Revista española de anestesiología y reanimación
-
Rev Esp Anestesiol Reanim · Jan 2004
Multicenter Study[Influence of a child's age on anesthetic technique based on analgesia with remifentanil].
To study the possible pharmacodynamic differences in children under anesthesia based on remifentanil. ⋯ No differences were found between age groups with regard to remifentanil requirements, end tidal concentrations of sevoflurane, or mean times until spontaneous ventilation or extubation. Nor were there differences in the percentages of complications (5.4%), of which 4 were cases of intense postoperative muscular rigidity, or in the incidence of nausea-vomiting (3.4%). The quality of recovery from anesthesia (Aldrete test) was better in the 8-12-year-old group (P < 0.05), however, while agitation (Postoperative Agitation Score) and pain (visual analog scale or observational scales) were greater in the group of 1-3-year-olds (P < 0.05). The evaluation of the technique by participating caregivers was excellent for 20%, very good for 41%, good for 29%, adequate for 8% and poor for 2% of the cases.
-
Rev Esp Anestesiol Reanim · Jan 2004
Case Reports[General anesthesia by infusion of remifentanil for debridement and grafting of large burns in 3 pediatric patients].
Three 13-year-olds with burns on 30%, 70%, and 75% of their body surface areas and with related respiratory tract lesions underwent multiple surgical interventions for debridement, graft placement, and topical treatments. Balanced general anesthesia was provided with sevoflurane and an infusion of remifentanil and cisatracurium. ⋯ Remifentanil is an effective analgesic for meeting the needs of patients with severe burns. The combination of remifentanil, sevoflurane, and cisatracurium provides good hemodynamic stability and is very appropriate for patients who must undergo a large number of surgical interventions.
-
Rev Esp Anestesiol Reanim · Jan 2004
Review[Intracranial and spinal subdural hematoma: a rare complication of epidural and subarachnoid anesthesia].
Subdural and epidural hematomas complicating central blocks are rare but serious complications that can lead to permanent neurological deficits. This review discusses cranial and spinal subdural hematomas, including the history of this complication in the literature. ⋯ The anatomy of tissues that envelop and contain chronic subdural hematomas are described and the various neurological alterations that can develop are mentioned. Finally, diagnostic imaging options and corrective surgical techniques are reviewed.
-
Rev Esp Anestesiol Reanim · Jan 2004
Case Reports[Vertebral osteomyelitis and epidural abscess after epidural anesthesia for a cesarean section].
A 40-year-old woman underwent cesarean section under epidural anesthesia. The anesthetic procedure was carried out in strict aseptic conditions, the catheter was withdrawn 24 hours after surgery, and the patient was discharged 5 days after surgery. She was readmitted with fever, backache, and pain in the lower limbs, with signs of radiculitis but no indication of inflammation or pain at the site of puncture. ⋯ Vertebral osteomyelitis is an unusual event after epidural anesthesia and there have been few opportunities to demonstrate a relationship. Such infections appear spontaneously in immunodepressed patients who undergo diagnostic procedures and treatments that lead to bacteremias with secondary colonization of spinal structures. The topography and characteristics of the infectious lesion, the patient's susceptibility, and the anesthetic procedure and pathogenic agent may help clarify the cause of the osteomyelitis.