Honorato-Cía, C. (Cristina)
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- Bilateral subgaleal hematoma after a robot-assisted radical prostatectomy: an uncommon complication(2023) Martinez-Simon, A. (Antonio); Ancizu, F.J. (Francisco Javier); Olavide, I. (Isidro); Honorato-Cía, C. (Cristina); Rubio-Baines, I. (I.)Robot-assisted radical prostatectomy is a relatively re-cent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema.We present a case of a 62-year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully.Robot-assisted radical prostatectomy can be a challeng-ing procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trende-lenburg, a non-assessed jugular vein insufficiency, and/or patient's obesity.
- Experiencia del centro de simulación de la Facultad de medicina de la Universidad de Navarra(Facultad de Medicina y Ciencias de la salud de la Universidad de Alcalá, 2021) Uruñuela, N. (Nekane); Martin-Calvo, N. (Nerea); Fernández-González, S. (Secundino); Valencia, D. (David); Alcalde, J. (Juan); Pueyo-Villoslada, F.J. (Francisco Javier); Díez, J.C. (Juan Carlos); Diez-Goñi, N. (Nieves); Honorato-Cía, C. (Cristina); Orio, R. (Rubén)En los últimos años, las facultades de Medicina se han visto en la necesidad de ofrecer cambios en su forma de impartir la docencia; los alumnos, los pacientes y la normativa han cambiado. Estas circunstancias obligan a una renovación permanente con el objetivo de innovar y alcanzar la excelencia en la docencia universitaria. Fruto de esa renovación, la simulación ha adquirido un papel fundamental en la formación en el Grado de Medicina. La simulación ofrece un entorno seguro y controlado en el que reproducir, tantas veces como sea necesario, situaciones en las que el estudiante va construyendo su aprendizaje a partir de un trabajo explicativo, reflexivo, vivencial y colaborativo. Por otro lado, los avances tecnológicos hacen que las herramientas docentes en simulación sean altamente cambiantes, lo que obliga a una actualización permanente del equipo técnico y del equipo docente. En este monográfico acerca de la simulación en el Grado de Medicina se expondrá la experiencia del Centro de Simulación de la Facultad de Medicina (CSM) de la Universidad de Navarra, que se inauguró en 2011.
- 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.
- 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.