contour continuous cardiac output (PiCCO) monitoring by means of transpulmonary thermodilution provides 2 indices of systolic function: the cardiac function index and the global ejection fraction. Our aim was to compare these 2 PiCCO indices to the left-ventricular ejection fraction obtained by transthoracic echocardiography. ⋯ In patients without marked changes in regional segment contractility, the global ejection fraction and the cardiac function index calculated by the PiCCO monitor offer a reliable and simple way to assess left-ventricular systolic function. Low values for these indicators suggest the need for echocardiographic assessment of left- and right-ventricular function.
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Physiologic balance between fluids and electrolytes should remain stable during the perioperative period. Gaps in our understanding of how this balance is maintained has given rise to inappropriate management practices. ⋯ There is currently renewed interest in studying the best use of fluids and/or blood products during and after surgery. This update of perioperative fluid therapy is based on a review of indexed literature retrieved by means of a PubMed search for the period of January 1999 through December 2009.
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Rev Esp Anestesiol Reanim · Nov 2010
[Respiratory failure from upper airway collapse following anterior cervical spine surgery].
To determine the frequencies of variables that might predispose to upper airway collapse in a series of patients undergoing anterior cervical spine surgery. ⋯ Upper airway obstruction after anterior cervical spine surgery is an unforeseen event and the emergency assessment of the airway may not coincide with the assessment of the anesthetist during the preanesthetic visit. This event may constitute an emergency for which preparation times and resources may differ from those available when this complication is foreseen. The problem for the anesthetist is not the impossibility of tracheal intubation but rather the difficulty of ventilating through a facial mask or supraglottic device, possibly with life-threatening consequences.
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Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. ⋯ Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a woman with resolving sepsis with renal and hepatic complications.