Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Nov 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of preemptive and postincisional lumbar epidural morphine in pulmonary resection. Preliminary report].
To evaluate the efficacy and incidence of side effects of two types of lumbar epidural analgesia with morphine, preemptive or postincisional, combined with total intravenous anesthesia in chest surgery. ⋯ Preemptive analgesia with lumbar epidural morphine in addition to the general anesthesia described here seems to provide higher-quality analgesia with few side effects, reducing the need for propofol and alfentanil during surgery and for postoperative morphine and metamizole.
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A potential space between the dura mater and the arachnoides is thought to exist, occupied by a serous fluid and called the subdural space. Recent studies may change this classical concept, however. The dura-arachnoid complex from the epidural to the arachnoid space is formed by morphologically distinct layers: the dura mater, the subdural compartment and the arachnoid mater, which are made up of different cell types. ⋯ The zone of least resistance in the dura-arachnoid complex was the subdural compartment, which could be torn mainly along intercellular spaces, though cell rupture was also observed, affecting the cytoplasmic membranes of adjacent cells. The subdural space is opened by tearing the subdural compartment between neurothelial cells alongside the collagen fibers of the dura mater. Such a tear can be caused mechanically by injecting air or contrast media, which exert pressure on a laminar structure that tends to separate because it is weaker than neighboring ones.
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Rev Esp Anestesiol Reanim · Nov 1998
Review[A new hydroxyethyl starch for volume replacement: Elohes 6%].
Various consensus groups convened in recent years to discuss plasma volume expansion solutions have suggested limiting the use of human albumin because of its high cost and have favored synthetic crystalloids or colloids for most clinical settings. Dextrans are colloids that are not widely used in most Europeans countries. Gelatins, in spite of the fact that unlimited amounts can be used, produce only moderate volume expansion and can trigger allergic reactions. ⋯ If the recommended daily dose of this HES is respected, however, coagulation disorders are minimal. The effect of HES on kidney function is at present a subject of controversy. Thus, thanks to its prolonged effect on volume and few side effects, medium molecular weight HES colloids are the ones most often recommended for use in anesthesia and postoperative intensive care.
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Rev Esp Anestesiol Reanim · Nov 1998
Clinical Trial[Prediction of mortality and quality of life in polytraumatized patients: APACHE II versus APACHE III].
To evaluate the APACHE II and III prognostic assessment systems as predictors of mortality in polytraumatized patients and to compare each system's admission assessments to the patient's quality of life one month, six months and one year later. ⋯ The APACHE II and APACHE III prognostic systems predict relative risk of death in polytraumatized patients. APACHE III, but not APACHE II, at admission is significantly related to quality of life one year later.
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Rev Esp Anestesiol Reanim · Nov 1998
Clinical Trial[Continuous parascalene block for shoulder surgery].
To evaluate the efficacy and incidence of side effects of parascalene brachial plexus block for shoulder surgery and for postoperative analgesia. ⋯ The parascalene approach is easy to use and entails few risks while providing excellent anesthetic conditions for open and arthroscopic shoulder operations. It is useful for ambulatory analgesia to facilitate early rehabilitation after surgery.