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Resumen: La oxigenación por membrana extracorpórea (extracorporeal membrane oxygenation, ECMO) es un sistema extracorpóreo de asistencia cardiorrespiratoria cuya utilización se ha visto incrementada en la última década. La insuficiencia respiratoria, el shock postcardiotomía y el fallo primario del injerto cardíaco o pulmonar son complicaciones que pueden requerir la utilización de asistencia mecánica cardiorrespiratoria y, en este escenario, el conocimiento de las peculiaridades perioperatorias médicas y quirúrgicas es fundamental.A pesar de la evolución tecnológica en el área de la asistencia extracorpórea, la morbimortalidad de estos pacientes continúa siendo elevada, por lo tanto, la decisión del implante de la ECMO como la de su retirada debe establecerse dentro de un equipo multidisciplinar experto en el área.El presente documento de consenso pretende unificar conocimientos y aportar recomendaciones basadas tanto en la bibliografía reciente como en la experiencia de los principales centros nacionales implantadores de ECMO con el objetivo final de mejorar la atención integral al paciente. Abstract: ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial.Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area.This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centers experience with the goal of improving comprehensive patient care.

Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future.

Resumen A pesar de la extendida y frecuente utilizacion del cateter de arteria pulmonar en nuestro medio para el manejo hemodinamico en pacientes criticos y particularmente en pacientes tras cirugia cardiaca, en la actualidad siguen planteandose dudas sobre la necesidad de su uso. Es preciso valorar el riesgo/beneficio de su colocacion y tener en cuenta sus posibles complicaciones, que aun siendo poco frecuentes, pueden llegar a ser potencialmente graves. En este articulo exponemos una complicacion muy poco frecuente ocurrida en nuestro centro sobre el uso del cateter de arteria pulmonar de la que no teniamos constancia hasta ahora. Se trata de una perforacion del tabique interventricular y de la pared libre del ventriculo izquierdo debido a una acodadura firme del cateter de arteria pulmonar, que no fue sospechada ni diagnosticada salvo por la vision directa del corazon, tras la esternotomia, durante la cirugia cardiaca. La mejora de la seguridad del paciente implica reflexionar sobre el valor de los eventos adversos, de manera que al aumentar la conciencia de la situacion y del mecanismo por el que se producen, pueda reducirse la probabilidad de repeticion.

ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centers experience with the goal of improving comprehensive patient care. (C) 2021 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.

Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future.

The aim of this work is to analyse the origin of phenotypic plastic changes into a biologic structure, in this case the hip. As a hypothesis of the work, the possibility that changes could be explained following the Lamarckian paradigm, opposed to the Darwinian paradigm, is shown. The section material and methods of this work have been published in part I. Studies in plants and fish have been added.Results showed that the ball-and-socket design of the hip joint remains unchanged. Phenotype in the elements that form the hip joint tissues showed significant plastic changes.Interpretation of our results suggest that changes in phenotype plasticity of the hip joint are immanent to phenotype and cannot be explained by following Lamarck's or Darwin's paradigm.

A 45-year-old woman with a posterior mediastinal tumor underwent right thoracotomy for resection, developing hypertension and difficult-to-control tachycardia while the tumor was being manipulated. A catecholamine-secreting tumor was suspected, the operation halted, and the patient prepared for surgery at a later time. The tumor was a mediastinal paraganglioma and the final outcome was satisfactory. Risk related to anesthesia is high in such patients, with perioperative mortality ranging from 40 to 85%. Correct diagnosis and appropriate preoperative drug preparation with adrenergic receptor blockers appreciably decreases morbidity and mortality related to surgery. We discuss the effect of labetalol on such tumors and describe our observations.