Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 1999
Randomized Controlled Trial Clinical Trial[Utility of double burst stimulation in the detection of residual neuromuscular blockade].
To assess the usefulness of double burst stimulation (DBS) for detecting neuromuscular blockade caused by atracurium and vecuronium. ⋯ Assuming that DBS reduces the risk of residual curarization and that a TOF-ratio greater than 0.75 indicates adequate recovery from neuromuscular blockade, manual assessment of DBS response as obtained in this study indicates curarization and equal responses do not guarantee its absence. The most reliable index of recovery from neuromuscular blockade is the TR obtained by electromyographic monitoring.
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Rev Esp Anestesiol Reanim · Feb 1999
Comparative Study[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia].
Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization. ⋯ Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.
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Rev Esp Anestesiol Reanim · Feb 1999
Case Reports[Impossibility of intubation due to angioedema secondary to an angiotensin-converting enzyme inhibitor].
Angioedema secondary to treatment of one year's duration with angiotensin converting enzyme inhibitor (ACEI) (lisinopril) in a 56-year-old man scheduled for elective cardiac surgery led unexpectedly to impossible intubation. Surgical access (tracheostomy) was required when airway control was threatened. We review the clinical course, etiology and treatment of angioedema secondary to ACEI therapy. This is a life threatening complication which, though rare, is becoming increasingly frequent with increased use of such drugs.
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Rev Esp Anestesiol Reanim · Feb 1999
Case Reports[Ventilation in prone decubitus in a patient with respiratory distress during heart surgery].
Acute respiratory failure and adult respiratory distress syndrome are serious complications after heart surgery and are associated with a high mortality rate. We report the case of a 50-year-old man who developed severe respiratory distress after heart surgery with extracorporeal circulation and for whom oxygenation was possible with ventilation in prone decubitus position only after other therapeutic measured had failed. The physiological bases of ventilation in prone decubitus position, as well as the indications and contraindications of the technique are discussed. Early treatment, which is fundamental for managing these patients, facilitates a favorable outcome as is illustrated by the case we report.
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Remifentanil is a new opioid in the fentanyl family. Developed and marketed by Glaxo Wellcome Inc., it was approved by the U. S. ⋯ Remifentanil is an analog of fentanyl (4-piperidyl anilide) with a methyl-ester group that allows the molecule to be hydrolyzed by esterases in plasma and tissues. Rapid onset and metabolism make it an easy drug to control for achieving the desired depth of anesthesia, although these aspects are also the drug's main drawbacks given that the anesthesiologist must plan and initiate postoperative analgesia before surgery ends. Rapid onset and potency also mean that the use of this drug for either postoperative analgesia or monitored sedation in awake state with spontaneous breathing needs further study to assess safety.