Patient Blood Management: A conceptual and analytical vision from the leadership in Spain.

The evolution of blood saving programs to Patient Blood Management (PBM) represents a broader and more comprehensive approach to optimize the use of the patient's own blood, thus improving clinical outcomes and minimizing the risks associated with allogeneic blood transfusion with a holistic view of socio-economic sustainability. Implementing the strategies of the three PBM pillars in any hospital center involves a transversal change throughout the organization in which it can be very useful to apply the strategy defined by Kotter at the business level for change management. The support of renowned institutions such as the World Health Organization and the European Commission demonstrates the importance and urgency of implementing PBM programs, setting guidelines at an international level and supporting the adoption of effective strategies in the management of blood transfusion at a national and institutional level.

Transfusion-associated adverse events incidence and severity after the implementation of an active hemovigilance program with 24 h follow-up. A prospective cohort study.

Background: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program.

Study Design And Methods: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion.

Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement.

Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the prevention and treatment of postpartum haemorrhage as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, and transfusion medicine was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA).

Contraception, pregnancy and rare respiratory diseases.

Three percent of rare diseases are pneumopathies. Improvements in survival and quality of life have led to a new situation where patients with rare respiratory diseases want to plan their reproductive lives. The intention of this review is to present the experience accumulated in the field of the reproductive health of these women.

Maternity and lung transplantation: cases in Spain.

We contacted and analyzed the data of 18 lung transplant recipients who had had children. The complications we detected included: hypertension (50%), diabetes mellitus (21%), preeclampsia (13%), infection (21%), rejection (30%), loss of graft function (23%) and a lower percentage of live births than in transplant recipients of other organs. Other aspects to keep in mind are: the potential risk for fetal alterations (caused by drugs used as prophylaxis against rejection crossing the placental barrier); greater risk for infection and alterations in drug levels due to changes in metabolism typical of pregnancy and postpartum period.

[Efficacy of low-dose oxytocin during elective cesarean section].

Background And Objective: In cesarean section, the optimal dose of oxytocin to reduce the risk of hemorrhage with the least risk of adverse effects has yet to be defined. We studied the effects of using 2 different doses of oxytocin in women undergoing elective cesarean section under spinal anesthesia. The women had had no prior labor.

[Paresthesia and spinal anesthesia for cesarean section: comparison of patient positioning].

Objective: To determine the incidence of paresthesia during lumbar puncture performed with the patient in different positions.

Material And Methods: A single-blind prospective study of patients scheduled for elective cesarean section, randomized to 3 groups. In group 1 patients were seated in the direction of the long axis of the table, with heels resting on the table.

[Is oxygen therapy truly useful and necessary during elective cesarean section under spinal anesthesia?].

Objective: To analyze maternal and fetal well-being with and without the application of oxygen therapy.

Material And Methods: Randomized trial of full-term parturients who had received prenatal care during pregnancy. The women were healthy and classified as ASA 1.

[Continuous subarachnoid analgesia and anesthesia for labor and cesarean section in a patient who had previously undergone surgery for ependymoma].

We report the case of a 38-year-old primipara who had undergone surgery 2 years earlier for an intradural ependymoma at L2-L3 and who was currently asymptomatic. A combined epidural-subarachnoid block was performed for analgesia during labor but this technique was only effective for the first 2 hours. When analgesia via epidural cannula was no longer adequate, it was decided to perform a continuous subarachnoid block.

[Air embolism during elective cesarean section, and uterine atony due to fetal macrosomia].

We report the case of a paradoxical air embolism during a scheduled cesarean section for fetal macrosomia (7.010 kg) in a 38-year-old woman with a history of gestational diabetes and preeclampsia. Spinal anesthesia was satisfactory and well tolerated.

[Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases].

Objectives: To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia.

Methods: One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord.

[Experience with uterine artery embolization in the treatment of massive postpartum hemorrhage].

Objective: To analyze our experience with uterine artery embolization in the management of massive hemorrhage in obstetric patients.

Patients And Methods: This observational, retrospective study analyzed all deliveries requiring a blood transfusion that were performed in the maternity unit of Hospital Universitario La Paz between January 1, 2000 and December 31, 2005.

Results: A total of 57,835 deliveries were performed with an incidence of postpartum hemorrhage of 0.

[Cesarean section in a woman with acute blood-stage malaria].

Malaria infection during pregnancy is a serious health problem in most of the world's tropical regions. The disease has also been imported into Western countries, however, as an increasing number of infected women, who may become pregnant, emigrate from areas where malaria is endemic. Infection during pregnancy can have serious repercussions for both mother and fetus.

[Emergency cesarean in a patient with Coffin-Siris syndrome].

Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia.

[Acute myocardial infarction during tocolytic treatment with ritodrine].

Ritodrine, a beta2-adrenergic agonist with a selective effect on the uterine muscle, is prescribed to prevent premature labor and to treat a hypertonic uterus. At therapeutic doses ritodrine has chronotropic and peripheral vasodilator effects. At high doses it has been related to sporadic cases of subendocardial necrosis, pulmonary edema, and death in pregnancy.

[Comparison of 2 techniques for combined spinal-epidural analgesia for advanced labor in childbirth].

Objectives: To assess whether using a needle-locking device in combined spinal-epidural analgesia leads to better quality of pain relief for advanced stages of obstetric labor than can be achieved with conventional materials.

Patients And Methods: A total of 230 women in advanced labor were randomized to 2 groups. In both groups the needle-through-needle technique was used.

[Postpartum seizures in 2 epileptic patients].

We report the cases of 2 women with epilepsy who suffered generalized postpartum seizures on the first day after giving birth. The first had a history of febrile convulsions in childhood and had a seizure in the 36th week of gestation due to sleep deprivation. She had received epidural analgesia for labor pain.

[Amniotic fluid embolism: review].

The amniotic fluid embolism, is a very uncommon syndrome but because of its severity and high mortality, it is interesting to study and to get a deep knowledge of its etiopathogenia and physiopathology. In this article, we revise the actually purposed pathogenic mechanisms, specially the humoral mechanisms in front of mechanical, as it was defended a few years ago. The diagnostic of this syndrome, is an interesting question, because it is not only pathology, actually it trends to immunologic diagnosis.

[Anesthesia for vertebral osteoclasis in a patient with severe predominantly cervical spondylitis ankylopoietica].

We present a patient suffering severe, mainly cervical, ankylopoietic spondylitis who was scheduled for posterior vertebral osteoclasis under local anesthesia. We describe handling of anesthesia, particularly airway control by flexible bronchoscopy in an awake, locally anesthetized patient sedated with benzodiazepines and inhalational anesthetics as compared with other alternatives: an awake patient who is not intubated, under local anesthesia and sedated with narcotics and gaseous anesthetics, or a patient under general anesthesia with placement of a flexible bronchoscope and neurological monitoring by evoked potentials. The surgical technique was Simmons' posterior vertebral osteoclasis, with the column extended and immobilized with wire.