Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Oct 2004
Review Case Reports[Horner's syndrome following epidural analgesia for labor].
Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. ⋯ The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.
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Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. ⋯ We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.
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Oxygenation, or rather denitrogenation, prior to apnea during anesthetic induction attempts to replace alveolar nitrogen with oxygen to achieve an intrapulmonary oxygen reserve that will allow apnea to be as prolonged as possible with the least possible desaturation. During apnea, the rate of arterial desaturation depends mainly on the volume of oxygen stored in the lung, on mixed venous oxygen saturation, and on the presence of intrapulmonary shunt. ⋯ The efficacy of preoxygenation can be assessed by expired oxygen fraction or by pulse oximetry. In a healthy adult, both methods described ensure sufficient oxygenation (pulse oximetry 90% to 95%) after a period of apnea lasting between 6 and 10 minutes.
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Rev Esp Anestesiol Reanim · Apr 2004
Review[A review of clinical evidence supporting techniques to prevent chronic postoperative pain syndromes].
To conduct a systematic review to evaluate the level of evidence for using acute postoperative pain management techniques with a view to pre-empting the later development of chronic pain syndromes. ⋯ Only chronic pain following thoracotomy has been found to be preempted by acute pain management and only by continuous thoracic epidural analgesia started before surgery. There is no solid evidence demonstrating that other techniques used to relieve acute postoperative pain have a beneficial effect in preempting chronic postoperative pain syndromes.
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Rev Esp Anestesiol Reanim · Mar 2004
Review[Ventilatory management of the severely brain-injured patient].
Mechanical ventilation is necessary for treating patients with severe brain injury because it guarantees the airway (through endotracheal intubation), permits sedation (and even curarization), and prevents hypoxemia and/or hypercapnia. Hyperventilation continues to be a focus of debate in the current literature. ⋯ Gas insufflation through the trachea is a promising therapeutic option for correcting hypercapnia secondary to ventilation for lung protection in such patients. Finally, multimodal monitoring (intracranial pressure, central venous pressure, oxygen saturation detected in the jugular bulb, cerebral oxygen pressure) is recommended for adjusting PEEP and controlling hyperventilation.