Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Dec 2003
Review[Peripheral nerve block for surgical anesthesia and postoperative analgesia of the legs].
Even though peripheral nerve blocks (PNB) on the lower limb offer advantages over neuroaxial blockades and general anesthesia, their use has not been fully established. The infrequency with which PNBs are used may be due to inadequate learning, the need to make several injections, the time until onset of block, or anesthesiologists' and surgeons' lack of familiarity with the benefits of regional blocks. Interest seems to have increased in recent years, as numerous publications have focused on lower limb PNBs for surgery and postoperative analgesia. Our aim was to review the main approaches used and the indications for each.
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Rev Esp Anestesiol Reanim · Dec 2003
Review Case Reports[A case of "ventilation difficulty-intubation difficulty" solved with transtracheal jet ventilation].
A 56-year-old man recovering from a glossectomy and radical neck dissection presented severe oral bleeding, tracheal deviation with an asphyxiating hematoma and cyanosis. When 2 attempts at orotracheal intubation with the patient awake failed, transtracheal jet ventilation was used temporarily until a definitive airway could be established. Transtracheal jet ventilation is highly useful for managing an airway and maintaining gas exchange in life-threatening situations in which intubation and ventilation has become impossible, yet it is rarely used for that purpose. An easy, fast procedure that has not been widely used in Spain, this technique provides effective ventilation and oxygen while a definitive resolution of the emergency is sought.
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Rev Esp Anestesiol Reanim · Dec 2003
Case Reports[Peripartum cardiomyopathy and preeclampsia: an association with fatal outcome].
A 33-year-old obese gypsy woman was admitted in labor with signs of preeclampsia followed by sudden pulmonary edema and cardiac arrest. Cesarean delivery was performed during resuscitation maneuvers, but both mother and fetus died. ⋯ The association of latent peripartum cardiomyopathy and episodes of hypertension greatly increases the risk of maternal and fetal death. Careful management of anesthesia and rigorous measures are necessary with a view to possible litigation.
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Rev Esp Anestesiol Reanim · Dec 2003
Review[Spinal cord compression caused by hematoma related to neuroaxial anesthesia in Spain].
Spinal cord compression from a hematoma is a rare serious complication of neuroaxial anesthesia. Our objective was to investigate cases reported and published by Spanish authors. ⋯ The number of compressive spinal hematomas reported or published by Spanish authors is fairly high, and there are cases related to both sub-arachnoid and epidural anesthesia. Nonsurgical treatment was provided in 45% of the cases and the outcome was satisfactory in 70%. Risk factors were identified in over half of the reported cases.
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Rev Esp Anestesiol Reanim · Dec 2003
Case Reports[Treatment with desmopressin before epidural anesthesia in a patient with type I von Willebrand disease].
A 33-year-old primipara with von Willebrand disease type I was admitted in labor at 37 weeks, requesting epidural analgesia. The consultant hematologist advised treating with desmopressin acetate (DDAVP) before inserting an epidural catheter. Desmopressin at a dose of 0.3 microgram/Kg was administered intravenously and the catheter was inserted to L3-L4 to infuse 0.1% bupivacaine with 2 micrograms/mL of fentanyl at a rate of 12 mL/h. ⋯ A woman with von Willebrand's disease can receive an epidural block for analgesia during childbirth. The decision to perform the block should be individualized, based on coagulation tests. DDAVP may play a role in improving hemostasis.