Revista española de anestesiología y reanimación
-
Rev Esp Anestesiol Reanim · Dec 2005
Review[Perioperative use of beta-blockers in noncardiac surgery].
A variety of strategies have been used to reduce the high prevalence and mortality rates of cardiac complications in patients undergoing noncardiac surgery. One approach taken is to prescribe agents that block beta-adrenergic receptors. The effect of beta-blockers on myocardial ischemia is multifactorial: they correct myocardial oxygen imbalance, prevent rupture of atheromatous plaque, and reduce coronary vasoconstriction. We summarize the results of several recently published studies that confirm the beneficial effects and the low incidence of side effects.
-
Extubation, like intubation, is a critical moment in general anesthesia. There are no algorithms or ordered sequences of steps for extubation. ⋯ This review will analyze the clinical conditions and pathophysiology associated with extubations at high risk of complications. We will describe strategies for extubating in situations in which a difficult airway is known or suspected.
-
A large part of the success of epidural anesthesia rests on correct identification of the epidural space. The last hundred years have seen the description of numerous techniques for locating the space in the most straightforward, effective, safe, and reliable manner. To evaluate the advantages and disadvantages of these approaches and the complications associated with each, we carried out a MEDLINE search using the following key words: "epidural analgesia," "epidural anesthesia," "epidural space," "identification," and "loss of resistance" (LOR). ⋯ LOR with air, with isotonic saline, or a combination of both were the techniques shown to be simplest and safest. With respect to safety, LOR with air led to the greatest number of complications (pneumocephalus, air embolism, insufficient analgesia, higher incidence of dural puncture, nerve root compression, subcutaneous emphysema). When a small air bubble is created inside the syringe, LOR with saline solution is reliable and teachable, as well as safe and effective.
-
Cardiac arrhythmias are a common complication of surgery and anesthesia. They are more likely to occur in patients with heart disease and the presence of a transitory imbalance can supply the underlying substrate for reentry, triggered activity, or abnormal automaticity. The physiologic impact of a given arrhythmia depends on its duration, on ventricular response, and on the underlying cardiac disease. ⋯ The anesthesiologist must cope with a plethora of problems related to the patient's clinical state and the trauma of surgical manipulation. Experience with electrocardiography and the application of various devices (pacemakers, cardioverters, implantable defibrillators) and knowledge of the pharmacodynamics and pharmacokinetics of new intravenous drugs will be essential for patient management. The purpose of the present review is to provide the anesthesiologist with an overview of current views on the diagnosis and management of arrhythmias during anesthesia.