Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Dec 2001
Review Comparative Study[Anesthesia for carotid endarterectomy].
Carotid endarterectomy (CE) is among the most common vascular procedures. Recent studies have examined indications for CE and the usefulness of multiple vascular procedures, and have compared general and locoregional anesthesia. Randomized prospective trials have confirmed that the efficacy of CE exceeds 70% in patients experiencing a transient ischemic attack (TIA) with an ipsilateral stenotic carotid lesion. ⋯ Blood pressure and heart rate are higher during cervical block than during general anesthesia, but hypertension is more common during general anesthesia. A randomized controlled trial comparing general anesthesia and cervical block found no significant differences in mortality, MI or TIA. Regional anesthesia is more cost-effective, given that less intensive care and shorter hospital stays are required.
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Rev Esp Anestesiol Reanim · Dec 2001
Review[Pulmonary hemodynamics and right ventricular function].
Measurement of continuous blood flow by thermodilution catheter takes into account measures that are intermittent, though the estimation of mean pressures is satisfactory. Natural pulsatile pulmonary circulation would remain unknown. To evaluate pulsatile pulmonary hemodynamics and its importance in right ventricular function, the calculation of impedance based on spectral analysis of pressure and flow waves would allow their respective contributions to resistance, elastance and wave reflection upon after right ventricle loading. Computerization allows bedside monitoring of this sophisticated assessment of right ventricle after loading.
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Congenital heart disease can increase or decrease pulmonary blood flow, pulmonary vascular resistance (PVR) or pulmonary artery pressure (PAP). PAP is the product of PVR and pulmonary minute volume (Qp), such that pulmonary hypertension (PHT) may develop as a result of an increase in either PVR or Qp or both. Given that the pulmonary vascular bed is a low pressure system with high flow, any increase in resistance would generate PHT. ⋯ The best approaches to diagnosis and prognosis are echocardiography and cardiac catheterization with vasodilators. Anesthetics that do not alter PVR should be used in such patients, who are sensitive to changes in pulmonary ventilation, to changes in cardiac output and to anesthetics. The treatment of PHT during intra and postoperative pediatric surgery is based on the use of high inspirated oxygen concentration (100%), an adequate sedation and the use of vasodilators (prostaglandin I2, nitric oxide, sodium nitroprusiate and milrinone).
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The contributions of remifentanil to anesthesia for heart surgery is described. The pharmacokinetic properties are described along with our clinical experience with the various modes and doses of perfusion for induction as well as during and after surgery.
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Rev Esp Anestesiol Reanim · Dec 2001
Review[The pulmonary vasodilatory effect of inhaled prostacyclin and milrinone in heart].
This paper examined the effect of inhaled prostaglandin I2 at a dose of 5-10 microgram/ml on vascular resistance in the treatment of pulmonary hypertension, for its local benefits and lack of effect on systemic vascular resistances. The treatment was also combined with inhaled milrinone at a dose of 1 mg/ml, given that the mechanisms of action of the two drugs are different and possibly complementary. Inhaling both drugs might be an effective approach to treating pulmonary hypertension.