Papers by Guillermina Fita
Journal of cardiothoracic and vascular anesthesia, 2007
Cardiac surgery in Jehovah's witness patients remains a challenge in the presence of low blood vo... more Cardiac surgery in Jehovah's witness patients remains a challenge in the presence of low blood volume and reduced hemoglobin (Hb). Perisurgical rHuEPO has proven useful to accelerate red blood cell production and increase Hb to reduce the risk of allogeneic blood transfusion. We report a case of a 57-year-old female Jehovah's witness suffering from severe calcified mitral valve stenosis with severe pulmonary hypertension and massive tricuspid insufficiency. The patient showed a poor quality of health and auricular fibrillation undergoing acenocumarol treatment. The patient was scheduled for mitral replacement and tricuspid annuloplasty surgery, and she refused all blood derivatives. In the preoperative assessment, laboratory results showed that there was a normochromic normocytic morphology, with levels of Hb of 12 g/dL, ferritin levels of 360 ng/mL (normalized ratio [NR] of 15-200), transferrin of 2.54 g/L (NR of 1.93-3.08), and soluble transferrin receptor of 2.03 mg/L (NR of 0.83-1.76). The patient was treated with 2 doses of both 200 mg of intravenous iron and 40,000 U of subcutaneous epoetin alfa (rHuEPO), in a week, and a third dose 2 days after the second one. This treatment was approved as a merciful use. A week after the last dose, the patient suffered a sudden onset of left hemiplegia, with facial paralysis and gaze deviation to the right. The cranial computerized axial tomography did not show alterations. At that time, Hb was 12.4 g/dL, and the platelet count was 362,000/L. Blood pressure was 107/60 mmHg. Control of anticoagulation gave an international normalized ratio value of 3.0. Three hours after disappearance of the symptoms the patient was discharged from the emergency room with the diagnosis of transient ischemic attack (TIA) and any additional treatment was added.
European Journal of Anaesthesiology, 2002
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Revista Española de Anestesiología y Reanimación, 2008
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European Journal of Anaesthesiology, 2006
anestesiologÍa EUR J ANAESTHESIOL. 2008 FEB;25(2):135-43. transoesopHageal ecHocardiograpHY accUr... more anestesiologÍa EUR J ANAESTHESIOL. 2008 FEB;25(2):135-43. transoesopHageal ecHocardiograpHY accUratelY detects cardiac oUtpUt Variation: a prospectiVe comparison witH tHermodilUtion in cardiac sUrgerY. Parra V, Fita G, Rovira I, Matute P, Gomar C, Paré C. BACKGROUND AND OBJECTIVE: Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques. METHODS: Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 +/-14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12 degrees C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre-and post-cardiopulmonary bypass. RESULTS: Echo-Doppler measurements were obtained in 44 patients (88%). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland-Altman analysis revealed a bias of 0.015 L min(-1), with narrow limits of agreement (-1.21 to 1.22 L min(-1)) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study. CONCLUSIONS: The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.
Cirugía Cardiovascular, 2014
Revista médica de Chile, 2011
Background: Neuropsychological dysfunction is a major cause of morbidity and mortality after card... more Background: Neuropsychological dysfunction is a major cause of morbidity and mortality after cardiac surgery. Aim: To evaluate if intraoperative cerebral desaturation and depth of anesthesia measured by bispectral index are related to postoperative cognitive dysfunction in cardiac surgery. Material and Methods: Prospective study in patients undergoing elective cardiac surgery with cardiopulmonary bypass. A comprehensive neuropsychological assessment was applied preoperatively and 3 months after surgery. Postoperative dysfunction was defi ned as a decrease of at least one standard deviation in two or more neuropsychological tests. Cerebral oxygenation and bispectral index were continuously recorded and corrected throughout surgery. Cerebral oxygenation data were analyzed by the mean value and at three thresholds: 50%, 40% and < 25% of the basal value. Bispectral index was analyzed at threshold of 45. Results: Fifty-six patients were initially enrolled and 48 completed the study. Nine of these (18.8 %) presented postoperative cognitive dysfunction. Mean cerebral saturation and bispectral index data were not different among the patients with or without cognitive dysfunction. There was no association between cerebral desaturation and bispectral index with changes in neurocognitive tests or with length of stay in the intensive care unit. A signifi cant but weak correlation was found between baseline Ray-neurocognitive score and intensive care unit stay (rho = -0.46; P = 0.001). Conclusions: We did not fi nd a signifi cant association between cerebral desaturation and depth of anesthesia with postoperative cognitive decline in this population of patients. (Rev Med Chile 2011; 139: 1553-1561.
European Journal of Anaesthesiology, 2000
Journal of Cardiothoracic and Vascular Anesthesia - J CARDIOTHORAC VASC ANESTH, 1999
M YXOMAS ARE THE most frequent benign cardiac neoplasm. Two to three times more common in women t... more M YXOMAS ARE THE most frequent benign cardiac neoplasm. Two to three times more common in women than men, they are intracavitary tumors usually appearing in the left atrium. Most atrial myxomas arise from the atrial septum and project into the atrial chamber. They are generally polypoid and pedunculated, with a diameter ranging from 1 to 15 cm. Myxomas are composed of cells, primitive capillaries, and loci of extramedullary hematopoiesis within a myxoid matrix of acid mucopolysaccharide. Symptoms are usually of short duration, episodic, and associated with syncope, but a wide range of symptoms (from hemodynamic impairment as a result of obstruction of flow across the atrioventricular valve to syncope or sudden death; embolization; or constitutional symptoms, including fever, weight loss, clubbing of fingers, myalgia, and arthralgia) can occur. Two-dimensional echocardiography is the most appropriate screening and diagnostic imaging tool. Surgical removal is indicated on diagnosis and is generally considered an emergency procedure. 1 A case is reported of a patient with heart failure and severe pulmonary hypertension secondary to a left atrial myxoma treated with inhaled nitric oxide (NO) before and after cardiac surgery for removal of the myxoma.
Journal of Cardiothoracic and Vascular Anesthesia, 1991
The aim of this study was to assess the incidence of adverse responses to antibiotic prophylaxis ... more The aim of this study was to assess the incidence of adverse responses to antibiotic prophylaxis with vancomycin in cardiac surgical patients. Prospectively, 116 consecutive patients (106 adults and 10 children) undergoing cardiac surgical procedures in this institution from January to June 1990 were studied. After the anesthetic induction, vancomycin, 1 g in adults and IO mglkg in children, was intravenously administered over 30 minutes. The infusion rate was slowed if any adverse effect was observed. As a control group, IO similar patients were evaluated during the same period of 30 minutes after anesthetic induction but prior to vancomycin administration and surgical stimulation. Thirty-one patients (26.72%) developed an adverse effect, mainly hypotension (29 patients, 25%). which was considered severe in 15 patients (12.93%). Seven patients (6.03%) developed a macu-
Intensive Care Medicine, 1996
Background: Normal cardiovascular function is regulated by a continouos synthesis of the endogeno... more Background: Normal cardiovascular function is regulated by a continouos synthesis of the endogenous vasodilator nitric oxide (NO) from endothelial cells by the constitutive nitric oxide synthase enzyme (cNOS). In septic states NO synthesis is stimulated by the inducible isoform of the enzyme (iNOS) leading to the excesive vasodilation and hypotension characteristic of septic shock (SS). The inhibition of both NOS enzymes can reverse the hypotensive state of SS, while the administration of exogenous gas NO by inhalation produce selective pulmonary vasodilation and improves gas-exchange, both in animals (1,2) and humans (3,4). Objective: To investigate the effects of selective and non-selective inhibitors of endogenous NO synthesis and the effects of inhaled exogenous NO upon haemodynamics and gas-exchange in an experimental model of SS. Materials and Methods: We studied 8 anesthetized and mechanically ventilated adult sheep with SS induced by a continuous infusion (20 ng/kg.min) of E. Coli lipopolysa ccharide (LPS) for 6 hours. After baseline maesurements (BAS) endotoxin was administered for 6 hours (LPS), then 50 mg/kg of aminoguanidine (AG), a selective inhibitor of iNOS was given i.v., thereafter 40 parts per million (ppm) of NO gas was given by inhalation for 30 min (NO) and then 30 mg/Kg of N~-nitro-L-arginine (L-NA) a inhibitor of both NOS isoenzymes was administered while breathing NO in oxygen. Systemic and pulmonary haemodynamics and arterial blood gas tension (PaO2) were measured at each step. Results: After 6 hours of LPS infusion all animals showed a haemodynamic state characterized by systemic hypotension (mean SAP decreased from 100+7 to 74+_3 mmHg), low cardiac output (CO decreased from 3.8+_0.8 to 2.29+_0.4 l/rain), pulmonary hypertension (mean PAP increased from 18+_1 to 29+_4 mmHg) and severe hypoxemia (PaO2 decreased from 238+_36 to 88+_43 mmHg). AG administration increased SAP to 88+_6 mmHg and CO to 3.06+_0.4 l/min without effects on PAP or PaO2. NO inhalation decreased PAP to 22+_3 mmHg and improved gas-exchange by increasing PaO2 to 108+_38 mmHg. With i.v. L-NA during NO inhalation SAP increased to 103+_8 mmHg but CO decreased to 2.14+_0.2 1/min, PAP did not change and PaO2 increased to 160+_35 mmHg (p<0.05 all).
European Journal of Anaesthesiology, 2000
European Journal of Anaesthesiology, 2002
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2005
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2006
anestesiologÍa EUR J ANAESTHESIOL. 2008 FEB;25(2):135-43. transoesopHageal ecHocardiograpHY accUr... more anestesiologÍa EUR J ANAESTHESIOL. 2008 FEB;25(2):135-43. transoesopHageal ecHocardiograpHY accUratelY detects cardiac oUtpUt Variation: a prospectiVe comparison witH tHermodilUtion in cardiac sUrgerY. Parra V, Fita G, Rovira I, Matute P, Gomar C, Paré C. BACKGROUND AND OBJECTIVE: Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques. METHODS: Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 +/-14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12 degrees C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre-and post-cardiopulmonary bypass. RESULTS: Echo-Doppler measurements were obtained in 44 patients (88%). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland-Altman analysis revealed a bias of 0.015 L min(-1), with narrow limits of agreement (-1.21 to 1.22 L min(-1)) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study. CONCLUSIONS: The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.
European Journal of Anaesthesiology, 2006
Of the 34 patients studied 7 had significantly different reaction (r) times between plain and hep... more Of the 34 patients studied 7 had significantly different reaction (r) times between plain and heparinase samples (difference greater than 5 minutes). This group accounted for both of the re-sternotomies which occurred within the cohort, experienced greater blood loss and consumed more blood products per capita (mean 2 units per capita) than the remaining 27 patients (mean 0.5 units per capita).
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Papers by Guillermina Fita