Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Oct 2010
[Oral ketamine-midazolam premedication of uncooperative patients in major outpatient surgery].
Currently, ketamine is not often used as an anesthetic. Its clinical characteristics and mechanism of action largely depend on antagonism of the N-methyl-D-aspartate receptor. ⋯ Oral ketamine is an effective premedication for major ambulatory surgery and does not increase the incidence of side effects.
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Rev Esp Anestesiol Reanim · Oct 2010
[Ultrasound-guided puncture: applications in a chronic pain clinic].
Ultrasonography provides an excellent tool for the real-time visualization of peripheral nerve structures in regional anesthesia. Techniques are enhanced further when the progress of the needle and diffusion of the anesthetic can be observed. In a chronic pain clinic, ultrasound-guided puncture offers the advantages of accurate images of structures where pain arises: muscles, fascias, tendons, periostea, and joint structures. ⋯ Unlike fluoroscopy, which produces radiation that is potentially dangerous for both patient and health care staff, ultrasound imaging is not harmful. Disadvantages are poor quality images of structures at a certain depth, acoustic shadows from bone structures that block the view of underlying tissues, and poor transport of ultrasound waves by air. Our aim is to describe a series of techniques for ultrasound-guided puncture and the results obtained on applying them weekly for 12 months in a chronic pain clinic.
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Rev Esp Anestesiol Reanim · Oct 2010
[Placement of a bronchial blocker through the I-gel supraglottic airway device for single-lung ventilation: preliminary study].
To describe the use of the I-gel supraglottic airway device when placing a bronchial blocker for single-lung ventilation, as applied in a preliminary study to explore the feasibility of adopting the technique with appropriate, selected patients undergoing certain thoracic surgery procedures. We used the technique for single-lung ventilation in 25 patients who required isolation of a lung for a variety of thoracic surgical procedures. ⋯ For an anesthetist with sufficient experience in managing a flexible fiberoptic bronchoscope, it was possible to carry out all procedures without remarkable anesthetic or surgical events. Single-lung ventilation achieved by introducing a bronchial blocker through the I-gel supraglottic device can facilitate safe, effective management of selected patients who must undergo certain thoracic surgery procedures.
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Rev Esp Anestesiol Reanim · Oct 2010
Review Practice Guideline[Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment].
Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. ⋯ The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.