Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 1998
Clinical Trial[Obstetrical anesthesia in 15 women with myasthenia gravis].
To report our experience in managing anesthesia during obstetric delivery of women with myasthenia gravis (MG) and to review the anesthetic technique of choice for vaginal or cesarean delivery in such cases. ⋯ Continuous lumbar epidural anesthesia is the technique of choice for vaginal as well as cesarean deliveries. The combination of opioids and local anesthetics is considered particularly beneficial for patients, as it allows the motor blockade to be decreased. General anesthesia is only indicated when there is bulbar involvement. Short-acting non depolarizing agents, among them atracurium Besilate, are the muscle relaxants of choice. Succinylcholine is contraindicated. Thanks to current optimization of anesthetic and recovery techniques and administration of non depolarizing muscle relaxants with neuromuscular monitoring, the prognosis for pregnant MG patients has improved considerably.
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Rev Esp Anestesiol Reanim · Feb 1998
Case Reports[Pressure pneumocephalus after posterior fossa surgery in the sitting position].
Pneumocephalus occurs commonly soon after intracranial surgery. When it presents as a significant increase in intracranial pressure it is called pressure pneumocephalus, a severe, life-threatening complication of neurosurgery that requires immediate treatment. ⋯ Treatment is simple, consisting of promptly releasing the pressurized gas by trephination to save the patient's life or prevent severe neurological sequelae. We report two cases of pressure pneumocephalus that illustrate several risk factors: sitting position during surgery, preoperative hydrocephaly, surgical opening of the fourth ventricular and the presence of cerebrospinal shunt during surgery.
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Rev Esp Anestesiol Reanim · Feb 1998
Case Reports[Early pressure in pneumocephalus: an perioperative complication in neuroanesthesia].
We report two cases of early-onset pressure pneumocephalus, one occurring during supratentorial brain surgery (craniopharyngioma) which was diagnosed at the end of the anesthetic period upon appearance of comatose status leading to the suspicion of surgical complication in the form of a hematoma. The second case of pneumocephalus was detected after posterior fossa surgery performed with the patient in the sitting position. We review the significance of our anesthetic management on the prevention of tension pneumocephalus, and discuss diagnostic and therapeutic measures available for use in the Postoperative Intensive Care Recovery Unit.
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Rev Esp Anestesiol Reanim · Feb 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of lidocaine and urapidil for prevention of hemodynamic response to tracheal intubation in patients in general good health].
To compare the efficacy of endovenous administration of 0.5 mg/kg-1 of urapidil to 1 mg/kg-1 of lidocaine for attenuating hemodynamic response to laryngoscopy and tracheal intubation. ⋯ In healthy ASA I and II patients with normal blood pressure, a dose of 1 mg/kg-1 of lidocaine provided better protection against the hemodynamic response to laryngoscopy and tracheal intubation than does 0.5 mg/kg-1 of urapidil.