Perioperative Management of Antiplatelet-Drugs in Cardiac Surgery

The management of coronary patients scheduled for a coronary artery bypass grafting (CABG), who are receiving one or more antiplatelet drugs, is plenty of controversies. It has been shown that withdrawal of antiplatelet drugs is associated with an increased risk of a thrombotic event, but surgery under an altered platelet function also means an increased risk of bleeding in the perioperative period. Because of the conflict recommendations, this review article tries to evaluate the outcome of different perioperative antiplatelet protocols in patients with coronary artery disease undergoing CABG

Observational study on fluid therapy management in surgical adult patients

Background: Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods: We designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group. Results: We recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period. Conclusions: The most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management

Demografía y crecimiento primario durante la regeneración de tres especies de pino a lo largo de gradientes climáticos

13 páginas, 4 figuras y 3 tablasLa regeneración es un proceso crítico en la dinámica de los bosques, que presenta una marcada heterogeneidad temporal y espacial. En este trabajo se pretende avanzar en el conocimiento de las variables bióticas y abióticas que determinan a escala local la presencia, abundancia y crecimiento primario de plántulas de tres especies de pino: Pinus sylvestris, P. nigra y P. uncinata, y determinar el efecto relativo del clima. Para ello se muestrearon 216 parcelas distribuidas a lo largo de gradientes climáticos en siete localidades montañosas. Se censaron las plántulas recién emergidas y el resto de juveniles, y se midieron los crecimientos anuales. Los resultados mostraron diferencias significativas entre especies con efectos directos e indirectos del clima sobre la demografía y el estado de los juveniles. En las tres especies se apreció que la supervivencia de los juveniles aparecía desplazada hacia altitudes mayores respecto donde se producía el óptimo de la emergencia. Las relaciones locales de competencia y facilitación ejercieron efectos importantes sobre la regeneración de las tres especies, siendo éstos modulados por el clima.Ministerio Español de Innovación y Ciencia Consolider-Montes (CSD2008_00040), Los autores agradecen a toda la gente que hizo posible el trabajo de campo: R. Freire, B. Santamaría, J. Martínez, D. López, R. Ruíz-Puche, E. Molina, L. Ivorra, S. Martín, B. Ros y C. Boubekeur. También el apoyo estadístico de R. Manson.Proyecto europeo BACCARA (CE: FP7-226299, 7FP)Peer reviewe

The Effects of Ash and Black Carbon (Biochar) on Germination of Different Tree Species

Forest fires generate large amounts of ash and biochar, or black carbon (BC), that cover the soil surface, interacting with the soil’s constituents and its seedbank. This study concerns reproductive ecology assessments supported by molecular characterisation to improve our understanding of the effects of fire and fire residues on the germination behaviour of 12 arboreal species with a wide geographic distribution. For this purpose, we analysed the effects of three ash and one BC concentration on the germination of Acacia dealbata Link, A. longifolia (Andrews) Willd., A. mearnsii De Wild., A. melanoxylon R. Br., Pinus nigra Arnold, P. pinaster Aiton, P. radiata D. Don, P. sylvestris L., Quercus ilex L., Q. pyrenaica Willd., Q. robur L., and Q. rubra L. Each tree species was exposed to ash and BC created from its foliage or twigs (except for Q. rubra, which was exposed to ash and BC of Ulex europaeus L.). We monitored germination percentage, the T50 parameter, and tracked the development of germination over time (up to 1 yr). The BC of A. dealbata, P. pinaster, and Q. robur was analysed by pyrolysis-gas chromatography-mass spectrometry (PY-GC-MS) to assess the molecular composition. In six species, ash inhibited the germination, while in another five species, germination was not affected by ash or by BC. In Q. rubra, ash and BC stimulated its germination. This stimulating effect of the BC on Q. rubra is likely to be related to the chemical composition of the ash and BC obtained from Ulex feedstock. The BC of U. europaeus has a very different molecular composition than the other BC samples analysed, which, together with other factors, probably allowed for its germination stimulating effects.This study was carried out within the Project 10MDS200007PR, financed by the Xunta de Galicia; the Project AGL2013-48189-C2-2-R, financed by the Ministerio de Economía y Competitividad, Spain; and FEDERS

The perioperative management of new direct oral anticoagulants: a question without answers

Summary New direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for longterm prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1-5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed

Fisiología aplicada a la fluidoterapia

En este capítulo se plantean como objetivos de conocimiento: - Comprender la dinámica de los fluidos que se administran durante cualquier acto médico a partir de la comprensión de la fisiología, que se encuentra en la base de toda práctica anestésica y es esencial en el campo de la fluidoterapia. - Entender la evolución del concepto de movimiento de fluidos a través del endotelio y las membranas celulares, en lo que se ha denominado ley de Starling modificada, que supone un avance importante en el conocimiento de cuáles son las mejores opciones en cada una de las situaciones clínicas, sobre todo en el contexto quirúrgico. - Conocer qué es el glicocálix y su papel en la regulación del mantenimiento de los fluidos en el espacio intravascular

Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update.

Journal Article; Review;The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST), myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.Ye