Revista española de anestesiología y reanimación
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An epidural abscess is a rare lesion whose consequences can cause high morbi-mortality, particularly in obstetrics, where it occurs in young, healthy patients. With increased use of regional anesthesia, the incidence of epidural abscess will increase. We therefore review the risk factors, most common etiology and clinical signs, which may be non-specific but are nevertheless suggestive. ⋯ It may be difficult to distinguish epidural abscess from other causes of medullar compression, but prompt diagnosis is essential so that emergency surgical repair can proceed and neurological recovery will be as early and complete as possible. Appropriate antibiotic therapy should be aggressive. Basic aseptic measures are critical for preventing infection through epidural needles, as the presence of infection at the moment of puncture facilitates greater susceptibility to epidural abscess.
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Rev Esp Anestesiol Reanim · May 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of low-dose intravenous ketamine in postoperative analgesia for hysterectomy and adnexectomy].
To evaluate the efficacy of low dose ketamine (0.15 mg/Kg i.v.) as a pre-emptive pain relief after general anesthesia. ⋯ A low dose of ketamine has no preemptive analgesic effect.
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Rev Esp Anestesiol Reanim · May 2002
[Preoperative hemoglobin as the only predictive factor of transfusional needs in knee arthroplasty].
To study transfusion requirements in total knee anthroplasty (TKA) in order to estimate needs and consider possible ways to improve principled management. ⋯ Preoperative Hb level was the single predictor of transfusion in our series of patients. In some cases the transfusion trigger was too liberal. Alternatives to homologous transfusion were hardly used, with PABP applied in only 5% of the cases. These findings encourage us to continue trying to improve the PABP program and transfusion criteria, to introduce alternatives and to improve baseline Hb levels.
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Rev Esp Anestesiol Reanim · May 2002
Case Reports[Epidural hematoma after catheter removal in a patient without coagulation disorders].
A 69-year-old man with rectal adenocarcinoma and no relevant medical history was scheduled for anterior resection of the tumor under combined anesthesia. The epidural catheter was removed 48 h after surgery. A clinical picture consistent with a diagnosis of epidural hematoma developed gradually and was confirmed by magnetic resonance imaging. ⋯ Our analysis of the literature on conditions leading to epidural hematoma after catheter insertion revealed that complications may appear for unknown reasons even when catheter management and thrombolytic prophylaxis are appropriate. Nevertheless, the maneuver for removing an epidural catheter is clearly not risk-free and can cause complications. Monitoring after removal is therefore important if complications are to be detected early.