Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Oct 1997
[Inflation of the endotracheal tube cuff as an aid for blind nasotracheal intubation in patients with predicted difficult laryngoscopy].
Inflation of the tracheal tube cuff to facilitate blind nasal intubation as described by Gobarck in 1987 has been shown to be effective for increasing the rate of successful intubation from 45 to 95% in patients with no airway alterations. We aimed to assess the usefulness of this technique in patients with anatomical alterations of the airway, in whom difficult intubation was predicted. ⋯ Inflation of the tracheal tube cuff is useful for facilitating nasotracheal intubation in the awake patient.
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Mivacurium is a short-acting nondepolarizing muscle relaxant (NDPMR) with a benzyl-isoquinoline structure and rapid, spontaneous reversal. It is hydrolyzed by cholinesterase in plasma and its chemical structure favors histamine release, leading to cutaneous or cardiovascular symptoms, particularly when the dose is increased or when the drug is injected rapidly. Both duration of effect and reversal of mivacurium are less dose dependent than they are with intermediate-duration NDPMRs. ⋯ Neuromuscular blockade may be prolonged in patients with low plasma cholinesterase activity, particularly in individuals who are homozygous for the atypical plasma cholinesterase gene. Monitoring is therefore recommended when mivacurium is used. Provided patients have normal plasma cholinesterase activity, mivacurium is indicated for interventions that are short or of unpredictable duration when rapid reversal of neuromuscular blockade is required, or whenever anticholinesterase agents must be avoided.
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Rev Esp Anestesiol Reanim · Oct 1997
Case Reports[Electromyographic characteristics of postanesthetic tremor].
Postanesthetic tremor is a frequent complication during recovery from surgery. Its etiopathogenesis is poorly understood and its electromyographic characteristics have scarcely been studies. ⋯ None of the three patients had electromyographic signs typical of hypothermic patients with tremor. We conclude that the electromyographic signs of postanesthetic tremor should be studied further and consider it noteworthy that the recordings we made could be attributable to high levels of circulating catecholamines, leading to exacerbation of physiologic tremor manifested in the form of postanesthetic shivering.
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Rev Esp Anestesiol Reanim · Oct 1997
Case Reports[Anaphylactic shock caused by the rupture of an unknown hepatic hydatid cyst].
We report the case of a 66-year-old woman with moderate-to-severe mitral stenosis who survived anaphylactic shock due to traumatic rupture of a hydatid liver cyst. Hydatid liver disease was diagnosed by ultrasound, and necessary life-support measures were taken, with hydration to restore electrolytic balance and vasoactive amines. ⋯ We discuss the immunologic mechanisms of anaphylactic shock and its treatment, and emphasize that Echinococcus liver cysts should be suspected in cases of anaphylaxis of uncertain etiology. Acute vascular collapse, generalized cutaneous erythema, urticaria and edema are suggestive of anaphylaxis arising from hydatidosis, particularly when patients reside in endemic areas.
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Rev Esp Anestesiol Reanim · Oct 1997
Randomized Controlled Trial Clinical Trial[Comparative study of postoperative analgesia with methadone and fentanyl in continuous peridural perfusion].
To determine whether continuous epidural perfusion of fentanyl, which is more liposoluble than methadone, provides a similar level of analgesia with fewer side effects than methadone administered by the same route for postoperative pain. ⋯ Continuous epidural perfusion of fentanyl provides good analgesia and is associated with less hypoxemia than is methadone.