Consumo de Propofol y tiempo de recuperación después del índice biespectral o el índice de estado cerebral como guías de la anestesia. Propofol consumption and recovery times after bispectral index or cerebral state index guidance of anaesthesia A. E. Delfino*, L. I. Cortinez, C. V. Fierro and H. R. Muñoz Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, PO Box 114-D, Santiago, Chile British Journal of Anaesthesia 2009; 103: 255-259. * Corresponding author. E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Background: We compared the propofol requirements and recovery times when either the bispectral index (BIS) monitor or the cerebral state monitor (CSM) is used to guide propofol anaesthesia. Methods: Forty patients undergoing laparoscopic cholecystectomy were studied. All patients were monitored with both monitors and were randomly allocated into two groups according to the monitor used to titrate propofol administration. Propofol was administered to maintain BIS or CSM within 40 and 60. Propofol consumption and clinical markers of recovery were assessed after surgery. Results: In the CSM group, the values of cerebral state index (CSI) and BIS were 47 (5) and 38 (6), respectively (P=0.00054). In the BIS group, the values of CSI and BIS were 47 (5) and 45 (2), respectively (P=0.15). In the BIS group, the total amount of propofol used was lower [109 (20) µg kg-1 min-1] than in the CSM group [130 (27) µg kg-1 min-1] (P=0.018). The time to eye opening was lower in the BIS [7.2 (3.5) min] than in the CSM group [10.7 (6.6)] (P=0.038). There were no differences in fentanyl consumption, or in other clinical markers of recovery. Conclusions: Compared with BIS, propofol anaesthesia guided with CSI resulted in 20% higher propofol doses. This, however, does not lead to clinically relevant differences in recovery times. Keywords: monitoring, depth of anaesthesia; recovery. Efectos hemodinámicos de dosis repetidas de oxytocina durante operación cesárea en parturientas sanas. Haemodynamic effects of repeated doses of oxytocin during Caesarean delivery in healthy parturients E. Langesæter*, L. A. Rosseland and A. Stubhaug British Journal of Anaesthesia 2009; 103:260-262. Division of Anaesthesia and Intensive Care, Oslo University Hospital - Rikshospitalet, N-0027 Oslo, Norway * Corresponding author. E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Background: The haemodynamic effects of oxytocin 5 u have been described previously, but still some authors attribute these effects to the delivery itself. We studied the haemodynamic effects of two repeated doses of oxytocin i.v. in 20 healthy women during spinal anaesthesia for Caesarean delivery. Methods: Data were obtained from a randomized controlled study of 80 pregnant women undergoing an elective Caesarean section. All women had an arterial line inserted, and LidCOPlus was used for measuring cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). Results: Twenty women required a second bolus of oxytocin 5 u. Both the first and the second doses produced clinically and statistically significant haemodynamic changes, but the haemodynamic changes induced by the second dose were smaller than after the first dose. The mean maximal change in CO after the first and second doses were 94% (CI 70-117) and 42% (CI 33-52), respectively (P<0.0001), and for systolic arterial pressure 31% (CI 27-35) and 23% (CI 20-27), respectively (P=0.003). Conclusions: An initial bolus of oxytocin 5 u produced prominent haemodynamic changes, whereas a second bolus produced smaller changes. This could be due to desensitization of endothelial oxytocin receptors. Keywords: anaesthesia, obstetric; complications, hypotension; heart, cardiac output; uterus, oxytocin.

Anestesia en cirugía cardiovascular  basada en Morfina proporciona recuperación superior y temprana comparada con Fentanil en pacientes sometidos a cirugía electiva cardíaca. Morphine-_base_d Cardiac Anesthesia Provides Superior Early Recovery Compared with Fentanyl in Elective Cardiac Surgery Patients Glenn S. Murphy, MD, Joseph W. Szokol, MD, Jesse H. Marymont, MD, Steven B. Greenberg, MD, Michael J. Avram, PhD, Jeffery S. Vender, MD, Saadia S. Sherwani, MD, Margarita Nisman, BA, and Victoria Doroski, BA . Anesthesia  Analgesia 2009; 109:311-319 From the Department of Anesthesiology, NorthShore University HealthSystem, Evanston, Illinois. Address correspondence and reprint requests to Glenn S. Murphy, MD, NorthShore Department of Anesthesiology, University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201. Address e-mail to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Abstract BACKGROUND: Experimental and clinical data suggest that morphine possesses unique cardioprotective and antiinflammatory properties. In this clinical investigation, we sought to determine whether the choice of intraoperative opioid (morphine or fentanyl) influences early recovery after cardiac surgery. METHODS: Ninety patients undergoing cardiac surgery with cardiopulmonary bypass were randomized to receive either morphine (40 mg) or fentanyl (600 µg) as part of a standardized opioid-isoflurane anesthetic. Quality of recovery was assessed using the QoR-40 questionnaire administered preoperatively and daily on postoperative days 1-3. During the first three postoperative days, pain was measured using a 100-mm visual analog scale, and the use of IV and oral pain medications (morphine or acetaminophen/hydrocodone) was quantified. Hemodynamic variables, duration of tracheal intubation, postoperative febrile reactions, organ morbidities, and intensive care unit (ICU) and hospital length of stay were evaluated. RESULTS: Compared with patients given fentanyl, those receiving morphine had higher global QoR-40 scores on postoperative days 1 (173 vs 160, P < 0.0001), 2 (174 vs 164, P < 0.0001), and 3 (177 vs 167, P < 0.001). Differences between the groups were observed in the QoR-40 dimensions of emotional state, physical comfort, and pain (all P < 0.01-0.0001). Postoperative visual analog scale pain scores, use of pain medication in the ICU and surgical ward, and postoperative febrile reactions were reduced significantly in the morphine group (all P < 0.01). No differences between the groups were noted in duration of tracheal intubation, ICU and hospital length of stay, or postoperative complications. CONCLUSIONS: In patients undergoing elective cardiac surgery with cardiopulmonary bypass, postoperative quality-of-life measures and pain control during recovery were enhanced when morphine (40 mg) was administered intraoperatively as part of a balanced anesthetic technique compared with fentanyl. Eficacia de la técnica de ahorro de sangre durante cirugía cardíaca: un _meta_-Análisis de estudios aleatorios. The Efficacy of an Intraoperative Cell Saver During Cardiac Surgery: A _meta_-Analysis of Randomized Trials Guyan Wang, MD, PhD*, Daniel Bainbridge, MD, FRCPC*, Janet Martin, PharmD, MSc (HTA&M)*, and Davy Cheng, MD, MSc, FRCPC, FCAHS* Anesthesia   Analgesia 2009; 109:320-330 From the *Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada; Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology and Perioperative Medicine, Evidence-_base_d Perioperative Clinical Outcomes Research Group (EPiCOR), and Department of Pharmacy, Physiology, and Pharmacology, High Impact Technology Evaluation Centre, Pharmacy, Physiology and Pharmacology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. Address correspondence and reprint requests to Daniel T. Bainbridge, MD, FRCPC, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Rd., Room C3-106, London, Ontario, Canada N6A 5A5. Address e-mail to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Abstract BACKGROUND: Cell salvage may be used during cardiac surgery to avoid allogeneic blood transfusion. It has also been claimed to improve patient outcomes by removing debris from shed blood, which may increase the risk of stroke or neurocognitive dysfunction. In this study, we sought to determine the overall safety and efficacy of cell salvage in cardiac surgery by performing a systematic review and _meta_-analysis of published randomized controlled trials. METHODS: A comprehensive search was undertaken to identify all randomized trials of cell saver use during cardiac surgery. MEDLINE, Cochrane Library, EM_base_, and abstract data_base_s were searched up to November 2008. All randomized trials comparing cell saver use and no cell saver use in cardiac surgery and reporting at least one predefined clinical outcome were included. The random effects model was used to calculate the odds ratios (OR, 95% confidence intervals [CI]) and the weighted mean differences (WMD, 95% CI) for dichotomous and continuous variables, respectively. RESULTS: Thirty-one randomized trials involving 2282 patients were included in the _meta_-analysis. During cardiac surgery, the use of an intraoperative cell saver reduced the rate of exposure to any allogeneic blood product (OR 0.63, 95% CI: 0.43-0.94, P = 0.02) and red blood cells (OR 0.60, 95% CI: 0.39-0.92, P = 0.02) and decreased the mean volume of total allogeneic blood products transfused per patient (WMD -256 mL, 95% CI: -416 to -95 mL, P = 0.002). There was no difference in hospital mortality (OR 0.65, 95% CI: 0.25-1.68, P = 0.37), postoperative stroke or transient ischemia attack (OR 0.59, 95% CI: 0.20-1.76, P = 0.34), atrial fibrillation (OR 0.92, 95% CI: 0.69-1.23, P = 0.56), renal dysfunction (OR 0.86, 95% CI: 0.41-1.80, P = 0.70), infection (OR 1.25, 95% CI: 0.75-2.10, P = 0.39), patients requiring fresh frozen plasma (OR 1.16, 95% CI: 0.82-1.66, P = 0.40), and patients requiring platelet transfusions (OR 0.90, 95% CI: 0.63-1.28, P = 0.55) between cell saver and noncell saver groups. CONCLUSIONS: Current evidence suggests that the use of a cell saver reduces exposure to allogeneic blood products or red blood cell transfusion for patients undergoing cardiac surgery. Subanalyses suggest that a cell saver may be beneficial only when it is used for shed blood and/or residual blood or during the entire operative period. Processing cardiotomy suction blood with a cell saver only during cardiopulmonary bypass has no significant effect on blood conservation and increases fresh frozen plasma transfusion.

Asociación de hemodilución y transfusión de eritrocitos con marcadores bioquímicos de lesión renal o esplácnica durante bypass cardiopulmonar. The Association of Hemodilution and Transfusion of Red Blood Cells with Biochemical Markers of Splanchnic and Renal Injury During Cardiopulmonary Bypass Rien A. J. M. Huybregts, MD*, Roel de Vroege, PhD*, Evert K. Jansen, MD*, Anne W. van Schijndel, MD*, Herman M. T. Christiaans, MD, and Willem van Oeveren, PhD Anesthesia  Analgesia 2009; 109:331-339 From the Departments of *Cardiac Surgery, and Anesthesiology, University Hospital Vrije Universiteit, Amsterdam; and Department of Biomaterials, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Address correspondence and reprint requests to Willem van Oeveren, PhD, Department of Biomedical Engineering and Anesthesiology, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. Address e-mail to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Abstract BACKGROUND: Hemodilution is the main cause of a low hematocrit concentration during cardiopulmonary bypass. This low hematocrit may be insufficient for optimal tissue oxygen delivery and often results in packed cell transfusion. Our _object_ive in this study was to find a relationship between intraoperative hematocrit and allogeneic blood transfusion on release of postoperative injury markers from the kidneys and the splanchnic area. METHODS: Fifty consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were included. Systemic tissue hypoxia was assessed by lactate concentrations. Kidney and splanchnic ischemia were assessed by the measurement of N-acetyl-β-d-glucosaminidase (NAG) and intestinal fatty acid binding protein (IFABP) in urine. Patients were retrospectively placed into groups according to their lowest hematocrit concentration on bypass (<24% or 24%). RESULTS: The intraoperative lactate and the postoperative NAG and IFABP concentrations were higher in the low hematocrit group (<24%) than in the high hematocrit group (24%; P < 0.05). Low hematocrit correlated with higher lactate concentrations (R2 = 0.150, P < 0.01) and with higher NAG concentrations (R2 = 0.138, P < 0.01) and IFABP concentrations (R2 = 0.107, P < 0.01) postoperatively. Transfusion of packed cells during cardiopulmonary bypass correlated with higher lactate (R2 = 0.089, P < 0.05), NAG (R2 = 0.431, P < 0.01), and IFABP concentrations (R2 = 0.189, P < 0.01). CONCLUSIONS: The results support the concept that hemodilution below an intraoperative hematocrit of 24% and consequently transfusion of red blood cells is related to release of injury markers of the kidneys and splanchnic area. Efecto de la infusión de Propofol en la función pancreática y hepática y estado acido-_base_ en niños sometidos a craneotomía y recibiendo Fentoina. The Effects of Propofol Infusion on Hepatic and Pancreatic Function and Acid-_base_ Status in Children Undergoing Craniotomy and Receiving Phenytoin Hatice Türe, MD*, Arzu Mercan, MD*, Ozge Koner, MD*, Bora Aykac, MD*, and Uur Türe, MD Anesthesia  Analgesia 2009; 109:366-371 From the Departments of *Anesthesiology and Reanimation, and Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey. Address correspondence and reprint requests to Hatice Türe, MD, Department of Anesthesiology and Intensive Care Unit, Yeditepe University School of Medicine, Devlet Yolu, Ankara Cad. No: 103-105, Kozyatagi, Istanbul, Turkey. Address e-mail to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Abstract BACKGROUND: In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-_base_ status compared with _base_line values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis. METHODS: In this prospective clinical study, we measured the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), -glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg · kg-1 · d-1 phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1, 3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation (2nd and 4th h), just after extubation, and 1, 2, 6, and 12 h after extubation. RESULTS: Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with _base_line with a peak value on postoperative Day 1 and returned to normal values within a week. _base_ excess levels after extubation were significantly decreased compared with _base_line. They were in the normal range, however, and returned to _base_line values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4-6 mo after surgery. CONCLUSIONS: Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clinical effect on the acid-_base_ status or pancreas or liver enzymes.