Hipoxemia nocturna después de cirugía abdominal: factores asociados y rol de la oxigenoterapia / Nocturnal hypoxemia after abdominal surgery: associated factors and usefulness of oxygen therapy

Fifteen elective patients (6 M, 9 F, 51+-8 years old) scheduled for laparotomy (n=8) or laparoscopy (n=7) were studied. Ventilatory parameters and pulse oximetry were measured pre and postoperatively. Patients were randomly assigned to receive oxygen by nasal cannula either during the first or the second postoperative night. PONH (Sat2 85) developed in seven patients (47 per cent)of which four had undergone laparoscopic surgery. PONH was more frequent in mildly obese patients and those presenting preoperative hypoxemia (p=0.03). Peak flow was lower in patients presenting PONH (p=0.04). In five patients, PONH was associated with significant tachycardia. Oxygen administration was associated with a higher SatO2 and prevented PONH in 6/7 patients. PONH is a common event in patients older than 40 years scheduled for open or laparascopic abdominal surgery, and develops more frequently in those with preoperative nocturnal hypoxemia and greater ventilatory impairment. PONH can be prevented, most of the time, with oxygen administration

Monitorización intraoperatoria del pH intramucoso gástrico / Intrasurgical monitorization of the gastric intramucosal pH

Eighteen patients subjected to abdominal surgery were studied. All received general anesthesia and hemodynamic parameters were maintained within 20 percent of basal values. A tononeter was placed in the stomach after induction of anesthesia. Arterial blood gases and samples from the tonometer were obtained 30 minutes after induction and at 2 hours of surgery. Intramucosal pH was calculated using Henderson-Haselbach equations. Basal gastric mucosal pH was 7.4ñ0.1 and did not change during surgery. Two patients had a pH persistently below 7.35 without hemodynamic alterations or systemic acidosis. Gastric mucosal pH is not modified by abdominal surgery and some patients have low values despite the absence of hemodynamic derangement

Anestesia peridural continua en pediatría / Continous peridural anesthesia in pediatrics

Se realizó una anestesia peridural continua en 51 pacientes, que tenían entre 20 días y 13 años de edad, sometidos a cirugía abdominal u ortopédica. En un paciente no se pudo ubicar el espacio peridural y en otro no se pudo avanzar el catéter. En los restantes no se presentaron problemas derivados del procedimiento. La mantención se hizo con halogenados en concentraciones menorea a ! mAC y fentanyl 2-4 µg/kg como dosis total, con lo que se obtuvieron muy buenas condiciones de analgesia intraoperatoria. El catéter se usó para analgesia en el postoperatorio, administrándose 0,2 ml/kg de bupivacaína 0,2 por ciento o 30-70 µg/kg de morfina. En 29 casos no fue necesario otro tipo de analgesia. No hubo complicaciones atribuíbles a la analgesia peridural postoperatoria