fernando gilsanz - Academia.edu (original) (raw)
Papers by fernando gilsanz
Intracranial Pressure VII, 1989
High-frequency ventilation (HFV) has lesser hemodynamic repercussions and lower risk of barotraum... more High-frequency ventilation (HFV) has lesser hemodynamic repercussions and lower risk of barotrauma production, although it does not seem to affect the mean intracranial pressure (ICP) (Babinski et al. 1984). This fact, however, does not preclude a beneficial effect of HFV on the intracranial dynamic state.
European Journal of Anaesthesiology, 2014
Background and Goal of Study: The Burnout Syndrome (BS) is preconditioned by demographics, econom... more Background and Goal of Study: The Burnout Syndrome (BS) is preconditioned by demographics, economics, social and professional factors af fecting in general medical doctors and particularly medical trainees. The aim of this study was to evaluate the BS prevalence evolution among Catalan residents of Anaesthesiology over the last 2 years. Materials and methods: This is an observational, cross-sectional and prospective study of Anaesthesiology residents performing their training during the academic years 2012-2013 and 2013-2014 in Catalonia. The survey was carried out during theoretical classes of fered by the Catalan Society of Anaesthesiology, mostly visited by first (R1), second (R2) and third (R3) year residents. Social-demographics recorded were: gender, age, single or not, with children or not, salary, number of working hours/week, on-call shif ts/month. The anonymous and voluntary Maslach Burnout Inventory questionnaire was used for the analysis of motional exhaustion, depersonalization and personal accomplishment. According to definition, BS is present when the questionnaire final score has more than 26 points for emotional exhaustion and more than 9 points for depersonalization. Statistical analysis was performed with SPSS®. Data are presented as percentages or absolute numbers; p < 0.05 was considered to be significant. Results and discussion: 154 Catalan residents answered the questionnaire in 2012-2013 (response rate 61.6%) and 110 in 2013-2014 (response rate 45.08%). There were no significant dif ferences in social-demographics among groups. During the last 2 years the more years of residency they had, the more BS was significantly present (2012: p=0.00595 and 2013: p=0.00277). Comparing both academic years, we observed less prevalence of BS in 2013-2014 without statistical significance (see table1).
European Journal of Anaesthesiology, 2013
Background and Goal of Study: Postoperative pain relief is one of major concerns for patients und... more Background and Goal of Study: Postoperative pain relief is one of major concerns for patients undergoing cardiac surgery. The objective of this study was to determine the incidence and risk factors of moderate to severe pain and analgesicrelated side ef fects in adult during 24 hours following cardiac surgery. Materials and Methods: We conducted a retrospective cohort of patients aged >18 years who underwent median sternotomy for elective cardiac surgery at Chiang Mai University Hospital from January 1, 2008 to December 31, 2010. Pain intensity was assessed by a numeric rating scale(NRS) every 2 hours postoperatively. Demographic data, type of operation (coronary bypass graf t, valve surgery), duration of surgery and side ef fects including nausea, vomiting, sedation score >3 and respiratory rate < 10 /min were recorded. Results and Discussion: Two thousand and fif ty four patients were included in this study. Morphine infusion at dose 1-2 mg/hr and fentanyl infusion at dose 10-20 μg/hr were used in 97% and 3% of patients, respectively. A small bolus dose of opioids was prescribed for supplement when patient had moderate to severe pain. Incidence of moderate to severe pain was 40.2%, 41.3%, 36% and 23.2% at 6, 12, 18 and 24 hour postoperatively. Among factors including age group, gender, type of operation and duration of surgery, only young age group (18-40 years) was the risk factor of developing moderate to severe pain (RR=1.51; 95%CI: 1.06-1.38). Only 58%, 65% and 42% of patients who had moderate to severe pain received bolus dose at 6, 12 and 18 hour postoperatively. Nausea and /or vomiting, sedation score >3 and respiratory rate < 10 /min occurred in 31.6%, 1.2% and 1.9% of patients, respectively. Respiratory depression significantly occurred in patient aged > 50 years. Conclusion(s): Postoperative pain management af ter adult cardiac surgery provided suf ficient analgesia for only about 60%. Prophylactic antiemetic, frequent assessment, patient controlled analgesia technique, adequate monitoring respiratory depression could improve the quality of pain control and minimize side ef fects. 14AP8-10
Revista española de anestesiología y reanimación
European Journal of Anaesthesiology, 2014
Minerva anestesiologica
To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine p... more To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine plus fentanyl in patients undergoing lower limb surgery. A single blind, randomised, prospective, multicentre study was designed to compare both therapies. The study was conducted in 10 tertiary hospitals. A total of 96 patients who were ASA I or II, who required at least a 24-hour-stay in the hospital and who were subjected to surgery of lower limbs with epidural anaesthesia were enrolled in this study. Treatments were administered at a dosage of 1.2 ml per metamera,including a test dose (3 mL) and the dose of fentanyl (100 mg). Patients were then randomly allocated to receive either Levobupivacaine (n = 49) or bupivacaine (N.= 47). The primary endpoint was sensory blockade (SB) duration. Secondary evaluations included motor blockade (MB), post-surgery analgesic medication usage, safety and the investigator global evaluation. SB duration was similar for both interventions: 195 min (165-2...
European Journal of Anaesthesiology, 2013
Background: Inotropic drugs are part of the treatment of heart failure; however, inotropic treatm... more Background: Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse ef fects and increased mortality. Recently, levosimendan has been proved to be ef fective in acute heart failure, reducing the mortality and improving cardiac and renal performance. Case report: We report the case of a 75-year-old woman with history of hypertension, chronic atrial fibrillation and congestive heart failure with baseline LVEF of 30%, an episode of pulmonary embolism in 2004, chronic renal failure (baseline creatinine 2,2 mg/mL), obstructive sleep apnea-syndrome associated with morbid obesity, and dyslipidaemia. She was admit ted to the emergency department due to an accidental fall with pertrochanteric fracture of the right femur. During the preoperative stay she developed a cardiogenic shock complicated with acute renal failure; renal replacement therapy was started with continuous veno-venous hemofiltration. In order to optimize the patient and improve kidney function, it was decided to start a treatment with levosimendan at 0,05 mcg/kg/min, avoiding the induction bolus and gradually increasing the dose up to 0,1 mcg/kg/min, according to the haemodynamic response and the tolerance of the patient. The treatment proved to be ef fective and the patient was successfully withdrawn from renal replacement and was lately submit ted to the intervention. She was largely transfused perioperatively (up to six times) but she did not develop any new episode of cardiac failure. Discussion: Levosimendan may constitute a valid choice to be considered in the management of preoperative decompensated heart failure associated with renal insuf ficiency. The main property of the drug allowed to restore renal function and to prepare the patient for the intervention. Moreover, the new equilibrium, between increased cardiac function and beneficial vasodilation, revealed helpful during and af ter intervention because it allowed the cardiovascular system of our patient to deal with the consequences of haemorrhage and fluid therapy. References: Davis et al. Br J Anaesth 2004; 93: 121±8 Learning points: The role of inotropes in optimization of high-risk surgical patients may encompass other factors apart from an increase in oxygen transport variables. Levosimendan may have promising ef fects for perioperative cardiac and renal function optimisation in patients undergoing elective noncardiac surgery. 18AP2-9
Revista de la Sociedad Española del Dolor
Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.... more Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.92%. Neurological damage secondary to epidural technique is about 2:10,000. In last years, epidural anesthesia has become a generalized practice in obstetrics. Because of it, sometimes, the postpartum neurological damage can be attributed to epidural analgesia, forgetting other mechanisms. We present a 21 years old patient, 139 cm height, who 24 hours after epidural labor analgesia suffered a "drop foot", whose evolution was toward a complete resolution. Drop foot can be consequence of peroneal nerve, sciatic or lumbar or radicular damage. Clinical evolution, and complementary studies, such as RNM or EMG are useful for differential diagnosis. It looks necessary to study peripartum peripheric neuropathies to discard its possible relation to anesthetic technique. These lesions should be minimized by our side with adequate punction level choose, avoiding direct local anesthetic injection, especially when a paresthesias occurs, and with a correct risk factors evaluation in the obstetric patient. Once the lesion has occurred, it is important a close follow up until the complete resolution. © Sociedad Española del Dolor. Published by SED.
European Journal of Anaesthesiology, 2014
Background: Mothers of Africa (MOA) is a UK based medical educational charity that aims to reduce... more Background: Mothers of Africa (MOA) is a UK based medical educational charity that aims to reduce maternal deaths in sub-Saharan African countries including Liberia, by supporting the training of local healthcare professionals. Approximately 70% of emergency surgical workload in Liberia is obstetric and the maternal mortality ratio (MMR) is 770 per 100,000 live births [1]. MOA's experience and a previous study in the resource poor set ting show that 80% of maternal deaths occur during the post-operative period [2]. The 3-day BASIC DHS course (Basic Assessment and Support of Seriously Ill Patients in Developing Healthcare Systems) has been developed to improve care of such patients and others who are critically ill. In 2013 2 pilot courses ran in Liberia. Goal of Study: To aid development of the BASIC DHS course by assessing 1) The quality, usefulness and appropriateness of knowledge and skills delivered 2) The preferred teaching method 3) The ef fect on motivation to improve local services/care delivery 4) The ef fect on the confidence of healthcare providers in managing acutely unwell patients. Method: Follow-up questionnaire from 12 former delegates (doctors and nurse anaesthetists). Results and discussion: A 100% follow-up rate was achieved. 100% of participants reported changes to their clinical practice, with all giving examples of improved care. 83% reported positive changes within their departments and 58% reported developing new department protocols and guidelines as a result of the course. 100% felt more empowered in their workplace and 92% reported improvements in interactions with colleagues. The majority wanted a longer course with more time for skills stations and interactive discussions. The participant's average confidence rating in managing critically ill patients improved rom 6.3 out of 10 pre-course to 9.25 out of 10 post-course. Conclusion: This pilot of the BASIC DHS course in Liberia has been well received with subjective evidence of empowerment and improved ways of working. The Liberians themselves will drive forward improvements in the course supported by MOA. Further objective evidence is required to demonstrate impacts on patient outcomes but initial results from the pilots are promising. References:
Revista española de anestesiología y reanimación, 2012
Mujer de 27 anos en tratamiento con 12.500 UI de dalteparina sodica desde la semana 28 de gestaci... more Mujer de 27 anos en tratamiento con 12.500 UI de dalteparina sodica desde la semana 28 de gestacion (embarazo gemelar), por trombosis venosa profunda (TVP) en vena femoral e iliaca izquierda. En la semana 36 se indico la colocacion de un filtro de cava (fig. 1) al objetivarse la obstruccion de la vena femoral comun izquierda por un trombo de 18 mm de diametro, tras lo cual se realizo cesarea con anestesia general sin incidencias. En el postoperatorio inmediato se reinicio el tratamiento con heparina de bajo peso molecular y 5 dias despues se retiro el filtro de cava. En este caso, la decision de terminar la gestacion por cesarea se baso en la existencia de un embarazo gemelar casi a termino y en la persistencia de la TVP a pesar del tratamiento. Dado que la terapia anticoagulante con heparina durante 8 semanas no fue suficiente, y para reducir la posibilidad de desprendimiento del trombo durante la cesarea, se inserto el filtro de cava previo a la realizacion de la cesarea como prevencion del tromboembolismo pulmonar.
Revista Española de Anestesiología y Reanimación, 2011
European Journal of Anaesthesiology, 2014
Revista Española de Anestesiología y Reanimación, 2008
European Journal of Anaesthesiology, 2013
Anaesthesia, 1983
A cnse is presented of phaeoc~hromocytomu with cuteuholumine-induced cardiomyopath). The dlfecult... more A cnse is presented of phaeoc~hromocytomu with cuteuholumine-induced cardiomyopath). The dlfeculties in the rnanugenient when left ventricuiar failure occurred are reported and the importance of nionitoring pulmonary artery pressure during the unaesthetic procedure is strrssed.
Revista Española de Anestesiología y Reanimación (English Edition), 2020
Objective: Publications of diverse medical specialties confirm that gender differences still exis... more Objective: Publications of diverse medical specialties confirm that gender differences still exist in the medical field. This particular study aims to investigate whether this problem exists in the specialty of Anaesthesiology in Spain. Methods: An anonymous survey was distributed among anaesthesiologists in Spain. It had 39 questions and was designed to investigate professional position, work conditions, personal situation, and individual perceptions. The goal was to target the majority of anaesthesiologists working in Spain. Results: Completed surveys were received from 1619 respondents which represents 17.6% of the total number of anaesthesiologists in Spain; 654 respondents were male (40.4%) and 965 were female (59.6%). The greater differences were found in the following areas: 70.0% of the respondents advised that their head of department is male. When asked about management and leadership positions, 25.2% of female respondents had ever had any management role in contrast to 46.1 % of men (p < 0.001). Regarding academic positions, 10.3% of male respondents are university professors in contrast to only 4.8% of women (p < 0.001). 46.0% of the women surveyed believe that gender discrimination exists in the workplace whereas only 12.6% of men reported the same. A third of women (36.6%) consider their gender a barrier to promotion and fear losing their job due to pregnancy. Furthermore, both genders have witnessed patients and colleagues treating staff differently according to gender.
Revista española de anestesiología y reanimación, 2005
Summary Little is known of the effect on oocytes of anesthesia administered during retrieval. The... more Summary Little is known of the effect on oocytes of anesthesia administered during retrieval. The main objective of this study was to compare the prolactin and stress hormone responses to surgical stimulus under 4 anesthetic techniques and to determine whether there is an effect of technique on the number and quality of oocytes retrieved. METHODS: We designed a clinical trial to determine the plasma and follicular levels of prolactin and cortisol in patients in an assisted reproduction program. The patients were randomized to 3 anesthetic groups: general anesthesia, spinal anesthesia, or sedation with alfentanil and midazolam plus paracervical block. Patients were consecutively assigned to the fourth group to receive sedation with remifentanil plus paracervical block. RESULTS: We studied 90 patients. The patients receiving general anesthesia had the greatest increase in prolactin by the end of the procedure. Follicular cortisol increased in the paracervical block group in which remi...
European Journal of Anaesthesiology, 2014
ent the part1 exam for the first time the same year (50-90%), with no changes between years (p=0,... more ent the part1 exam for the first time the same year (50-90%), with no changes between years (p=0,11 and 0,472 respectively). In 2011, their main objective was to pass EDA-1, while in 2012 and 2013 they were more interested in testing their theorical knowledge (p< 0,001). Candidates aspired to a planification of revisions (38-65,6%), a training with mocks of the exam (17,8-22%) and an orientative the study plan (8-15,6%). The interest for a planification of revisions and an orientative study plan increased through the years (p=0,001). Conclusion(s): This survey permit ted to assess the changes of expectations of future candidates to the EDAIC, and to orientate future editions of the training program towards organizational outcomes for a bet ter preparation of the exam.
Revista Española de Anestesiología y Reanimación, 2011
ABSTRACT Objectives To determine the difference between the estimated and measured values of the ... more ABSTRACT Objectives To determine the difference between the estimated and measured values of the left lateral decubitus (LLD) angle in the positioning of patients for scheduled cesarean section; to determine whether the accuracy of estimates differs between staff anesthesiologists and residents; and to assess the angle estimates of midwives and surgical nurses as well as their level of knowledge with respect to the utility of the LLD position.Methods This was a prospective, observational, double-blind study comparing staff anesthesiologists working in obstetrics to residents in their second, third, or fourth-year of training. We also presented a task and questions to midwives and surgical nurses who assisted during categories 3 and 4 cesarean sections (elective and scheduled procedures) according to the classification system of he National Institute of Clinical Excellence. The anesthesiologist was asked to place the patient in LLD position after onset of anesthesia and to estimate the LLD angle. A second anesthesiologist measured the angle. The midwives and nurses were asked to place a vacant surgical table at approximately 15°; the angle was then measured. Patient variables (weight, height, anesthetic technique) and staff variables (position, understanding of the purpose of the maneuver, estimated DLL angle, and measured angle) were recorded.ResultsOf 55 women who underwent cesarean sections (98.18% under regional anesthesia), 25 were assessed by staff anesthesiologists and 30 by residents. A total of 14 midwives and 10 surgical nurses participated in the surgical table positioning task and answered questions. The mean (SD) DLL angle estimate of the anesthesiologists was 12.4° (3.4°); the mean measured angle was 7.8° (3.1°). The estimates of staff anesthesiologists were significantly more accurate (P < .001). All the midwives understood the reason for using the DLL position in cesarean section, while only 1 nurse (10%) did (P < .05).Conclusion The DLL position angle is overestimated by resident anesthesiologists and midwives. It seems that the use and understanding of DLL positioning could be improved.
Intracranial Pressure VII, 1989
High-frequency ventilation (HFV) has lesser hemodynamic repercussions and lower risk of barotraum... more High-frequency ventilation (HFV) has lesser hemodynamic repercussions and lower risk of barotrauma production, although it does not seem to affect the mean intracranial pressure (ICP) (Babinski et al. 1984). This fact, however, does not preclude a beneficial effect of HFV on the intracranial dynamic state.
European Journal of Anaesthesiology, 2014
Background and Goal of Study: The Burnout Syndrome (BS) is preconditioned by demographics, econom... more Background and Goal of Study: The Burnout Syndrome (BS) is preconditioned by demographics, economics, social and professional factors af fecting in general medical doctors and particularly medical trainees. The aim of this study was to evaluate the BS prevalence evolution among Catalan residents of Anaesthesiology over the last 2 years. Materials and methods: This is an observational, cross-sectional and prospective study of Anaesthesiology residents performing their training during the academic years 2012-2013 and 2013-2014 in Catalonia. The survey was carried out during theoretical classes of fered by the Catalan Society of Anaesthesiology, mostly visited by first (R1), second (R2) and third (R3) year residents. Social-demographics recorded were: gender, age, single or not, with children or not, salary, number of working hours/week, on-call shif ts/month. The anonymous and voluntary Maslach Burnout Inventory questionnaire was used for the analysis of motional exhaustion, depersonalization and personal accomplishment. According to definition, BS is present when the questionnaire final score has more than 26 points for emotional exhaustion and more than 9 points for depersonalization. Statistical analysis was performed with SPSS®. Data are presented as percentages or absolute numbers; p < 0.05 was considered to be significant. Results and discussion: 154 Catalan residents answered the questionnaire in 2012-2013 (response rate 61.6%) and 110 in 2013-2014 (response rate 45.08%). There were no significant dif ferences in social-demographics among groups. During the last 2 years the more years of residency they had, the more BS was significantly present (2012: p=0.00595 and 2013: p=0.00277). Comparing both academic years, we observed less prevalence of BS in 2013-2014 without statistical significance (see table1).
European Journal of Anaesthesiology, 2013
Background and Goal of Study: Postoperative pain relief is one of major concerns for patients und... more Background and Goal of Study: Postoperative pain relief is one of major concerns for patients undergoing cardiac surgery. The objective of this study was to determine the incidence and risk factors of moderate to severe pain and analgesicrelated side ef fects in adult during 24 hours following cardiac surgery. Materials and Methods: We conducted a retrospective cohort of patients aged >18 years who underwent median sternotomy for elective cardiac surgery at Chiang Mai University Hospital from January 1, 2008 to December 31, 2010. Pain intensity was assessed by a numeric rating scale(NRS) every 2 hours postoperatively. Demographic data, type of operation (coronary bypass graf t, valve surgery), duration of surgery and side ef fects including nausea, vomiting, sedation score >3 and respiratory rate < 10 /min were recorded. Results and Discussion: Two thousand and fif ty four patients were included in this study. Morphine infusion at dose 1-2 mg/hr and fentanyl infusion at dose 10-20 μg/hr were used in 97% and 3% of patients, respectively. A small bolus dose of opioids was prescribed for supplement when patient had moderate to severe pain. Incidence of moderate to severe pain was 40.2%, 41.3%, 36% and 23.2% at 6, 12, 18 and 24 hour postoperatively. Among factors including age group, gender, type of operation and duration of surgery, only young age group (18-40 years) was the risk factor of developing moderate to severe pain (RR=1.51; 95%CI: 1.06-1.38). Only 58%, 65% and 42% of patients who had moderate to severe pain received bolus dose at 6, 12 and 18 hour postoperatively. Nausea and /or vomiting, sedation score >3 and respiratory rate < 10 /min occurred in 31.6%, 1.2% and 1.9% of patients, respectively. Respiratory depression significantly occurred in patient aged > 50 years. Conclusion(s): Postoperative pain management af ter adult cardiac surgery provided suf ficient analgesia for only about 60%. Prophylactic antiemetic, frequent assessment, patient controlled analgesia technique, adequate monitoring respiratory depression could improve the quality of pain control and minimize side ef fects. 14AP8-10
Revista española de anestesiología y reanimación
European Journal of Anaesthesiology, 2014
Minerva anestesiologica
To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine p... more To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine plus fentanyl in patients undergoing lower limb surgery. A single blind, randomised, prospective, multicentre study was designed to compare both therapies. The study was conducted in 10 tertiary hospitals. A total of 96 patients who were ASA I or II, who required at least a 24-hour-stay in the hospital and who were subjected to surgery of lower limbs with epidural anaesthesia were enrolled in this study. Treatments were administered at a dosage of 1.2 ml per metamera,including a test dose (3 mL) and the dose of fentanyl (100 mg). Patients were then randomly allocated to receive either Levobupivacaine (n = 49) or bupivacaine (N.= 47). The primary endpoint was sensory blockade (SB) duration. Secondary evaluations included motor blockade (MB), post-surgery analgesic medication usage, safety and the investigator global evaluation. SB duration was similar for both interventions: 195 min (165-2...
European Journal of Anaesthesiology, 2013
Background: Inotropic drugs are part of the treatment of heart failure; however, inotropic treatm... more Background: Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse ef fects and increased mortality. Recently, levosimendan has been proved to be ef fective in acute heart failure, reducing the mortality and improving cardiac and renal performance. Case report: We report the case of a 75-year-old woman with history of hypertension, chronic atrial fibrillation and congestive heart failure with baseline LVEF of 30%, an episode of pulmonary embolism in 2004, chronic renal failure (baseline creatinine 2,2 mg/mL), obstructive sleep apnea-syndrome associated with morbid obesity, and dyslipidaemia. She was admit ted to the emergency department due to an accidental fall with pertrochanteric fracture of the right femur. During the preoperative stay she developed a cardiogenic shock complicated with acute renal failure; renal replacement therapy was started with continuous veno-venous hemofiltration. In order to optimize the patient and improve kidney function, it was decided to start a treatment with levosimendan at 0,05 mcg/kg/min, avoiding the induction bolus and gradually increasing the dose up to 0,1 mcg/kg/min, according to the haemodynamic response and the tolerance of the patient. The treatment proved to be ef fective and the patient was successfully withdrawn from renal replacement and was lately submit ted to the intervention. She was largely transfused perioperatively (up to six times) but she did not develop any new episode of cardiac failure. Discussion: Levosimendan may constitute a valid choice to be considered in the management of preoperative decompensated heart failure associated with renal insuf ficiency. The main property of the drug allowed to restore renal function and to prepare the patient for the intervention. Moreover, the new equilibrium, between increased cardiac function and beneficial vasodilation, revealed helpful during and af ter intervention because it allowed the cardiovascular system of our patient to deal with the consequences of haemorrhage and fluid therapy. References: Davis et al. Br J Anaesth 2004; 93: 121±8 Learning points: The role of inotropes in optimization of high-risk surgical patients may encompass other factors apart from an increase in oxygen transport variables. Levosimendan may have promising ef fects for perioperative cardiac and renal function optimisation in patients undergoing elective noncardiac surgery. 18AP2-9
Revista de la Sociedad Española del Dolor
Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.... more Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.92%. Neurological damage secondary to epidural technique is about 2:10,000. In last years, epidural anesthesia has become a generalized practice in obstetrics. Because of it, sometimes, the postpartum neurological damage can be attributed to epidural analgesia, forgetting other mechanisms. We present a 21 years old patient, 139 cm height, who 24 hours after epidural labor analgesia suffered a "drop foot", whose evolution was toward a complete resolution. Drop foot can be consequence of peroneal nerve, sciatic or lumbar or radicular damage. Clinical evolution, and complementary studies, such as RNM or EMG are useful for differential diagnosis. It looks necessary to study peripartum peripheric neuropathies to discard its possible relation to anesthetic technique. These lesions should be minimized by our side with adequate punction level choose, avoiding direct local anesthetic injection, especially when a paresthesias occurs, and with a correct risk factors evaluation in the obstetric patient. Once the lesion has occurred, it is important a close follow up until the complete resolution. © Sociedad Española del Dolor. Published by SED.
European Journal of Anaesthesiology, 2014
Background: Mothers of Africa (MOA) is a UK based medical educational charity that aims to reduce... more Background: Mothers of Africa (MOA) is a UK based medical educational charity that aims to reduce maternal deaths in sub-Saharan African countries including Liberia, by supporting the training of local healthcare professionals. Approximately 70% of emergency surgical workload in Liberia is obstetric and the maternal mortality ratio (MMR) is 770 per 100,000 live births [1]. MOA's experience and a previous study in the resource poor set ting show that 80% of maternal deaths occur during the post-operative period [2]. The 3-day BASIC DHS course (Basic Assessment and Support of Seriously Ill Patients in Developing Healthcare Systems) has been developed to improve care of such patients and others who are critically ill. In 2013 2 pilot courses ran in Liberia. Goal of Study: To aid development of the BASIC DHS course by assessing 1) The quality, usefulness and appropriateness of knowledge and skills delivered 2) The preferred teaching method 3) The ef fect on motivation to improve local services/care delivery 4) The ef fect on the confidence of healthcare providers in managing acutely unwell patients. Method: Follow-up questionnaire from 12 former delegates (doctors and nurse anaesthetists). Results and discussion: A 100% follow-up rate was achieved. 100% of participants reported changes to their clinical practice, with all giving examples of improved care. 83% reported positive changes within their departments and 58% reported developing new department protocols and guidelines as a result of the course. 100% felt more empowered in their workplace and 92% reported improvements in interactions with colleagues. The majority wanted a longer course with more time for skills stations and interactive discussions. The participant's average confidence rating in managing critically ill patients improved rom 6.3 out of 10 pre-course to 9.25 out of 10 post-course. Conclusion: This pilot of the BASIC DHS course in Liberia has been well received with subjective evidence of empowerment and improved ways of working. The Liberians themselves will drive forward improvements in the course supported by MOA. Further objective evidence is required to demonstrate impacts on patient outcomes but initial results from the pilots are promising. References:
Revista española de anestesiología y reanimación, 2012
Mujer de 27 anos en tratamiento con 12.500 UI de dalteparina sodica desde la semana 28 de gestaci... more Mujer de 27 anos en tratamiento con 12.500 UI de dalteparina sodica desde la semana 28 de gestacion (embarazo gemelar), por trombosis venosa profunda (TVP) en vena femoral e iliaca izquierda. En la semana 36 se indico la colocacion de un filtro de cava (fig. 1) al objetivarse la obstruccion de la vena femoral comun izquierda por un trombo de 18 mm de diametro, tras lo cual se realizo cesarea con anestesia general sin incidencias. En el postoperatorio inmediato se reinicio el tratamiento con heparina de bajo peso molecular y 5 dias despues se retiro el filtro de cava. En este caso, la decision de terminar la gestacion por cesarea se baso en la existencia de un embarazo gemelar casi a termino y en la persistencia de la TVP a pesar del tratamiento. Dado que la terapia anticoagulante con heparina durante 8 semanas no fue suficiente, y para reducir la posibilidad de desprendimiento del trombo durante la cesarea, se inserto el filtro de cava previo a la realizacion de la cesarea como prevencion del tromboembolismo pulmonar.
Revista Española de Anestesiología y Reanimación, 2011
European Journal of Anaesthesiology, 2014
Revista Española de Anestesiología y Reanimación, 2008
European Journal of Anaesthesiology, 2013
Anaesthesia, 1983
A cnse is presented of phaeoc~hromocytomu with cuteuholumine-induced cardiomyopath). The dlfecult... more A cnse is presented of phaeoc~hromocytomu with cuteuholumine-induced cardiomyopath). The dlfeculties in the rnanugenient when left ventricuiar failure occurred are reported and the importance of nionitoring pulmonary artery pressure during the unaesthetic procedure is strrssed.
Revista Española de Anestesiología y Reanimación (English Edition), 2020
Objective: Publications of diverse medical specialties confirm that gender differences still exis... more Objective: Publications of diverse medical specialties confirm that gender differences still exist in the medical field. This particular study aims to investigate whether this problem exists in the specialty of Anaesthesiology in Spain. Methods: An anonymous survey was distributed among anaesthesiologists in Spain. It had 39 questions and was designed to investigate professional position, work conditions, personal situation, and individual perceptions. The goal was to target the majority of anaesthesiologists working in Spain. Results: Completed surveys were received from 1619 respondents which represents 17.6% of the total number of anaesthesiologists in Spain; 654 respondents were male (40.4%) and 965 were female (59.6%). The greater differences were found in the following areas: 70.0% of the respondents advised that their head of department is male. When asked about management and leadership positions, 25.2% of female respondents had ever had any management role in contrast to 46.1 % of men (p < 0.001). Regarding academic positions, 10.3% of male respondents are university professors in contrast to only 4.8% of women (p < 0.001). 46.0% of the women surveyed believe that gender discrimination exists in the workplace whereas only 12.6% of men reported the same. A third of women (36.6%) consider their gender a barrier to promotion and fear losing their job due to pregnancy. Furthermore, both genders have witnessed patients and colleagues treating staff differently according to gender.
Revista española de anestesiología y reanimación, 2005
Summary Little is known of the effect on oocytes of anesthesia administered during retrieval. The... more Summary Little is known of the effect on oocytes of anesthesia administered during retrieval. The main objective of this study was to compare the prolactin and stress hormone responses to surgical stimulus under 4 anesthetic techniques and to determine whether there is an effect of technique on the number and quality of oocytes retrieved. METHODS: We designed a clinical trial to determine the plasma and follicular levels of prolactin and cortisol in patients in an assisted reproduction program. The patients were randomized to 3 anesthetic groups: general anesthesia, spinal anesthesia, or sedation with alfentanil and midazolam plus paracervical block. Patients were consecutively assigned to the fourth group to receive sedation with remifentanil plus paracervical block. RESULTS: We studied 90 patients. The patients receiving general anesthesia had the greatest increase in prolactin by the end of the procedure. Follicular cortisol increased in the paracervical block group in which remi...
European Journal of Anaesthesiology, 2014
ent the part1 exam for the first time the same year (50-90%), with no changes between years (p=0,... more ent the part1 exam for the first time the same year (50-90%), with no changes between years (p=0,11 and 0,472 respectively). In 2011, their main objective was to pass EDA-1, while in 2012 and 2013 they were more interested in testing their theorical knowledge (p< 0,001). Candidates aspired to a planification of revisions (38-65,6%), a training with mocks of the exam (17,8-22%) and an orientative the study plan (8-15,6%). The interest for a planification of revisions and an orientative study plan increased through the years (p=0,001). Conclusion(s): This survey permit ted to assess the changes of expectations of future candidates to the EDAIC, and to orientate future editions of the training program towards organizational outcomes for a bet ter preparation of the exam.
Revista Española de Anestesiología y Reanimación, 2011
ABSTRACT Objectives To determine the difference between the estimated and measured values of the ... more ABSTRACT Objectives To determine the difference between the estimated and measured values of the left lateral decubitus (LLD) angle in the positioning of patients for scheduled cesarean section; to determine whether the accuracy of estimates differs between staff anesthesiologists and residents; and to assess the angle estimates of midwives and surgical nurses as well as their level of knowledge with respect to the utility of the LLD position.Methods This was a prospective, observational, double-blind study comparing staff anesthesiologists working in obstetrics to residents in their second, third, or fourth-year of training. We also presented a task and questions to midwives and surgical nurses who assisted during categories 3 and 4 cesarean sections (elective and scheduled procedures) according to the classification system of he National Institute of Clinical Excellence. The anesthesiologist was asked to place the patient in LLD position after onset of anesthesia and to estimate the LLD angle. A second anesthesiologist measured the angle. The midwives and nurses were asked to place a vacant surgical table at approximately 15°; the angle was then measured. Patient variables (weight, height, anesthetic technique) and staff variables (position, understanding of the purpose of the maneuver, estimated DLL angle, and measured angle) were recorded.ResultsOf 55 women who underwent cesarean sections (98.18% under regional anesthesia), 25 were assessed by staff anesthesiologists and 30 by residents. A total of 14 midwives and 10 surgical nurses participated in the surgical table positioning task and answered questions. The mean (SD) DLL angle estimate of the anesthesiologists was 12.4° (3.4°); the mean measured angle was 7.8° (3.1°). The estimates of staff anesthesiologists were significantly more accurate (P < .001). All the midwives understood the reason for using the DLL position in cesarean section, while only 1 nurse (10%) did (P < .05).Conclusion The DLL position angle is overestimated by resident anesthesiologists and midwives. It seems that the use and understanding of DLL positioning could be improved.