Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Dec 2005
Review[Perioperative use of beta-blockers in noncardiac surgery].
A variety of strategies have been used to reduce the high prevalence and mortality rates of cardiac complications in patients undergoing noncardiac surgery. One approach taken is to prescribe agents that block beta-adrenergic receptors. The effect of beta-blockers on myocardial ischemia is multifactorial: they correct myocardial oxygen imbalance, prevent rupture of atheromatous plaque, and reduce coronary vasoconstriction. We summarize the results of several recently published studies that confirm the beneficial effects and the low incidence of side effects.
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Rev Esp Anestesiol Reanim · Dec 2005
Randomized Controlled Trial Comparative Study[Metabolic and immune response to spinal vs intravenous morphine for analgesia after radical prostatectomy].
To study differences between the endocrine-metabolic and immune cell responses to spinal or intravenous administration of morphine for analgesia after radical prostatectomy. ⋯ Patients who received morphine by spinal infusion had a less marked endocrine-metabolic response. Although local cell responses were similar in the 2 groups, the response in peripheral blood was different, possibly reflecting different mechanisms of central modulation of the inflammatory response to stress.
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Rev Esp Anestesiol Reanim · Dec 2005
Case Reports[Late mediastinitis with bilateral hydrothorax after vessel perforation by a central venous catheter].
A central venous catheter was inserted into the right internal jugular vein of a 67-year-old woman to provide parenteral nutrition on the 7th day after surgery. Five days later, mediastinitis with bilateral hydrothorax had developed and was causing respiratory failure and systemic inflammatory response syndrome secondary to documented vascular perforation by the catheter. ⋯ However, it should not be forgotten that a radiograph is 2-dimensional and a single image of a catheter tip can correspond to a variety of locations (superior vena cava, vena innominata, extravascular location, and more). Even when there is clinical and radiologic evidence of catheter positioning, vascular perforation should be suspected in patients with a central venous catheter and bilateral pleural effusion who present respiratory insufficiency and hemodynamic instability.