Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Dec 2004
Case Reports[Sedation with remifentanil for tracheostomy in a pediatric patient].
Remifentanil is an ultra-short-acting opioid that is frequently used in adults for surgical anesthesia or conscious sedation, but its use in children is much less common. We report the case of a 7-year-old boy with lateral cervical tumors displacing all cervical and facial structures. An emergency tracheostomy was performed when he developed respiratory difficulty due to partial airway obstruction. ⋯ In the case we report, the patient's risk of complete airway obstruction due to bleeding upon manipulation had to be assessed and compared with the respiratory depression that might possibly have been caused by remifentanil perfusion. We judged that the option of sedation would cause less morbidity and offered greater safety for the patient. The outcome of this case is consistent with reports that remifentanil is a good option for adequately sedating children who are breathing spontaneously.
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Rev Esp Anestesiol Reanim · Dec 2004
Case Reports[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa].
The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. ⋯ The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.
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Rev Esp Anestesiol Reanim · Dec 2004
Comparative Study[Interaction between vecuronium and atracurium revisited by adapting an alternative method].
Given that contradictory conclusions about the interaction between vecuronium and atracurium have been reached by previous investigators, the present study used an alternative method to analyze this interaction by way of the respective potencies of the two agents and the potency of their combination. ⋯ The alternative method presented for analyzing the potency of the individual components of the vecuronium-atracurium interaction demonstrated that their effect is greater after combination and definitively synergistic.
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Rev Esp Anestesiol Reanim · Nov 2004
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of 4 techniques for internal saphenous nerve block].
To assess the efficacy of 4 techniques for internal saphenous nerve block with 10 mL of 1.5% mepivacaine. ⋯ The femoral nerve approach in the inguinal region, with nerve stimulator, to block the internal saphenous nerve led to a larger number of successful blocks than did the paravenous or transsartorial approaches, or the technique of subcutaneous infiltration between the tibial tuberosity and internal gastrocnemius muscle.
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Rev Esp Anestesiol Reanim · Nov 2004
Case Reports[Epidural spinal cord stimulation for interstitial cystitis].
Interstitial cystitis, a chronic inflammatory disorder of the bladder wall, is highly painful and incapacitating. Urinary frequency and urgency develop, as well as nocturia, dysuria, perineal pain and reduction of bladder capacity. The condition seems to arise from a variety of factors with multiple and diverse pathogenic mechanisms and is refractory to medical and surgical treatment. Because treatments are ineffective and recent studies have implicated an inflammatory neurogenic mechanism in the pathogenesis of interstitial cystitis, neuromodulation by epidural spinal cord stimulation has been suggested for treating patients in whom other measures have failed. ⋯ Results from this and previous reports allow us to state that retrograde epidural spinal cord stimulation seems to be a relatively non-invasive therapeutic approach for treating interstitial cystitis that is refractory to conventional treatments.