Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Nov 1999
Review[Esmolol in anesthesiology: pharmacology and indications].
Esmolol is a beta-adrenergic receptor antagonist with a relatively specific affinity for beta 1 adrenergic receptors. Its mechanism of action is therefore largely cardioselective and only high doses block beta 2 adrenergic receptors. The pharmacologic features of the drug give it rapid onset of beta-blocking action (distribution half-life = 2 minutes) and a short duration of action due to rapid clearance (clearance half-life = 9 minutes). ⋯ The esmolol dose is therefore manageable and individual adjustments can be made in function of a patient's clinical status. Such properties mean that esmolol is indicated for short-term treatment of hypertension and tachycardia during the perioperative period and in clinical situations that require easy unblocking of beta receptors. Hypertension and bradycardia are the most frequent complications associated with the administration of esmolol, such that blood pressure, heart rate and electrocardiographic data must be monitored.
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Rev Esp Anestesiol Reanim · Oct 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Mobilization of alpha-glutathione S-transferase in the anesthetized patient].
To measure and assess changes in plasma concentrations of alpha glutathione S-transferase (alpha-GST) during and after anesthesia with isoflurane, desflurane and propofol. ⋯ By measuring alpha-GST changes in plasma, we have detected signs of disturbance in hepatocellular integrity after anesthesia with all three maintenance agents used. However, the slight and transitory nature of the events confirms the scarce hepatotoxic potential of isoflurane, desflurane and propofol.
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Rev Esp Anestesiol Reanim · Oct 1999
Case Reports[Hypotension refractory to ephedrine after sympathetic blockade in a patient on long-term therapy with tricyclic antidepressants].
A 61-year-old woman in chronic treatment with 25 mg of amitriptyline underwent ovarian cancer resection under combined general and epidural lumbar anesthesia. After administration of local anesthetic she presented signs of severe arterial hypotension that was refractory to high doses of ephedrine and administration of dopamine alpha-adrenergic substances. Control was achieved with 200 micrograms of noradrenaline. We review the anesthetic implications of chronic use of tricyclic antidepressives as they affect choice of vasopressin for treating hypotensive events during anesthesia.
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Health care givers suffer problems of abuse of and addiction to substances at a rate similar to or perhaps higher than that of the general population according to available studies, most of which were done in the United States. Anesthesiologists tend to have the highest incidence of addiction. Among the risk factors identified are self-medication, stress at work and easy access to drugs. ⋯ The main obstacle to treating such patients is denial, which makes identification of abusers and their adherence to a program difficult. The therapeutic phases are identification, intervention, treatment, return to work and follow-up. Addicts are chronic patients who require follow-up for many years, given that the risk of relapse is always present.