Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Mar 2007
Review[Epidural fat in various diseases: contribution of magnetic resonance imaging and potential implications for neuro axial anesthesia].
Epidural fat is a reservoir of lipophilic substances that cushions the pulsatile movements of the dural sac, protects nerve structures, and facilitates the movement of the dural sac over the periosteum of the spinal canal during flexion and extension. Excessive epidural fat can compress the underlying structures, however, and affect the placement of catheters and the distribution of injected solutions. ⋯ The relevance of epidural fat in spinal surgery is considered. Finally, we discuss the possible anesthetic implications of the abnormal deposition of epidural fat, to explain the unexpected complications that can arise during performance of epidural anesthesia.
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Rev Esp Anestesiol Reanim · Feb 2007
Review[Analysis of resident anesthesiologists' difficulties with epidural analgesia for labor and childbirth and complication rates].
To analyze the number of attempts to provide an epidural or spinal-epidural block for labor and complication rates when the procedures are performed by resident or staff anesthesiologists. ⋯ The number of attempts needed was 1.28 for staff anesthesiologists and 1.52 for residents (P = .02). The differences between the 2 groups in the incidences of complications (blood noted during puncture, accidental dural puncture, pain during expulsion, repeat epidural or spinal puncture, nausea, or back pain) were not significant.
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Rev Esp Anestesiol Reanim · Feb 2007
Case Reports[Airway management in a man with ankylosing spondylitis].
We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. ⋯ We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.