Manejo anestésico de pacientes con trombocitemia esencial / Anesthetic management of a patient with essential trombocythemia

La trombocitemia esencial forma parte del grupo de neoplasias mieloproliferativas. Se caracteriza por síntomas microvasculares y vasomotores, recuento plaquetario superior a 450 x 109/l, proliferación megacariocítica con morfología grande y madura, ausencia de proliferación eritroide y granulocítica, demostración de JAK2V617F u otro marcador clonal y ausencia de evidencia de trombocitosis reactiva. Se reporta el manejo anestésico en una paciente donde las principales consideraciones están relacionadas con la prevención de eventos hemorrágicos y trombóticos. La suspensión de la aspirina, el mantenimiento del tratamiento con hidroxiurea, la preparación con ácido tranexámico, el uso pre y posoperatorio de fraxiparina, hidratación adecuada, uso de medias elásticas en miembros inferiores, deambulación precoz, buena hemostasia quirúrgica y disponibilidad de concentrados de plaquetas son los elementos fundamentales en la conducción anestésica de esta paciente(AU)

Essential thrombocythemia is part of the group of myeloproliferative neoplasms. It is characterized by microvascular and vasomotor symptoms, platelet count over 450x109/L, megakaryocytic proliferation with large and mature morphology, absence of erythroid and granulocytic proliferation, demonstration of JAK2V617F or other clonal marker, and absence of evidence of reactive thrombocytosis. Anesthetic management is reported in a patient, whose case's main considerations are related to the prevention of hemorrhagic and thrombotic events. Aspirin suspension, maintenance of hydroxyurea treatment, preparation with tranexamic acid, pre- and post-operative use of fraxiparin, adequate hydration, use of elastic stockings in lower limbs, early ambulation, good surgical hemostasis, as well as availability of platelet concentrates are the fundamental elements in the anesthetic management of this patient(AU)

Randomized, double-blind, placebo-controlled study of the analgesic effect of intraoperative esmolol for laparoscopic gastroplasty

Abstract Purpose To evaluate the analgesic effect of esmolol in patients submitted to laparoscopic gastroplasty. Methods Forty patients aged between 18 and 50 years with American Society of Anesthesiologists (ASA) physical status scores of II and III who underwent gastric bypass were allocated to two groups. Group 1 patients received a 0.5-mg/kg bolus of esmolol in 30 mL of saline before induction of anesthesia, followed by an infusion at 15 µg/kg/min until the end of surgery. Group 2 patients received 30 mL of saline as a bolus and then an infusion of saline. Anesthesia included fentanyl (3 µg/kg), propofol (2-4 mg/kg), rocuronium (0.6 mg/kg), and 2% sevoflurane, with remifentanil if necessary. The following parameters were evaluated: pain intensity over 24h, remifentanil consumption, the first analgesic request, morphine consumption, and side effects. Results Pain intensity was lower in the esmolol group except at T0 (after extubation) and 12h postoperatively. Remifentanil supplementation, recovery time, and postoperative morphine supplementation were lower in the esmolol group. No differences in the time to the first analgesic request or side effects were found between the groups. Conclusion Intraoperative esmolol promotes reductions in pain intensity and the need for analgesic supplementation without adverse effects, thus representing an effective drug for multimodal analgesia in gastroplasty.

Use of eugenol for anesthesia of lesser guitarfish Zapteryx brevirostris (Rhinobatidae) / Uso de eugenol para anestesia de raia-viola Zapteryx brevirostris (Rhinobatidae)

Abstract Anesthesia can be utilized as a non-lethal procedure to allow easy handling of teleosts and elasmobranchs in captivity or in the wild. For this, anesthetic protocols need to be established according to the species. The aim of this study was to determine the ideal concentration of eugenol for anesthesia of Zapteryx brevirostris. Four concentrations were tested: 21.25, 42.50, 85.00 and 170.00 mg L-1 (ratio of 1:5 with absolute ethanol). The perfect concentration of eugenol for this species was 85.0 mg L-1 , which enabled up to 300 seconds of work on the fish, without any response to handling.

Resumo A anestesia pode ser utilizada como um procedimento não letal que facilita o manejo de teleósteos e elasmobrânquios de cativeiro e de vida livre. Para isso, protocolos anestésicos devem ser estabelecidos de acordo com a espécie. O objetivo deste trabalho foi determinar a concentração ideal do eugenol para anestesiar Zapteryx brevirostris. Foram testadas as concentrações de 21,25; 42,50; 85,00 e 170,00 mg L-1 (1:5 de álcool absoluto). A concentração de 85,0 mg L-1 de eugenol foi a mais adequada para a espécie, permitindo uma janela de trabalho de até trezentos segundos com o animal não respondendo ao manejo.

Fibrosis quística del adulto y cirugía laparoscópica / Cystic fibrosis in the adult and laparoscopic surgery

Introducción: La fibrosis quística es una enfermedad genética que constituye causa frecuente de neumopatía crónica grave en adultos jóvenes. Se asocia a cirrosis de vías biliares y cálculos vesiculares, por lo que el anestesiólogo debe estar familiarizado con las características clínicas de la enfermedad a fin de disminuir el índice de complicaciones perioperatorias que pueden presentarse. Objetivo: Presentar las características clínicas y la conducta perioperatoria en una paciente con diagnóstico de fibrosis quística anunciada para colecistectomía videolaparoscópica. Caso clínico: Paciente femenina de 19 años de edad, raza negra, con múltiples infecciones respiratorias durante la infancia, que se diagnosticó como caso nuevo de fibrosis quística y durante los estudios se observó litiasis vesicular sintomática por lo que se anunció para colecistectomía videolaparoscópica. Se describe la evaluación y preparación preoperatoria, así como la conducta anestésica intraoperatoria. Conclusiones: Los resultados anestésicos dependen de la atención a una enfermedad compleja que afecta a múltiples órganos y el control estrecho y el tratamiento oportuno de la enfermedad pulmonar previa(AU)

Introduction: Cystic fibrosis is a genetic disease that is a frequent cause of severe chronic lung disease in young adults. It is associated with biliary tract cirrhosis and gallstones, a reason why the anesthesiologist must be familiar with the clinical characteristics of the disease in order to reduce the rate of perioperative complications that may occur. Objective: To present the clinical characteristics and perioperative behavior in a patient diagnosed with cystic fibrosis announced for videolaparoscopic cholecystectomy. Clinical case: Female patient of 19 years of age, black race, with multiple respiratory infections during childhood, who was diagnosed as a new case of cystic fibrosis. During the studies, symptomatic vesicular lithiasis was observed, that's why the patient what was announced for videolaparoscopic cholecystectomy. The evaluation and preoperative preparation, as well as the intraoperative anesthetic behavior are described. Conclusions: Anesthetic outcomes depend on the attention to a complex disease that affects multiple organs and the close control and timely treatment of previous lung disease(AU)

Anestesia regional mandibular con modificación de tacher / Regional anesthesia with tacher modification

La anestesia dental es un tema importante en la práctica cotidiana enlas diversas especialidades odontológicas, motivo por el que nace lanecesidad de hacer una revisión de las técnicas anestésicas actuales. Con base en nuestra experiencia nos dimos cuenta de que la practicidad de utilizar referencias anatómicas confiables nos sirven de guía para obtener una mejor efi cacia al momento de anestesiar el nervio alveolar mandibular. Lo anterior se traduce en menor dolor posterior a la punción, menor dosis anestésica y una profundidad anestésica adecuada en tejidos blandos y duros, del mismo modo nos permite llevar a cabo diversos tratamientos con un margen de seguridad más amplio y disminuir losriesgos de toxicidad. Cabe mencionar que dicha técnica se ha incluido enla práctica clínica cotidiana en nuestra práctica privada en el Postgradode Ortodoncia del Instituto universitario Franco Inglés de México yen el Servicio de Cirugía Oral y Maxilofacial del Centro Médico Lic.Adolfo López Mateos en la ciudad de Toluca, Estado de México.

Dental anesthesia is an important issue in daily practice in the variousdental specialties, which is why the need for a review of the anesthetictechnique arises. Based on our experience, we realized the practicalityof using reliable anatomical references that serve as a guide, to obtaina better effi cacy when anesthetizing the mandibular alveolar nerve,resulting in less pain after puncture, lower anesthetic dose and anadequate anesthetic depth in soft and hard tissues, which allows us tocarry out various treatments with a wider margin of safety and reducethe risks of toxicity. It is worth mentioning that this technique hasbeen included in daily clinical practice in our private practice, in theorthodontic postgraduate course of the Instituto Franco in Mexico andin the oral and maxillofacial surgery service of the Licensed MedicalCenter «Adolfo Lopez Mateos¼ in the City of Toluca, State of Mexico.

Neuralgias of the Head: Occipital Neuralgia

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

Analgesic effect of Hypericum perforatum, Valeriana officinalis and Piper methysticum for orofacial pain

To evaluate in vivo the association of hypericum Hypericum perforatum, valerian Valeriana officinalis and kava Piper methysticum with analgesia by assessing their effects in reducing orofacial pain as well as the possible hepatic, hematologic and biochemical alterations induced by regular administration of these extracts. METHODS: Orofacial pain was induced in mice with the administration of 2.5% formalin in the upper lip. After 60 min, the animals were treated with saline, carbamazepine and hydroalcoholic plant extracts. The nociceptive intensity was determined by the timing at which the animal remained rubbing the injected area. To assess the hepatotoxic effect, mice were chronically treated for 25 days with saline, carbamazepine and hydroalcoholic extract. The animals were euthanized and the liver weighed, followed by a differential count of leukocytes and measurement of alanine transaminase and alkaline phosphatase. RESULTS: The evaluation of analgesic activity in phase 1 reduced the time of rubbing compared to the control by 86% 0.05 mL/10 g and 76% 0.10 mL/10 g. In phase 2, the extracts reduced rubbing time by 94% and 85%, respectively. In the evaluation of alkaline phosphatase, the groups treated with extracts at doses of 0.05 mL/10 g and 0.1 mL/10 g increased by 16.1% and 9.5% compared to the control group and a reduction of 8.5% and 9.1% in the evaluation of alanine transaminase respectively. It was demonstrated that in the differential counts showed an increase in eosinophils in the treated group with 0.05 mL/10 g. CONCLUSIONS: The use of hydroalcoholic extract of the associated plants reduced the orofacial formalin-induced pain with better results than carbamazepine, at both the neural conductor level of pain phase 1 and in inflammatory or later pain phase 2 without presenting hepatotoxicity. The observed eosinophilia is suggestive of a phenomenon called hormesis...

The effects of anesthetic regimen in 90% hepatectomy in rats / Os efeitos do regime anestésico na hepatectomia de 90% em ratos

PURPOSE: To evaluate the influence of the anesthetic regimen on anesthetic recovery, survival, and blood glucose levels following a 90% partial hepatectomy in rats. METHODS: Thirty adult male Wistar rats were divided into two groups according to their anesthetic regimens: intraperitoneal ketamine and xylazine or inhaled isoflurane. In order to prevent hypoglycemia, glucose was administered intraperitoneally and glucose (20%) was added to the drinking water. RESULTS: Anesthetic recovery time was longer in the ketamine and xylazine group. The survival rate after 72 hours was lower (log rank=0.0001) in the ketamine and xylazine group (0.0%) than in the isoflurane group (26.7%). The blood glucose after six hours was lower (p=0.017) in the ketamine and xylazine group (63±31.7 mg/dL) than in the isoflurane group (98±21.2 mg/dL). The prolonged anesthesia recovery time associated with ketamine and xylazine decreased the survival rate and blood glucose levels after 90% hepatectomy. CONCLUSION: Isoflurane anesthesia reduced the recovery time and incidence of hypoglycemia and increased the survival rate in the early hours, providing a therapeutic window that is suitable for experimental studies.

OBJETIVO: Avaliar a influência do regime anestésico sobre a recuperação anestésica, a sobrevida em 72 horas e a glicemia após hepatectomia parcial de 90% em ratos. MÉTODOS: Trinta ratos Wistar machos adultos foram distribuídos em dois grupos conforme o regime anestésico: combinação de ketamina e xilazina intraperitoneal ou isoflurano inalatório. Para prevenção de hipoglicemia foi administrada glicose intraperitoneal e adicionado glicose (20%) na água de beber. RESULTADOS: A recuperação anestésica no grupo ketamina e xilazina foi mais prolongada. Durante primeira hora após hepatectomia, nenhum rato anestesiado com ketamina e xilazina despertou. Todos do grupo isoflurano estavam ativos minutos após final da cirurgia. A sobrevida em 72 horas foi menor (Log rank=0,0001) no grupo ketamina e xilazina (0,0%) que no grupo isoflurano (26,7%). Glicemia em 6 horas do grupo ketamina e xilazina (63±31,7 mg/dL) foi menor (p=0,017) que no grupo isoflurano (98 ±21,2 mg/dL). Prolongado tempo de recuperação anestésica com ketamina e xilazina diminuiu sobrevida e glicemia após hepatectomia 90%. CONCLUSÃO: Anestesia com isoflurano reduziu tempo de recuperação e hipoglicemia, além de aumentar a sobrevida nas primeiras horas, possibilitando uma janela terapêutica adequada para estudos experimentais.

Avaliação da utilização de anestésico tópico para instalação de mini-implantes ortodônticos / Evaluation of the use of tropical anesthetics for installation of orthodontic mini-implants

Objetivos: o objetivo deste trabalho foi avaliar a eficiência do uso de anestésico tópico para inserção de mini-implantes utilizados como meio de ancoragem esquelética em Ortodontia. Material e Métodos:o anestésico tópico a base de lidocaína 20% em gel foi utilizado para inserção de mini-implantes em 40 pacientes em tratamento com aparelhos fixos. A idade média dos pacientes era 23,58 anos. Os pacientes responderam a um questionário com quatro perguntas de múltipla escolha, avaliando a aceitabilidade e o desconforto durante a anestesia e a colocação do mini-implante. Os dados foram avaliados em porcentagem e pelo teste qui-quadrado para avaliação do dimorfismo sexual. Resultados: 92,5% dos pacientes relataram que não sentiram nenhum incômodo durante a aplicação do anestésico tópico e apenas7,5% sentiram uma leve dormência, o que mostra que o anestésico teve boa aceitação pelos pacientes. Em relação ao procedimento de instalação dos mini-implantes, somente 20% dos indivíduos da amostra relacionaram a dor (independente da intensidade) como a sensação mais desagradável durante todo o procedimento de colocação do mini-implante.Entretanto, 47,5% dos pacientes não sentiram dor alguma e apenas10% dos pacientes sentiram dor intensa. Houve diferença entre os gêneros apenas com relação à sensação mais desagradável durante todo o procedimento, sendo que a maioria das mulheres (55%) relatou não ter sentido nada desagradável, comparando com apenas 40% dos homens. Conclusão: a instalação de mini-implantes com anestésico tópico se mostrou viável e eficiente, podendo ser uma alternativa, mas são necessários mais estudos e comparações com outros métodos de anestesia.

Objectives: the objective of this study was to evaluate the efficiency of the use of topical anesthetics for insertion of miniimplants used as skeletal anchorage in orthodontics. Material and methods: the topical anesthetics based in lidocaine gel 20% was used to the insertion of mini-implants in 40 patients in treatment with fixed appliances. The mean age of the patients was 23.58 years. Patients answered to a questionnaire with 4 multiple choice questions, evaluating the acceptability and discomfort of the patients during anesthetics and placement of mini-implant. Data were evaluated by percentage and by the chi-square test to evaluate the sexual dimorphism. Results:92.5% of the patients reported that did not feel any discomfort during the application of the topical anesthetics, and only 7.5% felta slight dormancy, what shows that the anesthetics presented good acceptance by the patients. In relation to the procedure of installation of mini-implants, only 20% of the subjects related pain (regardless ofthe intensity) as the more unpleasant sensation during the procedure of placement of the mini-implant. However, 47.5% of the patients did not feel any pain and only 10% of the subjects felt intense pain. There was difference between sexes only regarding the more unpleasant sensation during the procedure, and the majority of the females (55%)reported not to feel any unpleasant sensation, comparing with only 40% of the males. Conclusion: the installation of mini-implants with topical anesthetics proved to be feasible and effective, it could bean altemative, but more studies and comparisons with other type of anesthesia are necessary.

Osteosarcoma intracraneal relacionado con el embarazo: a propósito de un caso / Intracranial osteosarcoma related to pregnancy: a case report

El paladar hendido es un defecto congénito de las estructuras que forman la bóveda palatina, y es característico por una hendidura o apertura en el paladar superior. Objetivo: describir el manejo de la vía aérea en el paciente con paladar hendido. Caso Clínico: se presenta un caso, sobre el manejo de la vía aérea de un paciente con paladar hendido tipo IV de 45 años, que se anunció para tratamiento quirúrgico electivo con el diagnóstico de tumor de sigmoide, en el Hospital Universitario Manuel Ascunce Domenech.

Cleft palate is a congenital defect of structures that form the palatal vault, and it is characterized by an aperture or opening in the upper palate. Objective: to describe the handling of the airway in a patient with cleft palate. Clinical case: a case of a patient with type IV cleft palate of 45 year-old was presented, with diagnosis of sigmoid tumor, who was approached the airway for elective surgical treatment at the Teaching Hospital Manuel Ascunce Domenech.

Recomendaciones para el tratamiento del dolor neuropático / Recommendations for the treatment of neuropathic pain

Con la introducción y el desarrollo de nuevos productos que han demostrado ser eficaces en el dolor neuropático (DN), se ha generado una clara necesidad de tener un algoritmo basado en la evidencia para tratar las diferentes condiciones del DN. El objetivo de este artículo es elaborar unas recomendaciones para el tratamiento del DN que estén avaladas por la evidencia científica y que estén consensuadas por un grupo multidisciplinario de expertos en metodología y en tratamiento del dolor. La evidencia se ha obtenido de estudios de metanálisis que recogen la mayor información disponible para cada tipo de DN. La búsqueda bibliográfica se llevó a cabo por 5 revisores, que se centraron individualmente en las diferentes formas de presentación del DN. Las bases de datos consultadas fueron la Cochrane Library, EMBASE (año 2000 en adelante) y PUBMED(año 2000 en adelante), y se seleccionaron metaanálisis y ensayos clínicos aleatorizados y controlados. Finalmente, los autores, especialistas en dolor, evaluaron e hicieron las recomendaciones clínicas para el tratamiento del DN. En algunos tipos de DN, de los cuales no hay suficiente información, se han incluido recomendaciones basadas en publicaciones científicas sin evidencia, con el objetivo de que estas recomendaciones proporcionen la mayor información posible acerca de su tratamiento. Se han revisado estudios de eficacia y seguridad de neuralgia postherpética (NPH), neuropatía diabética dolorosa (NDD) y neuralgia del trigémino(NT) como paradigmas de DN periférico, y también se ha recogido la escasa información existente acerca del DN central(DNC) y el dolor simpático (DS). Con los resultados obtenidos con este estudio bibliográfico y las evidencias extraídas, se ha elaborado un algoritmo de decisión con los fármacos disponibles actualmente en la farmacopea española para la NPH y la NDD; por otro lado, y de forma independiente, para la NT y, finalmente, para el DNC y el DS.

The introduction and development of new products with demonstrated efficacy in neuropathic pain has generated a clear need for an evidence-based algorithm to treat the different types of neuropathic pain. The present article aims to provide recommendations on the treatment of neuropathic pain supported by the scientific evidence and agreed on by consensus by a multidisciplinary group of experts in methodology and pain management. The evidence was obtained from meta-analyses including the greatest amount of information available for each type of neuropathic pain. The literature search was performed by 5 reviewers, who focussed individually on the distinct forms of presentation of neuropathic pain. The databases consulted were the Cochrane Library, EMBASE (from 2000 onwards), and PUBMED (from 2000 onwards). Meta-analyses and randomized, controlled clinical trials were selected. Finally, retrieved articles were evaluated and clinical recommendations for the treatment of neuropathic pain were designed by the pain specialists. For some types of neuropathic pain, there is insufficient information. In these types of pain, recommendations based on scientific publications without evidence were included to provide the reatest possible amount of information on their treatment. Studies of safety and efficacy in postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia (TN) were reviewed as paradigms of peripheral neuropathic pain. The scarce available information on central neuropathic pain (CNP) and sympathetic pain (SP) was also gathered. Based on the results obtained with this literature review and the evidence extracted, a decision algorithm was designed with the drugs currently available in the Spanish pharmacopeia for PHN and PDN, and separate decision algorithms were designed for TN and finally for CNP and S P.

Electrobisturí en las incisiones de hernioplastia inguinal / Comparative study of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplsty

Objetivo: Determinar si el uso del electrobisturí versus el bisturí convencional para realizar la incisión cutánea en la hernioplastia inguinal, predispone un aumento del dolor postoperatorio, mayor requerimiento analgésico postoperatorio y un incremento en la formación de colecciones a nivel de la herida quirúrgica.

Objetive: To determine whether the use of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplasty, predisposes an increased postoperative pain, better postoperative analgesic requeriment and an increase in the formation of collections at the surgical wound.

Comparación de etomidato, ketamina y propofol como inductores para gastroduodenoscopia en perros / Comparison of etomidate, ketamine and propofol as inducers for gastroduodenoscopy in dogs

La endoscopia digestiva superior (EDS) es un método diagnóstico muy utilizado actualmente en la medicina de pequeños animales. El procedimiento requiere anestésicos y la selección de los mismos es crucial. Este estudio comparó los efectos de tres inductores etomidato, ketamina y propofol, en su capacidad para facilitar o hacer más difícil el paso del endoscopio hasta el duodeno. También se determinó, con cuál de estos agentes inductores se utilizaba menos tiempo para realizar la técnica, y se estableció el protocolo que permite una recuperación más rápida. Se encontró que ninguno de los inductores utilizados dificultó significativamente el acceso al estómago ni el paso por el mismo. Con el etomidato se pasó por el estómago en un tiempo menor pero la diferencia no fue significativa, como tampoco hubo diferencia en el tiempo necesario para atravesar el píloro; sin embargo, desde el punto de vista clínico este paso si fue menos fácil con la ketamina. En cuanto a la recuperación anestésica el propofol permitió un tiempo de recuperación menor (p>0.05). Se concluye que los tres agentes tuvieron un comportamiento similar desde el punto de vista estadístico, pero clínicamente el etomidato fue mejor.

Upper digestive endoscopy (EDS) is a currently used diagnostic method in small animal practice. The procedure requires anesthetics which selection is crucial. This study compared the effects of three of them: etomidate, ketamine and propofol, regarding capacity to facilitate the passage of the endoscope until (or down to) to the duodenum. It was also determined which of these inducers contribute the best to perform the technique in a shorter time, and which one of the protocols leads to a faster recovery. The results indicate that none of the inducers make significantly more difficult the access to the stomach, nor the passage through this organ, although with etomidato the time needed was shorter. There were no differences either in time or difficulty to go through the pylorus. Nevertheless, from the clinical point of view ketamine made this step more difficult. For recovery, propofol did present a significant shorter period (p>0.05). It is concluded that the three studied agents show a similar statistical profile, but from the clinical point of view etomidato behaves better.

Manejo anestésico en un paciente de 8 años de edad con diagnóstico de obstrucción intestinal en el Hospital Manuel de Jesús Rivera La Mascota noviembre 2004 / I manage anesthetic in a 8 year-old patient with diagnosis of intestinal obstruction in the Hospital Manuel of Jesus Rivera The Mascot November 2004

Presente analisis del estudio de caso del Manejo anestésico en un paciente de 8 años de edad con diagnóstico de obstrucción intestinal en el Hospital Manuel de Jesús Rivera La Mascota noviembre 2004, realizado para obtar el título de anestesia y reanimación en enfermería. Se analiza paciente con manejo anestesico sometido a cirugia por obstrucción intestinal causada por invaginación. Hace 11 meses fue intervenido quirúrgicamente a causa de una invaginación Ileocecocolica Ascendente en la cual no presentó ningún tipo de dificultad, actualmente paciente cursa con un estado de diarrea aguda mas ascaridiasis, presenta estado de palidez. Paciente activo, reactivo, hidratado, no alérgico, no presenta dificultad aparente para intubación endotraqueal, paciente NPO. Durante el durante el acto operatorio se tomaron medidas inmediatas como la toma del pulso, presión y temperatura, asi como la saturación de oxígeno en la sangre y la capacidad del paciente de eliminar bióxido de carbono del pulmón utilizando métodos no invasivos (que no le duelan al niño). En conclusión es importante para el medico y el anestesista conocer la fisiopatología de la enfermedad del paciente para determinar el mejor protocolo anestésico y quirúrgico que permita correcto manejo de la anestesia y la cirugía conforme a cada paciente.

Anestesia en la tetralogía de Fallot / Anesthesia in the tetralogy of Fallot

Se presenta una revisión bibliográfica sobre las características fundamentales de esta enfermedad, la repercusión hemodinámica que produce, las complicaciones que se presentan durante el preoperatorio, los defectos asociados a esta, el tratamiento preoperatorio y el manejo anestésico que se utiliza. Estos pacientes que se programan para una reconstrucción anatómica, están en el mejor de los casos sólo compensados parcialmente, por lo que pueden presentar inestabilidad hemodinámica con la administración de los agentes anestésicos, especialmente durante la inducción anestésica. Por todo lo anterior es que deben ser atendidos con delicadeza y cuidado extremo para evitar empeorar la disfunción cardiovascular preexistente, que crearía un ciclo de agravamiento de la hipoxia, acidosis y disminución del gasto cardíaco

Midazolam como codyuvante en la anestesia epidural en pacientes sometidas a cesareas, Hospital Escuela Bertha Calderón Roque septiembre-diciembre 2004 / Midazolam as codyuvante in the anesthesia epidural in patient submitted to cesareas, School Hospital Bertha Calderón Roque September -December 2004

Se realizó un Ensayo Clínico Controlado, ciego, con el propósito de evaluar al Midazolam como coadyuvante en el Anestesia Epidural en pacientes sometidas a cesárea, en el Hospital Bertha Calderón Roque en el perídodo Septiembre ù Diciembre del 2003. Se selecciono a 60 pacientes elegibles y al azar, distribuyéndose en dos grupos de estudio cuya característica distintiva fue la aplicación o no de Midazolam junto con anestésicos locales por vía Epidural, al grupo con Midazolam se aplico 3 mg de esta junto con Bupivacaina + Epinefrina al 0.5 porciento y Lidocaina al 2 porciento.En cuanto a las características generales a conocer, de los pacientes en estudio se encontró que la edad promedio fue de 22.17 +1- 6.05 años y de 21.8 +1- 4.12 años en el grupo Sin y con Midazolam respectivamente. El peso promedio fue de 67.96 +1- 4.7 y de 68.19 +1- 1.60 kg en el primero y segundo grupo respectivamente. La mayoría fueron clasificados como ASA II , con 40 pacientes y 20 pacientes fueron clasificados como ASA 1 no encontrándose clasificadas pacientes como ASA I En cuanto a las Gestas 29 pacientes cursaban con su segundo embarazo, 22 con el primer embarazo y 9 con el tercer embarazo. El tiempo de regresión del Bloqueo sensitivo ( hasta TIO ) fue de 143.62 mm y 145.32 mm en el grupo Sin y con Midazolam respectivamente . El tiempo de regresión del Bloqueo motor fue de 121.2 y de 118.87 mm la duración de la analgesia pos operatoria fue de 135.69 y de 166.45 mm en los grupos respectivos antes mencionados. El nivel de sedación más frecuente alcanzado fue el III con 17 pacientes y el nivel II fue alcanzado por 14 pacientes. Los productos de las pacientes del primer grupo fueron calificados en su mayoría con un Apgar de 8/9 (16 ) y 7/9 (1). Del segundo grupo 14 fueron 8/9. El nivel sensitivo alcanzado fue el de T6 en 46 pacientes y T4 en 14 pacientes. La PAM y la FC en ambos grupos tuvieron sus mayores variaciones a los 5min posterior a la aplicación del Bloqueo Epidural en relación al valor basal. Según la EVA, a partir de los 60 mm en el grupo Sin Midazolam se alcanzó, el valor de 5 por 9 pacientes aumentándose este numero a los 90 y l2Omin. En el grupo con Midazolam se alcanzó el valor de 5 a partir de los 90min , por 11 pacientes, encontrándose a los l2Omin el total de estas entre el valor 5 y 6 de la Escala...