Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jan 1989
Review[Headache after spinal puncture. Treatment alternatives: epidural blood patch].
Headache is one of the most frequent complications of the subarachnoid puncture. Physiopathology and the different clinical factors involved in this type of headache are reviewed. The treatment is based in two types of procedures: those increasing cerebrospinal fluid production and those trying to decrease its leakage, like the epidural blood patch.
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Rev Esp Anestesiol Reanim · Jan 1989
Case Reports[Mixed benzodiazepine poisoning and reversal with flumazenil (Ro 15-1788)].
A case of 17 year old female with acute benzodiazepines (800 mg of bentazepan and 400 mg de chlordiazepoxide) and tricyclic antidepressants (500 mg of imipramine) self poisoning is reported. Initial examination showed comatous patient (Glasgow coma scale 7, sedation scale 4) and a critical respiratory failure with a suspicious of pulmonary aspiration of gastric contents. Supportive measures were started and flumazenil administered intravenous (0.1 mg/min) until a total dose of 1.2 mg; 15 minutes later neurological state was absolutely normal. We conclude that flumazenil is a selective and useful benzodiazepine antagonist in the treatment of acute benzodiazepine poisoning.
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Rev Esp Anestesiol Reanim · Jan 1989
Comparative Study[Comparison of venous pressure in the external jugular vein and the superior vena cava during anesthesia].
Venous pressure between the external jugular vein (EJV), and the superior caval vein (SCV) was compared in 15 patients, free of cardiorespiratory disease and undergoing abdominal surgery. In each patient data was taken in four different positions: A) anaesthetized patient in supine position and mechanical ventilation; B) anaesthetized patient in Trendelenburg position and mechanical ventilation; C) anaesthetized patient in anti-Trendelenburg and mechanical ventilation, and D) awake patient in supine position and spontaneous ventilation. A short, thick catheter with unique end lumen was used for EJV, and a long catheter from the basilic vein, to the SCV. ⋯ Linea correlation for the 4 positions was performed (r = 0.97, 0.91, 0.88 and 0.60 respectively) being significant for A-B y C positions. 4.5 cm H2O was the maximal difference obtained between SCV and EJV for A, B and C positions, and 10 cm H2O the maximal difference for the D position. The mean changes between the positions A-B, A-C and A-D was compared and significant differences (p less than or equal to 0.001) for A-C were seen, whereas A-B did not attain significant differences. We conclude that the EJV cannulation, with a short and thick catheter, allow the central venous pressure control during anaesthesia, in supine position, Trendelenburg and anti-Trendelenburg, but not during the recovery.
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Rev Esp Anestesiol Reanim · Jan 1989
Case Reports[Epidural anesthesia for cesarean section in a patient with Eisenmenger's syndrome].
A case of a 21 year old pregnant patient with a Eisenmenger's syndrome is reported. She was in her 38th weeks of pregnancy and submitted to a cesarean section under epidural anaesthesia. In spite of a FiO2 1 administered through a nonrebreathing mask, she presented refractory hypoxemia. ⋯ Eisenmenger's syndrome during pregnancy is reviewed. Maternal mortality rate is higher in cesarean section (75%) when compared with vaginal delivery. We conclude that epidural anaesthesia can be an useful technique for these patients under a careful hemodynamic management and a proper dose of local anaesthetics.