Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jan 2007
Review Case Reports[Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision].
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. ⋯ This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.
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Rev Esp Anestesiol Reanim · Jan 2007
Case Reports[Analgesia for childbirth in a patient with factor V Leiden mutation].
Factor V Leiden mutation is the most common congenital thrombophilic disorder, affecting between 5% and 8% of the Caucasian population. Pregnancy creates a state of hypercoagulability and all factors that increase the risk of thrombosis should be considered, as they may be cumulative. In recent years, the diagnosis of new allelic variants of thrombophilic states have increased the incidence of pregnant women receiving anticoagulant therapy, with the anesthetic considerations that implies. ⋯ She was taking low molecular weight heparin therapy. An epidural catheter was inserted to provide analgesia for labor, with all safety precautions to prevent an epidural hematoma. Epidural anesthesia is the technique of choice for obstetric labor in patients with hypercoagulability because of its effects of favoring blood flow and inhibiting clot formation.
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Rev Esp Anestesiol Reanim · Jan 2007
Review[Multimodal approaches to postoperative pain management and convalescence].
Coping with pain is a complex, multifactorial phenomenon that requires an interdisciplinary approach. Multimodal analgesia involves the association of several analgesics administered by different routes to achieve more effective relief than analgesics administered individually. This approach reduces side effects and increases patient satisfaction. ⋯ The choice of local anesthetic, the route of administration, and the duration of treatment will depend on the type of patient and operation. The combination of an anti-inflammatory drug with an analgesic that works on the central nervous system is recommended, whether the route is oral or parenteral, provided there are no contraindications. Integrating these techniques into a rehabilitation program will facilitate postoperative convalescence.
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Rev Esp Anestesiol Reanim · Jan 2007
Case Reports[Two cases of congenital airway obstruction managed with ex utero intrapartum treatment procedures: anesthetic implications].
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. ⋯ In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.
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Rev Esp Anestesiol Reanim · Jan 2007
[Patient satisfaction with spinal cord stimulation for failed back surgery syndrome].
The incidence of failed back surgery syndrome is about 40%. We studied the efficacy of and patient satisfaction with use of a spinal cord stimulator to treat this syndrome. ⋯ Spinal cord stimulation improves lumbar back pain in patients with failed back surgery syndrome and reduces the amount of additional medication taken to control pain. It is important for patients to adjust their expectations about the implanted stimulator.