Grupos Investigadores

Líneas de Investigación

  • Neuromonitorización anestésica en Neurocirugía.
  • Hemoterapia en Neurocirugía.
  • Efecto de las diferentes técnicas anestésica en la actividad de los ganglios basales y síntomas motores en pacientes con enfermedad de Parkinson.
  • Dolor agudo y crónico en Neurocirugía.

Palabras Clave

  • Propofol
  • Potenciales de campo local
  • Parkinson
  • Indice biespectral
  • Dexmedetomidina

Publicaciones Científicas desde 2018

  • Autores: Tomás-Biosca Martín, Ana; Martínez Simón, Antonio (Autor de correspondencia); Guridi Legarra, Jorge; et al.
    Revista: JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY
    ISSN 0898-4921 Vol.34 N° 2 2022 págs. 251 - 252
  • Autores: Guridi Legarra, Jorge; González Quarante, Lain Hermes (Autor de correspondencia)
    Revista: WORLD NEUROSURGERY
    ISSN 1878-8750 Vol.147 2021 págs. 11 - 22
    Resumen
    BACKGROUND: Lesioning the Forel field or the subthalamic region is considered a possible treatment for tremoric patients with Parkinson disease, essential tremor, and other diseases. This surgical treatment was performed in the 1960s to 1970s and was an alternative to thalamotomy. Recently, there has been increasing interest in the reappraisal of stimulating and/or lesioning these targets, partly as a result of innovations in imaging and noninvasive ablative technologies, such as magnetic resonance-guided focused ultrasonography. OBJECTIVE: We wanted to perform a thorough review of the subthalamic region, both from an anatomic and a surgical standpoint, to offer a comprehensive and updated analysis of the techniques and results reported for patients with tremor treated with different techniques. METHODS: We performed a systematic review of the literature, gathering articles that included patients who underwent ablative or stimulation surgical techniques, targeting the pallidothalamic pathways (pallidothalamic tractotomy), cerebellothalamic pathway (cerebellothalamic tractotomy), or subthalamic area. RESULTS: Pallidothalamic tractotomy consists of a reduced area that includes pallidofugal pathways. It may be considered an interesting target, given the benefit/risk ratio and the clinical effect, which, compared with pallidotomy, involves a lower risk of injury or involvement of vital structures such as the internal capsule or optic tract. Cerebellothalamic tractotomy and/or posterior subthalamic area are other alternative targets to thalamic stimulation or ablative surgery. CONCLUSIONS: Based on the significant breakthrough that magnetic resonance-guided focused ultrasonography has meant in the neurosurgical world, some classic targets such as the pallidothalamic tract, Forel field, and posterior subthalamic area may be reconsidered as surgical alternatives for patients with movement disorders.
  • Autores: Torroba Sanz, Beatriz (Autor de correspondencia); Mendez Martínez, Elena; Cacho Asenjo, Elena; et al.
    Revista: EUROPEAN JOURNAL OF HOSPITAL PHARMACY - SCIENCE AND PRACTICE
    ISSN 2047-9956 Vol.28 N° 5 2021 págs. 285 - 288
    Resumen
    We describe a Caucasian man in his late 60s who was admitted to the intensive care unit (ICU) with a history of cardiogenic shock secondary to an acute myocardial infarction. The patient's baseline serum creatinine levels were 0.9-1 mg/dL. On day 7 of the admission treatment with quetiapine was initiated due to a delirium episode. The next day the patient developed an erythematous-maculopapular rash and fever, with eosinophilia in the blood count. Over the following days the patient experienced an acute deterioration of kidney function requiring continuous renal replacement therapy. The skin lesions and eosinophilia resolved after withdrawal of quetiapine and systemic steroid therapy was administered. The patient was discharged from the ICU with a serum creatinine level of 2.6 mg/dL. Three months later, blood tests showed no recovery of the kidney function. According to the Naranjo adverse drug reaction probability scale, this event would be classified as 'probable' DRESS syndrome and, based on the RegiSCAR scoring system, was classified as 'definite' DRESS syndrome.
  • Autores: Martínez Simón, Antonio (Autor de correspondencia); Valencia Ustárroz, Miguel; Cacho Asenjo, Elena; et al.
    Revista: BRITISH JOURNAL OF ANAESTHESIA
    ISSN 0007-0912 Vol.127 N° 2 2021 págs. 245 - 253
    Resumen
    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 mg 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 mg 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 mg 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.
  • Autores: Gordo Luis, Cristina (Autor de correspondencia); Núñez Córdoba, Jorge María; Mateo Dueñas, Ricardo
    Revista: JOURNAL OF ADVANCED NURSING
    ISSN 0309-2402 Vol.77 N° 7 2021 págs. 3168 - 3175
    Resumen
    Aims To identify and prioritize the root causes of adverse drug events (ADEs) in hospitals and to assess the ability of artificial intelligence (AI) capabilities to prevent ADEs. Design A mixed method design was used. Methods A cross-sectional study for hospitals in Spain was carried out between February and April 2019 to identify and prioritize the root causes of ADEs. A nominal group technique was also used to assess the ability of AI capabilities to prevent ADEs. Results The main root cause of ADEs was a lack of adherence to safety protocols (64.8%), followed by identification errors (57.4%), and fragile and polymedicated patients (44.4%). An analysis of the AI capabilities to prevent the root causes of ADEs showed that identification and reading are two potentially useful capabilities. Conclusion Identification error is one of the main root causes of drug adverse events and AI capabilities could potentially prevent drug adverse events. Impact This study highlights the role of AI capabilities in safely identifying both patients and drugs, which is a crucial part of the medication administration process, and how this can prevent ADEs in hospitals.
  • Autores: Cacho Asenjo, Elena; Honorato Cia, María Cristina; Núñez Córdoba, Jorge María; et al.
    Revista: MOVEMENT DISORDERS CLINICAL PRACTICE
    ISSN 2330-1619 Vol.8 N° 5 2021 págs. 701 - 708
    Resumen
    Background During magnetic resonance-guided focused ultrasound for essential or parkinsonian tremor, adverse events (headache, nausea/vomiting, or anxiety) may alter the outcome of the procedure despite being mostly transient and mild. Objectives Our aim was to analyze the relationship between demographic, procedural, and anesthetic characteristics with magnetic resonance/ultrasound-related events. Methods This was a retrospective study at the Clinica Universidad de Navarra of patients undergoing thalamotomy with magnetic resonance-guided focused ultrasound between September 2018 and October 2019. The anesthesia protocol included headache and nausea/vomiting prophylaxis and rescue therapy. Dexmedetomidine was used for anxiolysis in some patients after thorough multidisciplinary assessment. Results A total of 123 patients were included. Headache was directly related to skull density ratio (P < 0.001) and skull thickness (P = 0.02). Patients with a skull density ratio less than 0.48 had 3 times the odds of experiencing moderate or severe headache (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.21-7.82) and had a higher odds of aborting sonication due to pain. Sex was associated with increased nausea (P = 0.007). Women had 4 times the odds of nausea than men (OR, 4.4; 95% CI, 1.61-12.11). Dexmedetomidine did not reduce headache or nausea incidence. Patients who received dexmedetomidine had a higher number (P = 0.01) and total minutes of sonication (P = 0.01). Conclusions Patients with lower skull density ratios and higher skull thicknesses could benefit from an aggressive analgesic prophylaxis. Women are more likely to experience nausea. Dexmedetomidine did not reduce headache and nausea, but increased the number and duration of sonications. Its exact effect on tremor is still unclear.
  • Autores: Mendez Martínez, Elena; Cacho Asenjo, Elena; Martínez Simón, Antonio; et al.
    Revista: ANESTHESIA AND ANALGESIA
    ISSN 0003-2999 Vol.133 N° 3S_SUPPL Supl. 2 2021 págs. 977
  • Autores: Cacho Asenjo, Elena; Honorato Cia, María Cristina; Mendez Martínez, Elena; et al.
    Revista: ANESTHESIA AND ANALGESIA
    ISSN 0003-2999 Vol.133 N° 3S_SUPPL Supl. 2 2021 págs. 976
  • Autores: Martínez Simón, Antonio; Cacho Asenjo, Elena; Valencia Ustárroz, Miguel; et al.
    Revista: ANESTHESIA AND ANALGESIA
    ISSN 0003-2999 Vol.133 N° 3S_SUPPL Supl. 2 2021 págs. 938
  • Autores: Iturri, F.; Valencia, L.; Honorato Cia, María Cristina; et al.
    Revista: REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACION
    ISSN 0034-9356 Vol.67 N° 2 2020 págs. 90 - 98
    Resumen
    The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach.
  • Autores: Di Caudo, Carla Gisela; Martínez Valbuena, Iván; Mundinano, I. C.; et al.
    Revista: FRONTIERS IN MOLECULAR NEUROSCIENCE
    ISSN 1662-5099 Vol.13 2020
    Resumen
    Parkinson's disease is characterized by motor and nonmotor symptoms that gradually appear as a consequence of the selective loss of dopaminergic neurons in the substantia nigra pars compacta. Currently, no treatment can slow Parkinson's disease progression. Inasmuch, there is a need to develop animal models that can be used to understand the pathophysiological mechanisms underlying dopaminergic neuron death. The initial goal of this study was to determine if canine adenovirus type 2 (CAV-2) vectors are effective gene transfer tools in the monkey brain. A second objective was to explore the possibility of developing a large nonhuman primate that expresses one of the most common genetic mutations causing Parkinson's disease. Our studies demonstrate the neuronal tropism, retrograde transport, biodistribution, and efficacy of CAV-2 vectors expressing GFP and leucine-rich repeat kinase 2 (LRRK2(G2019S)) in the Macaca fascicularis brain. Our data also suggest that following optimization CAV-2-mediated LRRK2(G2019S) expression could help us model the neurodegenerative processes of this genetic subtype of Parkinson's disease in monkeys.
  • Autores: Rodríguez Oroz, María Cruz; Parras Granero, Olga María; Gorospe Osinalde, María de Aránzazu; et al.
    Revista: MOVEMENT DISORDERS
    ISSN 0885-3185 Vol.35 2020 págs. S140 - S141
  • Autores: Honorato Cia, María Cristina (Autor de correspondencia); Martínez Simón, Antonio
    Revista: TRENDS IN ANAESTHESIA AND CRITICAL CARE
    ISSN 2210-8440 Vol.25 2019 págs. 14 - 20
  • Autores: Iturri, F.; Valencia, L. (Autor de correspondencia); Honorato, C; et al.
    Revista: REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACION
    ISSN 0034-9356 Vol.67 N° 2 2019 págs. 90 - 98
    Resumen
    The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach.
  • Autores: Carmona Abellán, María del Mar (Autor de correspondencia); Martínez Valbuena, Iván; DiCaudo, C.; et al.
    Revista: CLINICAL AUTONOMIC RESEARCH
    ISSN 0959-9851 Vol.29 N° 4 2019 págs. 415 - 425
    Resumen
    Purpose Systemic administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induces degeneration of dopaminergic neurons and reproduces the motor features of Parkinson disease (PD); however, the effect of MPTP on extranigral structures has been poorly studied. The aim of this research was to study the cardiac sympathetic innervation of control and MPTP-treated monkeys in order to describe the influence of MPTP toxicity on cardiac tissue. Methods Eight monkeys were included in the study and divided into two groups, four monkeys serving as controls and four forming the MPTP group. Sections from the anterior left ventricle were immunohistochemically examined to characterize the sympathetic fibers of cardiac tissue. The intensity of immunoreactivity in the nerve fibers was quantitatively analyzed using ImageJ software. Results As occurs in PD, the sympathetic peripheral nervous system is affected in MPTP-treated monkeys. The percentage of tyrosine hydroxylase immunoreactive fibers in the entire fascicle area was markedly lower in the MPTP group (24.23%) than the control group (35.27%) (p < 0.05), with preservation of neurofilament immunoreactive fibers in the epicardium of MPTP-treated monkeys. Alpha-synuclein deposits were observed in sections of the anterior left ventricle of MPTP-treated monkeys but not in control animals, whereas phosphorylated synuclein aggregates were not observed in either controls or MPTP-treated monkeys. Conclusion The peripheral autonomic system can also be affected by neurotoxins that specifically inhibit mitochondrial complex I.
  • Autores: Hernando Vela, Belén (Autor de correspondencia); Martínez Simón, Antonio; Cacho Asenjo, Elena; et al.
    Revista: CLINICAL ORAL INVESTIGATIONS
    ISSN 1432-6981 Vol.23 N° 1 2019 págs. 391 - 397
    Resumen
    ObjectivesTo evaluate the relationship between pharmacokinetic descriptors of dexmedetomidine (predicted area under the curve during the procedure, predicted plasma level at the end of the procedure, and duration of procedure) and sedation depth (proportion of time with bispectral index <85 during the procedure) with recovery time after ambulatory procedures.Materials and methodsClinical observational study of patients undergoing oral and maxillofacial ambulatory surgery with dexmedetomidine as sole sedative agent. Patients received a loading dose of dexmedetomidine (0.25-1gkg(-1)) followed by a maintenance infusion (0.2-1.4gkg(-1)h(-1)) to keep a bispectral index <85 until 5min before the end of the procedure, and were transferred to a post-anesthesia care unit until criteria for discharge were met.ResultsData from 75 patients was analyzed. Sedation depth was directly associated with recovery time (Pearson correlation coefficient [r]=0.26; p=0.024). Around 7% of the variation in recovery time was explained by the proportion of time with bispectral index <85. No association with procedure duration (r=0.01; p=0.9), predicted area under the curve (r=0.1; p=0.4), or predicted plasma level of dexmedetomidine at the end of the procedure (r=0.12; p=0.3) with recovery time was observed.ConclusionsSedation depth with dexmedetomidine could play a role in increasing recovery time after oral and maxillofacial ambulatory surgery. In our study, the pharmacokinetic descriptors of dexmedetomidine did not seem to influence recovery time.Clinical relevanceSedation depth with dexmedetomidine could play a role in increasing recovery time after ambulatory procedures.
  • Autores: Guridi Legarra, Jorge (Autor de correspondencia); Rodriguez-Rojas, R.; Carmona Abellán, María del Mar; et al.
    Revista: MOVEMENT DISORDERS
    ISSN 0885-3185 Vol.33 N° 10 2018 págs. 1540 - 1550
    Resumen
    For many years the subthalamic nucleus had a poor reputation among neurosurgeons as a result of the acute movement disorders that develop after its lesion or manipulation through different surgical procedures. However, this nucleus is now considered a key structure in relation to parkinsonism, and it is currently one of the preferred therapeutic targets for Parkinson's disease. The implication of the subthalamic nucleus in the pathophysiology of chorea and in the parkinsonian state is thought to be related to its role in modulating the basal ganglia, a fundamental circuit in movement control. Indeed, recent findings have renewed interest in this anatomical structure. Accordingly, this review aims to present a history of the subthalamic nucleus, evolving from the classic surgical concepts associated with the avoidance of this structure, to our current understanding of its importance based on findings from more recent models. Future developments regarding the relationship of the subthalamic nucleus to neuroprotection are also discussed in this review. (c) 2018 International Parkinson and Movement Disorder Society
  • Autores: Rodriguez-Rojas, R.; Carballo-Barreda, M.; Alvarez, L. ; et al.
    Revista: JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
    ISSN 0022-3050 Vol.89 N° 6 2018 págs. 572 - 578
    Resumen
    Objective Subthalamotomy is an effective alternative for the treatment of Parkinson's disease (PD). However, uncertainty about the optimal target location and the possibility of inducing haemichorea-ballism have limited its application. We assessed the correlation between the topography of radiofrequency-based lesions of the subthalamic nucleus (STN) with motor improvement and the emergence of haemichorea-ballism. Methods Sixty-four patients with PD treated with subthalamotomy were evaluated preoperatively and postoperatively using the Unified Parkinson's Disease Rating Scale motor score (UPDRSm), MRI and tractography. Patients were classified according to the degree of clinical motor improvement and dyskinesia scale. Lesions were segmented on MRI and averaged in a standard space. We examined the relationship between the extent of lesion-induced disruption of fibres surrounding the STN and the development of haemichorea-ballism. Results Maximum antiparkinsonian effect was obtained with lesions located within the dorsolateral motor region of the STN as compared with those centre-placed in the dorsal border of the STN and the zona incerta (71.3%, 53.5% and 20.8% UPDRSm reduction, respectively). However, lesions that extended dorsally beyond the STN showed lower probability of causing haemichoreaballism than those placed entirely within the nucleus. Tractography findings indicate that interruption of pallidothalamic fibres probably determines a low probability of haemichorea-ballism postoperatively. Conclusions The topography of the lesion is a major factor in the antiparkinsonian effect of subthalamotomy in patients with PD. Lesions involving the motor STN and pallidothalamic fibres induced significant motor improvement and were associated with a low incidence of haemichorea-ballism.
  • Autores: Honorato Cia, María Cristina; De Hert, S.; De Robertis, E.; et al.
    Libro: Research anthology on cross-industry challenges of industry 4.0
    ISSN 978-166842406-3 Vol.2 2021 págs. 752 - 766
    Resumen
    Foreseeing the needs and availability of anaesthesiologists across Europe is a challenging task. This is influenced by different factors that include the composition of the workforce and the organization and structure of health services in every country. Some trends call for attention, such as changes in work patterns brought about by an ageing specialist population, the increasing numbers of women in anaesthesia, or cultural and societal shifts towards work-life balance. Anaesthesiology is a challenging specialty with an expanding scope of practice, requiring highly motivated professionals, frequent long work hours, and addressing stressful situations often. To ensure quality anaesthesia provision, the wellbeing of this diverse population of anaesthesiologists should be addressed. Achieving rational and flexible work hours, adequate compensation, and promotion of a workplace culture that fosters safety, motivation to learn, and equal opportunities for leadership or academia positions are challenges to be addressed to make sure that excellence in patient care is maintained.

Proyectos desde 2018

  • Título: Desarrollo y validación de una herramienta digital basada en inteligencia artificial para la detección de publicaciones científicas relevantes en la toma de decisiones relacionadas con la Covid-19 Proyecto "Covid Content Curation".
    Código de expediente: 011-3638-2020-000001
    Investigador principal: JORGE MARIA NUÑEZ CORDOBA.
    Financiador: GOBIERNO DE NAVARRA. DEPARTAMENTO DE SALUD
    Convocatoria: 2020 GN Proyectos de Investigación en salud
    Fecha de inicio: 01-01-2021
    Fecha fin: 31-12-2021
    Importe concedido: 20.700,00 €
    Fondos FEDER: NO
  • Título: Desarrollo de técnicas de mapeado de la reactividad cerebrovascular. Aplicaciones en la cirugía de tumores cerebrales.
    Código de expediente: PI18/00084
    Investigador principal: MARIA ASUNCION FERNANDEZ SEARA.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2018 PI
    Fecha de inicio: 01-01-2019
    Fecha fin: 31-12-2022
    Importe concedido: 62.920,00 €
    Fondos FEDER: SI
  • Título: USO DE FORMULACIONES POLIMÉRICAS MUCOADHESIVAS PARA LA ERRADICACIÓN DE HELICOBACTER PYLORI
    Código de expediente: RTC-2017-6643-1
    Investigador principal: RAMON JESUS ANGOS MUSGO.
    Financiador: MINISTERIO DE CIENCIA E INNOVACIÓN
    Convocatoria: 2017 MINECO RETOS COLABORACIÓN
    Fecha de inicio: 01-07-2018
    Fecha fin: 30-04-2022
    Importe concedido: 148.104,88 €
    Fondos FEDER: SI
  • Título: PLATAFORMA DE UNIDADES DE INVESTIGACION CLINICA Y ENSAYOS CLINICOS Spanish Clinical Research Network (SCReN)
    Código de expediente: PT17/0017/0014
    Investigador principal: JOSE RAMON AZANZA PEREA.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2017 PLATAFORMAS
    Fecha de inicio: 01-01-2018
    Fecha fin: 31-12-2020
    Importe concedido: 102.300,00 €
    Fondos FEDER: SI
  • Título: Estudio de la obesidad como factor de riesgo de mortalidad y su prevención mediante recomendaciones dietéticas: Análisis longitudinal de la cohorte SUN.
    Código de expediente: PI17/01795
    Investigador principal: MAIRA BES RASTROLLO.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2017 PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2018
    Fecha fin: 30-06-2021
    Importe concedido: 93.170,00 €
    Fondos FEDER: SI
  • Título: Desarrollo de un nuevo modelo de enfermedad de Parkinson en primates no humanos mediante sobrexpresión de PLK2 en las neuronas dopaminérgicas
    Código de expediente: PI15/01816
    Investigador principal: MARIA ROSARIO ISABEL LUQUIN PIUDO.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2015 AES PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2016
    Fecha fin: 31-12-2018
    Importe concedido: 98.615,00 €
    Fondos FEDER: SI