Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jun 2008
Randomized Controlled Trial Comparative Study[Comparison of intrathecal fentanyl and bupivacaine in combined spinal-epidural obstetric analgesia].
To compare intrathecal injection of the opioid fentanyl to injection of bupivacaine, in terms of their effect of labour in the context within the combined spinal-epidural analgesia. ⋯ Our findings do not support the use of intradural fentanyl with the aim of shortening labor. Fentanyl leads to more pruritus, although this side effect does not affect maternal satisfaction.
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Rev Esp Anestesiol Reanim · Jun 2008
Case Reports[Total intravenous anesthesia for repositioning an implantable defibrillator in a patient with long QT syndrome].
We report the case of a 27-year-old woman with congenital long QT syndrome (LQTS) who was scheduled for surgery to reposition an implantable defibrillator. Given the risk of sudden death due to fatal ventricular arrhythmia, the woman required implantation of a defibrillator with pacemaker capability. ⋯ Anesthesia was maintained with an infusion of propofol and remifentanil. We describe the pathophysiology and treatment of LQTS and discuss anesthetic management for repositioning a defibrillator in a patient with congenital LQTS.
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Rev Esp Anestesiol Reanim · Jun 2008
[Hemodynamic variability caused by pressure-volume plotting and alveolar recruitment maneuvers in patients with adult respiratory distress syndrome].
The plotting of pressure-volume curves and the performance of alveolar recruitment maneuvers are common practices in the care of patients with adult respiratory distress syndrome (ARDS), even though potentially harmful hemodynamic effects are associated with sustaining a high intrathoracic pressure. Our aim was to analyze hemodynamic and ventilatory changes related to these 2 maneuvers and to assess the short-term effectiveness of recruitment. ⋯ The hemodynamic disturbances associated with the alveolar recruitment maneuver based on sustaining a high end-expiratory pressure and the minor improvement in oxygenation achieved as a result suggest that the routine use of that maneuver in ARDS patients is of questionable value.
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Rev Esp Anestesiol Reanim · Jun 2008
Review Meta Analysis Comparative Study[Combined general-epidural anesthesia compared to general anesthesia: a systematic review and meta-analysis of morbidity and mortality and analgesic efficacy in thoracoabdominal surgery].
We performed a systematic review of randomized controlled trials to compare combined general-epidural anesthesia, followed by postoperative epidural analgesia, and general anesthesia followed by postoperative parenteral analgesia without epidural analgesia in patients undergoing thoracoabdominal surgery. Outcome measures considered were mortality, length of stay in hospital and in the intensive care unit, analgesia, and morbidity. ⋯ Combined anesthesia provides better analgesia and is associated with fewer cases of postoperative respiratory failure. No significant differences were found in mortality, length of stay in hospital, or other morbidity variables.