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J V Llau

Publications and source records attributed to J V Llau.

16 recordsLinked to original sources
PubMed2007

Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations.

The wide use of anticlotting drugs by patients scheduled for surgery is a challenge for the anaesthesiologist when considering a regional anaesthesia technique. This practice seems safe if there is an appropriate management based on safety intervals established according to the pharmacology of the drug and the regional technique. Some anaesthesiology societies have published recommendations for the safe practice of regional anaesthesia with the simultaneous use of anticoagulants (heparin, low molecular weight heparins, oral anticoagulants (OA), fondaparinux and others) and antiplatelet agents (aspirin, clopidogrel, ticlopidine, argatroban and others). One of the most recent guidelines has been published by the Spanish Society of Anaesthesia and Critical Care. This article reviews these recommendations and compares them with others published in the last years. The recommendations are similar, but some interesting differences can be observed and need to be considered. A European consensus in this setting would probably be necessary.

Analgesia↗
PubMed1997

[Low molecular weight heparins. Implications in anesthesia and resuscitation].

Low molecular weight heparins are a group of drugs that have only recently been introduced in clinical practice. The are widely used for prophylaxis in thromboembolic disease and are being employed increasingly to treat established venous thrombosis. One way in which these drugs are often used is for prophylaxis in the perioperative period for patients at high risk of developing venous thromboembolism, and the anesthesiologist must therefore be familiar with the main aspects of this application. We review pharmacological characteristics of these drugs as well as the literature on low molecular weight heparins, stressing points of main interest to the anesthesiologist and intensive care recovery unit specialist, namely adverse effects (mainly bleeding) and the implications that use of low molecular weight heparin will have on choice of anesthetic (in particular the dilemma of whether to use local/regional anesthesia).

Anesthesia, Spinal↗
PubMed1995

[Selection and maintenance of lung donors].

Lung transplantation is a relatively modern procedure that can afford improvement in quality of life to certain terminal patients with irreversible respiratory failure. Selection of the donor and the recipient must be both strict and flexible, as we apply criteria that are constantly being revised and extended. The care afforded the donor must include certain elements: exhaustive monitorization that serves to guide the intravenous replacement of fluids and maintenance of hemodynamic stability; assisted ventilation with PEEP, FiO2 under 0.4 and adequate flow volumes; prevention and treatment of neurogenic pulmonary edema; and prevention of infections through careful airways management involving appropriate antibiotic prophylaxis. The same protocol must be maintained while the organ is being extracted and the organ itself must be properly preserved until implanted. The anesthesiologist is fully involved in optimum management of the lung donor. We consider that such care is essential for achieving more and better quality lung donations.

Female↗
PubMedDate not supplied

[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 offer a detailed discussion of patients treated with inhibitors of platelet aggregation (emphasizing that such treatment alone is not a contraindication for neuroaxial blockade although certainly guidelines must be followed), unfractionated heparin (anesthesia should be started at least 4 hours after administration of this drug or 30 minutes before, provided pulmonary arterial pressure is normal), low molecular weight heparin (which should be administered 12 hours before or 12 hours after the anesthetic technique), and oral anticoagulants (provision of regional anesthesia depends mainly on International Normalized Ratio monitoring). 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.

Administration, Oral↗