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Objectives To obtain a gene expression signature to distinguish between septic shock and non-septic shock in postoperative patients, since patients with both conditions show similar signs and symptoms. Methods Differentially expressed genes were selected by microarray analysis in the discovery cohort. These genes were evaluated by quantitative real time polymerase chain reactions in the validation cohort to determine their reliability and predictive capacity by receiver operating characteristic curve analysis. Results Differentially expressed genes selected were IGHG1, IL1R2, LCN2, LTF, MMP8, and OLFM4. The multivariate regression model for gene expression presented an area under the curve value of 0.922. These genes were able to discern between both shock conditions better than other biomarkers used for diagnosis of these conditions, such as procalcitonin (0.589), C-reactive protein (0.705), or neutrophils (0.605). Conclusions Gene expression patterns provided a robust tool to distinguish septic shock from non-septic shock postsurgical patients and shows the potential to provide an immediate and specific treatment, avoiding the unnecessary use of broad-spectrum antibiotics and the development of antimicrobial resistance, secondary infections and increase health care costs.

Median arcuate ligament syndrome, also known as celiac artery compression syndrome, is a rare and unusual clinical disorder. Its symptoms are non-specific, which complicates its diagnosis, and a multidisciplinary approach is required to treat the disorder. The ligament is circumferentially cleared by laparoscopy. Selective angiography and endovascular techniques may be used after laparoscopy. Vital organs and important vascular structures can be injured during the surgery. The combination of different procedures, as well as the high risk of damage, make this process a significant challenge for the anaesthetist. During corrective surgery for median arcuate ligament syndrome, general anaesthesia must be adapted to the various haemodynamic and ventilatory requirements, and strict control of pain established, as oral tolerance is a key factor in the post-operative recovery of these patients.

Resumen El sindrome del ligamento arcuato medio, o sindrome de compresion del tronco celiaco, es un cuadro clinico poco frecuente. La especificidad de sus sintomas hace dificil su diagnostico. En el caso descrito la correccion quirurgica del sindrome del ligamento arcuato medio preciso un abordaje multidisciplinar. Inicialmente se realizo una descompresion laparoscopica y, posteriormente, control angiografico y procedimientos endovasculares. La combinacion de diferentes tecnicas intervencionistas, asociada al riesgo de lesion de organos y estructuras vasculares importantes, convirtieron esta enfermedad en un reto para el anestesiologo. Durante la cirugia de correccion del sindrome del ligamento arcuato medio, la anestesia general ha de adaptarse a los diferentes requerimientos hemodinamicos y ventilatorios, y se ha de establecer un estrecho control del dolor, ya que el inicio de la tolerancia oral es un factor clave en la recuperacion postoperatoria de estos pacientes.

Mitochondrial dysfunction comprehends a wide range of genetic disorders. These patients’ precarious metabolic balance makes its management difficult. Furthermore, the same systems affected by mitochondrial disease can be altered by many of the frequently used anesthetic agents. Each patient has to be evaluated individually according to their comorbidities and anesthetic requirements.

Introduction The quality of postoperative recovery is one of the most important among all the quality indicators used in clinical situations. This is even more important after cancer surgery. Our aim was to evaluate this after non-reconstructive breast surgery under general anaesthesia and paravertebral blockade or serratus–intercostal plane blockade, in the early and late post-operative period. Material and methods A prospective observational study was conducted on 60 patients (25 paravertebral blockade group and 35 serratus–intercostal plane blockade group) scheduled for non-reconstructive breast surgery during a 6 month period. Every patient received general anaesthesia and were randomised to receive either paravertebral blockade or serratus–intercostal plane blockade. The quality of post-anaesthetic recovery was quantified by Postoperative Quality Recovery Scale, which is used to assess physiological, nociceptive, emotional, autonomy, cognitive and general state domains at different times: baseline (before surgery), 15 min after the end of surgery, at discharge to home, and one month after surgery. Results A total recovery of 95.93% was achieved in the early postoperative period (15 min PACU), 99.07% at discharge to home, and 99.25% at one month after the intervention. No significant differences were found between groups in total score or in each evaluated area. Conclusions A progressive improvement was observed in the scores assessed with the Postoperative Quality Recovery Scale, reaching values that would allow the discharge to home and early return to usual active life from the immediate postoperative period, with no significant differences between the 2 analgesic techniques. Savings in opioid use and the excellent recovery were observed in all measured domains observed.