Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Mar 2004
Case Reports[Open cholecystectomy under thoracic epidural anesthesia in diffuse interstitial lung disease].
Two patients, aged 73 and 58 years, with diffuse pulmonary fibrosis underwent emergency open cholecystectomies (subcostal approach) under thoracic epidural anesthesia with 0.5% ropivacaine and fentanyl in spontaneous ventilation. Pulmonary fibrosis was due to amiodarone administration in the first patient and of unknowon cause in the second. ⋯ Postoperative epidural analgesia was very satisfactory. Thoracic epidural anesthesia is a useful alternative to general anesthesia for subcostal cholecystectomy in patients with diffuse interstitial lung disease in advanced stages.
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Rev Esp Anestesiol Reanim · Mar 2004
[Effects of sevoflurane on mid-latency auditory evoked potentials and the 95% spectral frequency limit].
To investigate the effects of sevoflurane on mid-latency auditory evoked potentials (MLAEP) and compare them to changes in the encephalographic 95% spectral edge frequency (SEF95). ⋯ Our results indicate that the effect of sevoflurane on the MLEAP of Na, Pa and Nb is similar to that of other anesthetic gases. Even though the amplitude of the Na, Pa and Nb waves decreased in a dose-dependent way, SEF95 correlated more strongly with sevoflurane concentration.
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The PiCCO physiological monitor (Pulsion Medical Systems, Munich, Germany) was used for hemodynamic diagnosis and monitoring of 4 patients: a polytraumatized female patient with septic shock and ventilator-associated pneumonia; a man with congestive heart failure and cor pulmonale who developed acute heart failure while recovering from anterior resection of the rectum; a man with severe head injury and acute respiratory distress syndrome; and a polytraumatized male patient with a myocardial contusion. All were in a life-threatening situation, either immediately as in the case of the patient with myocardial contusion or eventually as in the patient with septic shock. ⋯ New less invasive monitoring systems designed to record parameters similar to those detected by the Swan-Ganz catheter but with fewer complications and risks have become available. One example, the PiCCO monitor, combines arterial thermodilution with analysis of the pulse waveform, providing a series of hemodynamic parameters useful for managing the critically ill patient.
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Rev Esp Anestesiol Reanim · Mar 2004
[Hemostasis-altering drugs and regional anesthetic techniques: safety guidelines].
New developments--in the form of emerging clinical settings for regional anesthesia as well as problems arising with the concomitant use of regional techniques and hemostasis-altering drugs--require the ongoing revision of safety guidelines. The annual meeting of ESRA held in Spain in 2003 saw the discussion and clarification of a variety of issues of current concern, including conclusions reached on the estimated risk of spinal hematoma when published safety guidelines are followed or not, precautions to take in epidural anesthesia during cardiac surgery, guidelines for using fondaparinux for thromboprophylaxis, the circumstances under which neuroaxial techniques can be used safely in patients under the effects of platelet aggregation inhibitors such as thienopyridine, and the application of epidural anesthesia in parturients with eclampsia who have received platelet aggregation inhibitors. Conclusions drawn at the meeting enrich and clarify certain important safety issues related to local and regional anesthesia in patients receiving antiplatelet drugs and/or anticoagulants.
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Rev Esp Anestesiol Reanim · Mar 2004
Randomized Controlled Trial Comparative Study Clinical Trial[Clinical effects and pharmacokinetics of ropivacaine and bupivacaine for epidural analgesia during labor].
To compare the analgesic efficacy, pharmacokinetics and histamine release of ropivacaine and bupivacaine with fentanyl in continuous epidural perfusion during labor and childbirth. ⋯ Analgesia was equally effective in both groups, without adverse maternal-fetal effects, with spontaneous micturition and absence of motor blockade in both groups. The plasma concentrations were higher with ropivacaine but were not toxic.