Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · May 2007
Review Case Reports[Neuraxial analgesia during labor in a patient with Arnold-Chiari type I malformation and syringomyelia].
Chiari type I malformation is a caudal displacement of the cerebellum with tonsillar herniation through the foramen magnum, frequently associated with syringomyelia, a syndrome characterized by cyst-like cavities in the spinal cord; each of the conditions leads to characteristic neurologic abnormalities. Pregnant patients with these types of malformation are considered to have an increased risk of brainstem compression and/or progression of the disease during labor. ⋯ The patient revealed during labor that she had syringomyelia associated with Chiari type I malformation, after having made no mention of it in previous history taking. Finally, we review the pathology observed in these patients.
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Rev Esp Anestesiol Reanim · May 2007
Review[Analgesia and sedation of mechanically ventilated critical patients].
Provision of adequate analgesia and sedation is an essential element in the overall management of critically ill patients who require mechanical ventilation. Familiarity with the regimens used for the different sedatives and analgesic drugs and awareness of their pharmacodynamics and pharmacokinetics in the context of each patient are essential for provision of the most appropriate treatment. In this article, we review assessment methods, the most recent therapeutic recommendations, and a range of analgesic and sedative drugs.
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Rev Esp Anestesiol Reanim · Apr 2007
Review[Anesthetic and physiologic implications of neurophysiologic monitoring with evoked potentials during spinal surgery].
Neurophysiologic monitoring with somatosensory and motor evoked potentials in spinal surgery is now widely applied in order to reduce the risk of neural injury and facilitate intraoperative decision making. Most anesthetics affect such monitoring by altering both somatosensory and motor evoked responses and these effects may place constraints on the choice of anesthetic. Intraoperative management includes maintaining stable physiologic conditions, which involves adjusting hemodynamic parameters, maintaining normal blood flow to promote proper oxygen exchange, ensuring proper ventilation, and avoiding variations in temperature. Close collaboration between the anesthetist, the surgeon, and the neurophysiologist will ensure the success of intraoperative monitoring and make it possible to avoid neural injury by making timely changes in the surgical approach.
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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.