Panadero-Sánchez, A. (Alfredo)
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- Influence of chemotherapy within 30 days before ICU admission on mortality in critically ill medical patients with cancer(SAGE Publications, 2019) Panadero-Sánchez, A. (Alfredo); Vives, M. (Marc); Monedero, P. (Pablo); Calderón-Pelayo, R. (Ricardo); Leon-Sanz, P. (Pilar); Calderón-Breñosa, P. (Pilar)Background: The main objective was to determine whether the administration of chemotherapy (CT) during the month before intensive care unit (ICU) admission of medical patients with cancer influences the survival rate. The design was a single-institution observational cohort study in an ICU of a tertiary university hospital. Methods: Our cohort included 248 oncology patients admitted to the ICU from 2005 to 2014 due to nonsurgical problems. Seventy-six (30.6%) patients had received CT in the month before admission (CT group) and 172 did not receive CT (control group). The main outcome measures were ICU, hospital, 30- day, 90-day, and 1-year mortalities. We performed survival analysis using the Kaplan-Meier estimator, comparing both groups using the log-rank test, and multivariate analysis using Cox regression adjusted for gender, age, maximum Sequential Organ Failure Assessment (SOFA), and delta maximum SOFA to calculate the hazard ratios (HRs) and their respective 95% confidence intervals. This association was also evaluated by a graphic representation of survival. Results: The CT group presented an ICU mortality rate of 27.6% versus 25.5% in the control group. The multivariate analysis adjusted for age, sex, and delta maximum SOFA showed significant differences between the groups (HR: 2.12; P ¼ .009). The hospital mortality rate was 55.3% in the CT group compared to 45.4% in the control group (adjusted HR: 1.81; P ¼ .003). At 30 days, the mortality rate was 56.6% in the CT group compared to 46.5% in the control group (adjusted HR: 1.69; P ¼ .008). Mortality at 90 days was 65.8% in the CT group versus 59.9% in the control group (adjusted HR: 1.47; P ¼ .03). One-year mortality was also higher in the CT group (79% vs 72.7%, adjusted HR: 1.44; P ¼ .02). Conclusion: The administration of CT in the month before ICU admission in patients with cancer was associated with higher mortality in the ICU, in the hospital, and 30 and 90 days after admission when adjusted for the increase in organ failure measured by delta maximum SOFA. We provide useful new information for decision-making about ICU management of patients with cancer.
- Effect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomy(2023) Panadero-Sánchez, A. (Alfredo); Valencia, M. (Miguel); Martinez-Simon, A. (Antonio); Cacho-Asenjo, E. (Elena); Manzanilla-Zapata, Ó. (Óscar); Honorato-Cía, C. (Cristina); Alegre-Esteban, M. (Manuel); Rubio-Baines, I. (I.); Nuñez-Cordoba, J.M. (Jorge M.)Background: Sugammadex has been associated with increases in the bispectral index (BIS). We evaluated the effects of sugammadex administration on quantitative electroencephalographic (EEG) and electromyographic (EMG) measures.Methods: We performed a prospective observational study of adult male patients undergoing robot-assisted radical prostatectomy. All patients received a sevoflurane-based general anaesthetic and a continuous infusion of rocuronium, which was reversed with 2 mg kg(-1) of sugammadex i.v. BIS, EEG, and EMG measures were captured with the BIS VistaTM monitor.Results: Twenty-five patients were included in this study. Compared with baseline, BIS increased at 4-6 min (13 coefficient: 3.63; 95% confidence interval [CI]: 2.22-5.04; P<0.001), spectral edge frequency 95 (SEF95) increased at 2-4 min (13 coefficient: 0.29; 95% CI: 0.05-0.52; P=0.016) and 4-6 min (13 coefficient: 0.71; 95% CI: 0.47-0.94; P<0.001), and EMG increased at 4-6 min (13 coefficient: 1.91; 95% CI: 1.00-2.81; P<0.001) after sugammadex administration. Compared with baseline, increased beta power was observed at 2-4 min (13 coefficient: 93; 95% CI: 1-185; P=0.046) and 4-6 min (13 co-efficient: 208; 95% CI: 116-300; P<0.001), and decreased delta power was observed at 4-6 min (13 coefficient: -526.72; 95% CI: -778 to -276; P<0.001) after sugammadex administration. Neither SEF95 nor frequency band data analysis adjusted for EMG showed substantial differences. None of the patients showed clinical signs of awakening.Conclusions: After neuromuscular block reversal with 2 mg kg(-1) sugammadex, BIS, SEF95, EMG, and beta power showed small but statistically significant increases over time, while delta power decreased.
- Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient(Gobierno de Navarra, 2022) Panadero-Sánchez, A. (Alfredo); Colombas, J. (J.); Belinchón-de-Diego, E. (E.); Martínez-Alcaraz, A. (A.); Rubio-Baines, I. (I.)La inducción anestésica inhalatoria con sevoflurano es muy empleada en la población pediátrica. Si bien los efectos sistémicos más comunes son ampliamente conocidos, no se conocen todos los efectos secundarios de este fármaco. Presentamos el caso clínico de un varón de cuatro años que desarrolló un episodio de taquicardia supraventricular sostenida tras la inducción anestésica con sevoflurano, que no cedió hasta que no se retiró el fármaco y se sustituyó el mantenimiento anestésico por una perfusión continua de fármacos hipnóticos intravenosos (propofol y remifentanilo). Desconocemos el mecanismo exacto por el que este episodio ha tenido una relación causal tan clara con la administración de sevoflurano; las posibilidades diagnósticas serían la taquicardia por reentrada intranodal o la existencia de una vía accesoria. No hemos encontrado en la literatura un episodio de taquicardia supraventricular mantenida con una relación causal directa con la administración de sevoflurano como en el caso que presentamos.
- Inflation of the endotracheal tube cuff in the pharynx for ventilation of paralyzed patients with unanticipated difficult airway(Lippincott, Williams & Wilkins, 1999) Panadero-Sánchez, A. (Alfredo); Macias, A. (Antonio); Monedero, P. (Pablo); Olavide, I. (Isidro); Mendieta, J.M. (José Manuel); Fernandez-Liesa, I. (Ignacio)
- Effects of dexmedetomidine on subthalamic local field potentials in parkinson's disease(Elsevier, 2021) Panadero-Sánchez, A. (Alfredo); Aldaz, A. (Azucena); Guridi-Legarra, J. (Jorge); Valencia, M. (Miguel); Martinez-Simon, A. (Antonio); Cacho-Asenjo, E. (Elena); Manzanilla-Zapata, Ó. (Óscar); Honorato-Cía, C. (Cristina); Alegre-Esteban, M. (Manuel); Nuñez-Cordoba, J.M. (Jorge M.)Background: Dexmedetomidine is frequently used for sedation during deep brain stimulator implantation in patients with Parkinson's disease, but its effect on subthalamic nucleus activity is not well known. The aim of this study was to quantify the effect of increasing doses of dexmedetomidine in this population. Methods: Controlled clinical trial assessing changes in subthalamic activity with increasing doses of dexmedetomidine (from 0.2 to 0.6 μg kg-1 h-1) in a non-operating theatre setting. We recorded local field potentials in 12 patients with Parkinson's disease with bilateral deep brain stimulators (24 nuclei) and compared basal activity in the nuclei of each patient and activity recorded with different doses. Plasma levels of dexmedetomidine were obtained and correlated with the dose administered. Results: With dexmedetomidine infusion, patients became clinically sedated, and at higher doses (0.5-0.6 μg kg-1 h-1) a significant decrease in the characteristic Parkinsonian subthalamic activity was observed (P<0.05 in beta activity). All subjects awoke to external stimulus over a median of 1 (range: 0-9) min, showing full restoration of subthalamic activity. Dexmedetomidine dose administered and plasma levels showed a positive correlation (repeated measures correlation coefficient=0.504; P<0.001). Conclusions: Patients needing some degree of sedation throughout subthalamic deep brain stimulator implantation for Parkinson's disease can probably receive dexmedetomidine up to 0.6 μg kg-1 h-1 without significant alteration of their characteristic subthalamic activity. If patients achieve a 'sedated' state, subthalamic activity decreases, but they can be easily awakened with a non-pharmacological external stimulus and recover baseline subthalamic activity patterns in less than 10 min.
- Effect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomy(Elsevier, 2023) Panadero-Sánchez, A. (Alfredo); Valencia, M. (Miguel); Martinez-Simon, A. (Antonio); Cacho-Asenjo, E. (Elena); Manzanilla-Zapata, Ó. (Óscar); Honorato-Cía, C. (Cristina); Alegre-Esteban, M. (Manuel); Rubio-Baines, I. (I.); Nuñez-Cordoba, J.M. (Jorge M.)Background: Sugammadex has been associated with increases in the bispectral index (BIS). We evaluated the effects of sugammadex administration on quantitative electroencephalographic (EEG) and electromyographic (EMG) measures. Methods: We performed a prospective observational study of adult male patients undergoing robot-assisted radical prostatectomy. All patients received a sevoflurane-based general anaesthetic and a continuous infusion of rocuronium, which was reversed with 2 mg kg1 of sugammadex i.v. BIS, EEG, and EMG measures were captured with the BIS Vista™ monitor. Results: Twenty-five patients were included in this study. Compared with baseline, BIS increased at 4e6 min (b coefficient: 3.63; 95% confidence interval [CI]: 2.22e5.04; P<0.001), spectral edge frequency 95 (SEF95) increased at 2e4 min (b coefficient: 0.29; 95% CI: 0.05e0.52; P¼0.016) and 4e6 min (b coefficient: 0.71; 95% CI: 0.47e0.94; P<0.001), and EMG increased at 4e6 min (b coefficient: 1.91; 95% CI: 1.00e2.81; P<0.001) after sugammadex administration. Compared with baseline, increased beta power was observed at 2e4 min (b coefficient: 93; 95% CI: 1e185; P¼0.046) and 4e6 min (b coefficient: 208; 95% CI: 116e300; P<0.001), and decreased delta power was observed at 4e6 min (b coefficient: 526.72; 95% CI: 778 to 276; P<0.001) after sugammadex administration. Neither SEF95 nor frequency band data analysis adjusted for EMG showed substantial differences. None of the patients showed clinical signs of awakening. Conclusions: After neuromuscular block reversal with 2 mg kg1 sugammadex, BIS, SEF95, EMG, and beta power showed small but statistically significant increases over time, while delta power decreased.
- Protección renal perioperatoria: bases fisiopatológicas de la insuficiencia renal aguda y medidas profilácticas(Elsevier España, 1998) Panadero-Sánchez, A. (Alfredo); Sainz, N. (N.); Monedero, P. (Pablo)