Revista española de anestesiología y reanimación
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The prevention of perioperative myocardial ischemia is one of the cornerstones of anesthetic techniques. From the perspective of anesthesiologists, the traditional relation between oxygen supply and demand is improved mainly by reducing demand. Cardiologists, however, look at the problem from the other side of the equation. ⋯ On the contrary, evidence suggests that infarction depends on changes in oxygen supply secondary to transient or permanent episodes of thrombotic vascular occlusion. Our data suggest that these thrombotic events are dependent on hypercoagulability. It may be that anesthesiologists should focus on preventing rupture of the atherosclerotic plaque or on examining changes in coagulation, given that such events might facilitate the appearance of thrombosis in coronary arteries with unstable plaques.
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The treatment of thoracic or abdominal aorta aneurysms with endoprostheses or aortic stents consists of placing the stents within the aorta to exclude the aneurysm, followed by inflation of a balloon inserted through the vessel in order to fix the stent to the vascular walls. The procedure is minimally invasive, causes little pain, and is performed by femoral arteriotomy or puncture. Absolute immobility of the lower limbs is required if lesions are to be avoided and the duration can not be foreseen. ⋯ Postoperative recovery occurs in a special observation ward in the first few hours after surgery, with strict monitoring of diuresis and hydration. Analgesic requirements are minimal and intravenous metamizol or ketorolac are adequate. In conclusion, stent implant is a complex procedure in patients with severe associated disease who require strict and full monitoring during surgery and in the first few hours afterwards.
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The pathophysiology of acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema due to extravasation from capillary lesions in the endothelium. A clinical diagnosis is made when there is a predisposing cause (sepsis and pneumonia being the most common) that gives rise to acute respiratory insufficiency (PaO2/FiO2 ratio (3/4) 200 mmHg, bilateral infiltrates visible on a chest film and hemodynamic or other clinical signs of left cardiac insufficiency). Most patients require invasive support ventilation at a high FiO2 and positive end-expiratory pressure (PEEP). The only therapeutic approach available at this time associated with a highly significant decrease in mortality in patients with ARDS is ventilation at low flow volumes (6 ml/kg) and moderate levels of PEEP (approximately 10 cmH2O).
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Rev Esp Anestesiol Reanim · Jun 2001
Review[Drugs that alter hemostasis and regional anesthetic techniques: safety guidelines. Consensus conference].
Patients about to undergo surgery are often taking drugs that alter hemostasis and affect anesthesia, particularly when neuroaxial techniques are used for subarachnoid or epidural anesthesia. The aim of this paper is to provide safety guidelines for regional anesthesia in patients receiving hemostasis-altering drugs, in order to reduce the risk of bleeding. ⋯ We also stress that removal of catheters should follow criteria similar to those listed above, that the risk of complications due to bleeding increases considerably in association with these drugs, and that adequate neurological monitoring is essential during postoperative recovery. Overall, the final decision to use regional anesthesia in patients receiving drugs that alter hemostasis must be made on an individual basis after assessment of benefit and risk.