Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 2002
Review[Magnetic resonance in dural post-puncture headache in patient with cerebrospinal fluid hypotension].
Magnetic resonance imaging (MRI) has allowed us to establish a set of radiologic signs associated with intracranial hypotension syndrome. Findings are partly influenced by cerebral displacement. Intracranial hypotension syndrome is characterized by a decrease in cerebrospinal fluid (CSF) pressure to less than 60 mm H2O associated with occipital headache radiating to the frontal and temporal zones. ⋯ Findings gradually disappear as symptoms diminish. The signs and symptoms that might develop during intracranial hypotension syndrome vary according to the brain structure that might be affected during descent, repositioning and the traction of anchoring structures. MRI allows the degree of cerebral and spinal involvement to be ascertained, to predict whether resolution of the clinical picture will be early or late and to visualize the effect of approaches to reducing CSF leakage.
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Rev Esp Anestesiol Reanim · Feb 2002
Case Reports[Infraclavicular brachial plexus block using a multiple injection technique and an approach in the cranial direction in a patient with anticipated difficulties in tracheal intubation].
A man with a pathologic diaphysial fracture of the middle third of the left humerus underwent emergency surgery for osteosynthesis of the fracture. Preoperative examination revealed that intubation would be difficult due to a history of radical surgery for epidermoid carcinoma of the oropharynx, and local-regional anesthesia was therefore considered. ⋯ Among the various levels of brachial plexus blockade, the infraclavicular option is little known and the least utilized, considering that one of its advantages is that the upper limb does not need to be moved for referencing (giving it an advantage over the axillary block) and that it has a lower incidence of pneumothorax (in comparison with a supraclavicular approach). Combined with a multiple injection technique and puncture in a cephalad direction, this solution allowed proximal surgery to be performed on the arm of a patient in whom intubation would have been difficult.
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Rev Esp Anestesiol Reanim · Feb 2002
[Indications for thoracic radiography in the preoperative evaluation for elective surgery].
To establish a protocol for ordering chest x-ray films for screening before elective surgery. To study the prevalence of anomalies detected in routinely-ordered chest x-rays, their influence on management of anesthesia and surgery and on the prevention of perioperative complications. ⋯ A preoperative chest x-ray should be ordered only for patients over 60 years of age, smokers of 10 cigarettes/day or more, those with heart or respiratory disease, those who have had contact with tuberculosis and who have not had any other chest x-ray taken within the past year.
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Rev Esp Anestesiol Reanim · Feb 2002
Case Reports[Cardiorespiratory arrest: a rare complication of subdural block].
We report a case of accidental subdural block after epidural anesthesia that manifested as cardiac arrest due to extensive spinal blockade 20 minutes after administration of 50 mg of 0.5% bupivacaine. The event resolved without sequelae. Subdural placement of the catheter was verified by computed axial tomography contrast medium. ⋯ The characteristics of the space depend, therefore, on factors that come together at the site. These data explain the great variability in the clinical manifestations of a subdural block. The case of cardiopulmonary arrest we report is rare in the literature.