Revista española de anestesiología y reanimación
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The prevention of perioperative myocardial ischemia is one of the cornerstones of anesthetic techniques. From the perspective of anesthesiologists, the traditional relation between oxygen supply and demand is improved mainly by reducing demand. Cardiologists, however, look at the problem from the other side of the equation. ⋯ On the contrary, evidence suggests that infarction depends on changes in oxygen supply secondary to transient or permanent episodes of thrombotic vascular occlusion. Our data suggest that these thrombotic events are dependent on hypercoagulability. It may be that anesthesiologists should focus on preventing rupture of the atherosclerotic plaque or on examining changes in coagulation, given that such events might facilitate the appearance of thrombosis in coronary arteries with unstable plaques.
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Rev Esp Anestesiol Reanim · Dec 2001
Review[The pulmonary vasodilatory effect of inhaled prostacyclin and milrinone in heart].
This paper examined the effect of inhaled prostaglandin I2 at a dose of 5-10 microgram/ml on vascular resistance in the treatment of pulmonary hypertension, for its local benefits and lack of effect on systemic vascular resistances. The treatment was also combined with inhaled milrinone at a dose of 1 mg/ml, given that the mechanisms of action of the two drugs are different and possibly complementary. Inhaling both drugs might be an effective approach to treating pulmonary hypertension.
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Carotid endarterectomy can be performed under general or locoregional anesthesia. If locoregional anesthesia is chosen, the state of awareness of the patient allows for direct viewing of the effect of vascular clamping of the corresponding neurological territory. We present the results of an anesthetic procedure using only an analgesic in patients who were intubated and ventilated but with a level of consciousness that allowed us to view the effect of carotid clamping on motor functions. ⋯ An advantage of this technique is that the duration of anesthesia is not limited, with adequate ventilation and maintenance of an adequate state of consciousness for clinical evaluation of the repercussions of carotid clamping. Hemodynamic monitoring detected the appearance of imbalances requiring therapeutic intervention. The procedure is interesting provided it is performed according to a strict protocol, with continuous clinical and instrumental monitoring of the patient's status.
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To assess the influence of epidural analgesia on the increased rate of cesarean delivery and to analyze associated factors. ⋯ Epidural analgesia increased the likelihood of cesarean delivery in our study. The same factors that most often encourage women to accept epidural analgesia (induced labor, greater pain, prolonged labor, etc.) may predict increased likelihood of cesarean delivery.
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Rev Esp Anestesiol Reanim · Nov 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Remifentanil or propofol for sedation in subarachnoid anesthesia. Effects on ventilation, hemodynamic stability and bispectral index].
To compare depth of sedation, hemodynamic and respiratory effects, and bispectral index (BIS) in surgical patients under subarachnoid anesthesia with intravenous perfusion of 1 mg/kg/h of propofol or 3 microgram/kg/h of remifentanil or placebo. ⋯ The sedation regimens used were safe and adequate. Propofol is associated with fewer complications than remifentanil.