Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Aug 2000
Case Reports[Elective cesarean section with epidural anesthesia in a pregnant woman with obstructive hypertrophic myocardiopathy].
Hypertrophic obstructive myocardiopathy (HOM) is characterised by left ventricular hypertrophy, which causes dynamic obstruction at the exit of the chamber and diastolic dysfunction of the myocardium. The use of epidural anesthesia in patients with HOM is controversial due to the hemodynamic repercussions of reduced preloading and postloading that occur. A 28-year-old woman with HOM was scheduled for cesarean delivery at 36.5 weeks because of delayed intrauterine growth. ⋯ However, experience in using epidural anesthesia for cesarean delivery is scarce. For our patient, epidural anesthesia with appropriate hemodynamic monitoring allowed surgery to take place without complications. We therefore believe that the technique might be useful for such patients.
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To determine mortality risk factors for critically ill postoperative patients. ⋯ Surgical patients in critical condition continue to account for a large number of admissions to and death in the ICU. The variables analyzed were sufficient to explain patient outcome, such that risk factors for mortality in surgical patients admitted to the ICU could be determined.
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Rev Esp Anestesiol Reanim · Jun 2000
Comparative Study Clinical Trial Controlled Clinical Trial[Comparison of patient-ventilator synchronization during pressure support ventilation versus amplified spontaneous pattern in postoperative patients].
Patient-ventilator desynchronization can develop during weaning from proportional-assist ventilation. Poor adaptation between ventilator assistance and the patient's ventilatory demand is termed asynchrony. ⋯ The incidence of asynchrony during assisted ventilation is very high with the PS mode and is substantially less with ASP. Asynchrony is difficult to detect clinically and is revealed only by advanced cycle-to-cycle monitoring.
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Rev Esp Anestesiol Reanim · Jun 2000
Review[Failure of obstetric epidural analgesia and its causes].
The frequency of failure to establish and maintain an epidural block is low in Spain for surgery but higher in obstetrics. The reasons are many, but noteworthy factors are the prior experience of the anesthesiologist, the anatomical features of the patient and the type of material used. However, we lack clinical and anatomical studies of the epidural space that would allow us to come to definitive conclusions. ⋯ The anesthesiologist should avoid inserting too much of the epidural catheter and should assure firm support, checking it periodically and taking into account the patient's position. Finally the anesthetic dose should be adjusted to the progress of labor. The risk of incomplete analgesia and the possible need to insert a second epidural catheter must be discussed with the patient during preanesthetic evaluation.
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Rev Esp Anestesiol Reanim · Jun 2000
Clinical Trial[Use of EMLA cream and ropivacaine in dacryocystorhinostomy with locoregional anesthesia and sedation].
To assess the usefulness of locoregional anesthesia and sedation as an alternative to general anesthesia for dacryocystorhinostomy. ⋯ Using locoregional anesthesia and sedation for dacryocystorhinostomy is safe and effective and provides a valid alternative to general anesthesia. We suggest using EMLA cream in the nasal dressing and ropivacaine for infiltration. The process can be considered major outpatient surgery.