Revista española de anestesiología y reanimación
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Cardiac arrhythmias are a common complication of surgery and anesthesia. They are more likely to occur in patients with heart disease and the presence of a transitory imbalance can supply the underlying substrate for reentry, triggered activity, or abnormal automaticity. The physiologic impact of a given arrhythmia depends on its duration, on ventricular response, and on the underlying cardiac disease. ⋯ The anesthesiologist must cope with a plethora of problems related to the patient's clinical state and the trauma of surgical manipulation. Experience with electrocardiography and the application of various devices (pacemakers, cardioverters, implantable defibrillators) and knowledge of the pharmacodynamics and pharmacokinetics of new intravenous drugs will be essential for patient management. The purpose of the present review is to provide the anesthesiologist with an overview of current views on the diagnosis and management of arrhythmias during anesthesia.
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Rev Esp Anestesiol Reanim · May 2005
Comparative Study[Measurement of cardiac output after cardiac surgery: validation of a partial carbon dioxide rebreathing (NICO) system in comparison with continuous thermodilution with a pulmonary artery catheter].
Cardiac output is usually monitored with a pulmonary artery catheter. However, because that method is not free of risk, devices have been designed in recent years to measure cardiac output in a way that is minimally invasive or fully noninvasive. Among such devices is the NICO monitor, which is based on a modified Fick equation (partial CO2 rebreathing). ⋯ Cardiac output estimated by the partial CO2 rebreathing method was lower than the measurement obtained by the pulmonary artery catheter. The percentage error between the 2 methods was 37%, indicating that the NICO monitor can not substitute for the traditional method. The better correlation found between normal-to-low cardiac output values and the absence of side effects of using the NICO method suggest that it might be indicated for detecting low cardiac output after cardiac surgery, especially when the risk-benefit ratio does not favor using a pulmonary artery catheter.
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Rev Esp Anestesiol Reanim · May 2005
Comparative Study[Possibility of cauda equina nerve root damage from lumbar punctures performed with 25-gauge Quincke and Whitacre needles].
To assess the possibility of puncturing nerve roots in the cauda equina with spinal needles with different point designs and to quantify the number of axons affected. ⋯ It is possible to achieve intraneural puncture with 25-gauge needles. However, full intraneural placement of the orifice of the needle is unlikely. In case of nerve trauma, the damage could be greater if puncture is carried out with a Quincke needle with the point inserted perpendicular to the nerve root.
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Rev Esp Anestesiol Reanim · May 2005
[Treatment of accidental dural puncture during obstetric epidural analgesia].
To assess the effectiveness of continuous intrathecal analgesia as prophylaxis for postdural puncture headache (PDPH) and for analgesia during labor in 12 patients who suffered accidental dural puncture. ⋯ Continuous intrathecal analgesia after accidental dural puncture was a safe way to provide analgesia during labor and to reduce the expected incidence of PDPH.