Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jan 2002
Case Reports[Cervical epidural anesthesia with 0.75% ropivacaine in shoulder surgery].
We present the cases of three patients scheduled for shoulder surgery under cervical epidural anesthesia with 0.75% ropivacaine. The technique was successful and surgery proceeded uneventfully in all three cases. The total doses of ropivacaine infused were 67, 90 and 109 mg. ⋯ Extent of the blockade to the upper thoracic sensory segments causes a total or partial sympathetic block with decreased heart rate, blood pressure and cardiac output. Limiting the initial and subsequent doses to restrict the sensory blockade to the surgical area will reduce hemodynamic complications. Ropivacaine provides an effective sensory block and a restricted motor block, reducing the probability of the restrictive pulmonary syndrome associated with cervical epidural anesthesia.
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Rev Esp Anestesiol Reanim · Jan 2002
[Indications for electrocardiogram in the preoperative assessment for programmed surgery].
To establish indications for ordering a screening electrocardiogram (ECG) before scheduled surgery. To study the prevalence of abnormalities found in routine ECGs and the impact of routine ECGs on anesthetic and surgical management and on preventing perioperative complications. ⋯ Preoperative ECGs should be obtained only in patients over 40 years of age who present cardiac or respiratory signs or symptoms and who are diagnosed of some heart or respiratory disease.
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Rev Esp Anestesiol Reanim · Jan 2002
[Lung transplantation in patients in mechanical ventilation before transplantation].
Mechanical ventilation before lung transplantation has been identified as a risk factor for early death after surgery. However, several studies have reported patient series in which ventilation assistance was given preoperatively without increasing the rates of postoperative complications and death, apart from increasing time of postoperative intubation. The present retrospective analysis of the postoperative course of patients who had been mechanically ventilated before transplantation encompasses a period of 5 years in our hospital. ⋯ The mean time of intubation after the operation was 10.3 days and the mean stay in the postoperative recovery and intensive care unit was 27.5 days. The most common postoperative complications were respiratory colonization (100%), with infection in 3 patients, and reimplantation injury (50%). Pretransplant mechanical ventilation was associated with high risk in the patient series we report; however, the survival rate observed suggest that such patients should be considered acceptable candidates to receive grafts if indicated.
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Rev Esp Anestesiol Reanim · Dec 2001
Review Comparative Study[Anesthesia for carotid endarterectomy].
Carotid endarterectomy (CE) is among the most common vascular procedures. Recent studies have examined indications for CE and the usefulness of multiple vascular procedures, and have compared general and locoregional anesthesia. Randomized prospective trials have confirmed that the efficacy of CE exceeds 70% in patients experiencing a transient ischemic attack (TIA) with an ipsilateral stenotic carotid lesion. ⋯ Blood pressure and heart rate are higher during cervical block than during general anesthesia, but hypertension is more common during general anesthesia. A randomized controlled trial comparing general anesthesia and cervical block found no significant differences in mortality, MI or TIA. Regional anesthesia is more cost-effective, given that less intensive care and shorter hospital stays are required.