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Biomedical subjects

E Bisbe

Publications and source records attributed to E Bisbe.

14 recordsLinked to original sources
PubMed2005

[Preoperative use of intravenous iron: a new transfusional therapy].

INTRODUCTION AND OBJECTIVE: Improving preoperative hemoglobin levels reduces transfusion requirements. The availability in Spain of iron sucrose formulas with good safety profiles has added a new therapeutic option for treating anemia. The aim of this study was to demonstrate the usefulness of preoperative intravenous infusion of iron for improving hemoglobin level before elective major orthopedic surgery. PATIENTS AND METHODS: From the beginning of 2003 until July 2004, 27 consecutive patients scheduled to undergo major orthopedic surgery were given preoperative intravenous iron infusions because of intolerance to oral iron administration, poor intestinal absorption, chronic inflammatory anemia, or functional iron deficit. Twenty patients received preoperative intravenous epoetin alfa and iron and 7 received only intravenous iron because epoetin alfa therapy was ruled out due to cardiovascular or thromboembolic disease or because they had pure iron deficiency. Variables studied were age, sex, weight, type of surgery, iron dose, duration of treatment, reason for treatment, blood parameters, hemoglobin levels, and use of transfusions. RESULTS: The preoperative increase in hemoglobin was 1.7 g dL(-1) (range, 10.8-12.5) for patients who received only intravenous iron therapy and half of them were transfused, although inappropriately in 1 case. The increase in the intravenous epoetin alfa plus iron group was 1.7 g dL(-1) (range, 10.9-12.6) and only 25% were transfused. CONCLUSIONS: Intravenous iron therapy improved the preoperative hemoglobin levels in anemic patients scheduled for major orthopedic surgery. This is a new intravenous treatment approach to evaluate.

Aged↗
PubMed2003

[Erythropoietin alone or as an adjuvant for the autologous blood donation program in major orthopedic surgery].

BACKGROUND: Patients with anemia undergoing elective joint replacement are often excluded from preoperative autologous donation (PAD). The purpose of this study was to compare the efficacy of preoperative erythropoietin (epoetin alpha) as an adjuvant treatment to PAD versus preoperative erythropoietin alfa alone in patients with mild anemia undergoing major orthopedic surgery. PATIENTS AND METHODS: The study enrolled 75 patients scheduled for total joint arthropalsty of the hip or knee or spinal surgery and with a hemoglobin (Hb) concentration between 10 and 13 g/dL. Group 1 patients were assigned to receive weekly doses of subcutaneous epoetin alpha (40,000 IU) 21, 14, and 7 days before surgery and to participate in the PAD program; group 2 patients were excluded from the PAD program and received 2 doses of epoetin alpha every week over the same period. RESULTS: Group 1 (n = 39) and group 2 (n = 36) were similar with respect to patient characteristics, biological parameters, and surgical procedures, In group 1, mean preoperative Hb rose fom 12.5 g/dL to 12.8 g/dL, patients received a mean 5.1 doses of epoetin alpha, and they gave a mean 1.9 units of autologus blood and 1 received allogenic blood. In group 30.7% received transfusions of autologous blood and 1 received allogenic blood. In group 2, preoperative Hb increased from 11.7 g/dL to 13.5 g/dL, patients received 3.8 doses of epoetin alpha, and 3 were transfused with allogenic blood (P > 0.05). CONCLUSION: Epoetin alpha alone and erythropoietin as a adjuvant to a PAD program are equally effective in reducing allogenic transfusion during hip and knee arthroplasty and spinal column surgery of up to 3 spaces.

Aged↗
PubMed1998

[Drug allergy in a population of surgical patients].

OBJECTIVES: To determine the prevalence of drug allergies in a population of surgical patients. To establish a clinical classification of events as being very or not very likely to be allergic reactions. To detect which drug groups are associated with greater incidence of anaphylactic reaction and to analyze the severity of such reactions. PATIENTS AND METHODS: Epidemiological study. During a preoperative interview, patients were asked if they were aware of the existence of any episode of allergy to drugs. If a patient answered yes, a specific data collection questionnaire on allergies was completed. Based on signs and symptoms described by the patient, reactions were classified as indicating high likelihood of allergy, low likelihood of allergy, or as being of unknown origin. RESULTS: We questioned 1,218 patients (754 women/464 men), of whom 159 (13.05%) reported being allergic to drugs. The total number of drugs employed was 212 (1.34 drugs/patient). Antibiotics (54.7%), nonsteroidal anti-inflammatory drugs (NSAIDs) (19.3%), radiological contrast media (6.1%) and local anesthetics (4.7%) were the substance groups most often mentioned. We classified 74.5% of the reactions as indicating high likelihood of allergy, 19.8% as indicating low likelihood, and 5.6% to be of unknown origin. The skin was involved in 72.1% of the reactions that were highly likely to have been caused by allergy; 6.9% of these reactions involved the respiratory tract, 4.4% the circulatory system, 12% the skin plus respiratory tract, and 4.4% the skin plus respiratory and circulatory systems. The most severe reactions (16.4%) were associated with radiological contrast media (36.4%), NSAIDs (33.3%) and intravenous administration (38.1%). Signs of latex allergy were seen in 0.4% and signs of allergy to hair dyes in 0.9%. All allergy tests were negative in all these patients. CONCLUSIONS: Drug allergy is reported by 13% of patients. It is highly likely that 74.5% of reactions are due to allergy. Antibiotics are the most frequently implicated drugs, followed by NSAIDs. The most serious reactions are caused by radiological contrast media and NSAIDs. Intravenous administration causes the most serious reactions.

Adolescent↗
PubMed1995

[Prolonged sedation with midazolam in critically ill patients undergoing artificial ventilation].

OBJECTIVES: To analyze the dose of midazolam needed for induction and maintenance of sedation, as well as its hemodynamic repercussions in critically ill patients requiring mechanical ventilation. PATIENTS AND METHODS: We studied 20 adult patients requiring mechanical ventilation for respiratory failure in the intensive care unit. An induction dose of 1 mg/min midazolam was given until the patient became drowsy (eyes closed but opened again) and this level of sedation was maintained by continuous intravenous perfusion. We calculated induction dose, maintenance dose and their correlation with age, weight, general state (APACHE-II index), liver function, hematocrit and blood chemistry. RESULTS: The induction dose was 4.76 +/- 3.4 mg and correlated with weight and plasma albumin levels. The maintenance dose of 6.4 +/- 3.97 mg/h did not correlate with any of the parameters studied. A statistically significant reduction in arterial pressure was observed. CONCLUSIONS: The sedation dose of midazolam in critically ill patients is related to weight and plasma albumin levels. Recovery time is related to mean maintenance dose.

APACHE↗
PubMed1995

[Prevalence of viral hepatitis in candidates for orthopedic surgery].

OBJECTIVES: To study the prevalence of positive serology results for hepatitis B and C viruses among patients scheduled for elective orthopedic surgery, to establish risk groups and to assess the economic cost involved in testing patients in such groups. PATIENTS AND METHODS: We performed a retrospective study of 1090 preoperative charts for patients awaiting elective orthopedic surgery between November 1993 and January 1995. Variables recorded were age, sex, physical status, history of alcoholism or addiction to injected drugs, associated disease (liver disease, chronic kidney failure and hemodialysis, and coagulation disorders), history of blood products transfusion, preoperative liver enzymes and blood levels of AcVHC and AgVHB as determined by enzyme immunoassay. RESULTS: Mean age was 51.8 (SD 17.5). Women predominated, accounting for 60.6% of the sample. ASA I and ASA II patients accounted for 84.9%, 72 (6.61%) had had previous transfusions, 51 (4.6%) suffered liver disease, 4 (0.36%) had coagulation disorder, 5 (0.45%) were receiving hemodialysis for chronic kidney failure, and 5 (0.45%) admitted having injected drugs. We discovered alterations in preoperative liver enzyme levels in 116 (10.6%) cases. Sixty-five (5.96%) were positive for AcVHC and 13 (1.19%) were positive for AgVHB. Factors that predicted positive results for hepatitis C and B were liver disease, previous administration of blood products, chronic kidney failure requiring hemodialysis, drug addiction and high preoperative liver enzyme levels. Serologic testing for viruses performed on patients in this risk group would have detected 76.6% of the positive cases, resulting in savings of 90% of the cost of indiscriminate testing. CONCLUSIONS: We believe that patients with histories of liver disease, blood product transfusion, chronic kidney failure with hemodialysis or drug addiction, or with high liver enzyme levels should be tested for hepatitis B and C before surgery.

Adult↗
PubMed1992

Effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in patients undergoing elective surgery.

We have compared the effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in a double-blind study in 110 patients undergoing elective surgery. Three hours before operation, the patients received, orally, omeprazole 40 mg, ranitidine 150 mg, famotidine 40 mg or placebo. Gastric volume and pH were measured immediately after induction of anaesthesia. Omeprazole, ranitidine and famotidine produced a significant increase in gastric pH and a significant decrease in gastric volume compared with placebo. When the effects of omeprazole on gastric volume were compared with those of ranitidine and famotidine, no significant difference was found, but omeprazole was significantly less effective in increasing gastric pH. The number of patients having a pH less than 2.5 and a volume greater than 0.4 ml kg-1 were: none in the ranitidine group, one (3%) in the famotidine group, four (15%) in the omeprazole group and six (23%) in the placebo group. We conclude that omeprazole 40 mg given 2-4 h before surgery does not afford adequate prophylaxis for the acid aspiration syndrome.

Adolescent↗
PubMed1989

Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery.

A randomised double-blind comparison of oral famotidine and ranitidine given 2 hours before induction, on gastric secretion (volume and pH) was carried out on 93 patients undergoing elective surgery. Gastric contents were aspirated immediately after tracheal intubation. Famotidine significantly reduced the gastric volume, compared with the other groups, including ranitidine. Both famotidine and ranitidine significantly elevated gastric pH towards neutral, compared with the other groups. There was no significant difference between ranitidine and famotidine in respect of the pH. The patients premedicated with famotidine and ranitidine were well protected against Mendelson's syndrome, whereas 38% of patients from the other groups remained at risk.

Adolescent↗
PubMedDate not supplied

[Respiratory distress in adults and disseminated intravascular coagulation after administration of iodinated contrast].

We report a patient with urinary sepsis who, during intravenous urography with iodinated contrast (70 mg Na, Ca diatrizoate and meglumine) developed dyspnea, tachypnea, sinus tachycardia and moderate hypoxemia (pO2: 72 with FiO2 of 0.21). She subsequently developed adult respiratory distress syndrome (ARDS) with refractory hypoxemia (pO2: 40 mmHg with FiO2 of 0.5) and disseminated intravascular coagulation (DIC) (prothrombin index: 5%, platelets: 20,000/mm3, APTT: 102/37 min, FDP: 80 ng/ml, and fibrinogen: 120 mg %). The patient required mechanical ventilation and treatment with inotropic drugs, antibiotics, corticosteroids, plasma, platelets and erythrocytes. The outcome was favorable, and she could be discharged from the Reanimation Service 7 days after admission. In severe systemic reactions to iodinated contrasts (SRIC), ARDS and DIC are common. In our patient, the close temporal association between the administration of iodinated contrast and the development of the clinical picture made us suspect their possible causal relation. A higher predisposition to SRIC in patients with sepsis has been reported. We review the SRIC in which the anesthesiologist may play a role for reanimation.

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