[Lung function and quality of analgesia after lung resection with epidural alfentanyl]. / Función pulmonar y calidad de la analgesia tras cirugía resectiva pulmonar con alfentanilo epidural.

OBJECTIVES: To evaluate the effects on postoperative pulmonary function and quality of analgesia of two protocols for epidural infusion of alfentanil after lung resection. PATIENTS AND METHODS: After informed consent, 30 ASA I-IV patients undergoing chest surgery (lobectomy or pneumonectomy) were randomly assigned to two groups of 15. A catheter was inserted into the epidural space at T5-7 (group T) or L2-3 (group L). After a test dose, an initial bolus of alfentanil (10 micrograms/kg) was administered. After anesthetic induction, epidural analgesia was performed with an infusion of 400 micrograms/h of alfentanil (group L) during and after surgery. Endovenous patent-controlled anesthesia (PCA) was provided with morphine. During the first 24 h after surgery, the following variables were recorded: arterial blood gas concentrations, spirometric parameters, pain on a visual analog scale (VAS) and side effects. ANOVA and Scheffé and chi-square tests were used to analyze the results (p < or = 0.05). RESULTS: In group T, PaO2 was significantly higher at 6 and 18 h (p < or = 0.05), while FEV1 and FVC were significantly higher at 12 and 18 h. Pain assessed by VAS and PCA need for morphine was significantly less in group T. CONCLUSIONS: Thoracic epidural analgesia with alfentanil and lidocaine improves postoperative lung function and reduces the need for top-up analgesia in comparison with lumbar epidural infusion of alfentanil.

Función pulmonar y calidad de la analgesia tras cirugía resectiva pulmonar con alfentanilo epidural / Lung function and quality of analgesia after lung resection with epidural alfentanil

OBJETIVOS. Evaluar la función pulmonar y la calidad analgésica de dos pautas de infusión epidural de alfentanilo tras la cirugía pulmonar resectiva.MATERIAL Y MÉTODOS. Tras el consentimiento informado, 30 pacientes ASA I-IV fueron incluidos aleatoriamente en dos grupos (n = 15) siendo sometidos a cirugía torácica (lobectomías o neumonectomías), a los cuales se les insertó un catéter epidural torácico en T5-7 (grupo T) o lumbar en L2-3 (grupo L). Tras una dosis test epidural, se administró previamente a la inducción anestésica un bolo de alfentanilo (10 µg/kg), prosiguiéndose con una infusión epidural de 400 µg/h de alfentanilo más 50 mg/h de lidocaína (grupo T) o 400 µg/h de alfentanilo (grupo L) durante la cirugía y postoperatorio. Además, se utilizó una analgesia controlada por el paciente intravenosa con morfina. Durante las primeras 24 h postoperatorias se registraron las siguientes variables: gasometrías arteriales, espirometría, escala analógica visual del dolor y efectos secundarios. El análisis estadístico consistió en los tests de ANOVA, Scheffé y 2 (p 0,05). RESULTADOS. La PaO2 fue significativamente mayor en el grupo T (6 y 18 h) (p 0,05). El volumen espirado forzado en el primer segundo1 y la capacidad vital forzada fueron superiores significativamente en el grupo T (12 y 18 h). El dolor y los requerimientos de morfina fueron significativamente menores en el grupo T. CONCLUSIONES. La analgesia epidural torácica con alfentanilo más lidocaína mejora la función pulmonar postoperatoria y reduce la necesidad de analgesia de rescate con respecto al alfentanilo epidural lumbar (AU)

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[Comparative study of preemptive and postincisional lumbar epidural morphine in pulmonary resection. Preliminary report]. / Estudio comparativo entre morfina epidural lumbar preventiva o postincisional en cirugía resectiva pulmonar. Informe preliminar.

OBJECTIVES: To evaluate the efficacy and incidence of side effects of two types of lumbar epidural analgesia with morphine, preemptive or postincisional, combined with total intravenous anesthesia in chest surgery. PATIENTS AND METHODS: This double-blind prospective study enrolled 20 patients (ASA I-IV) undergoing lobectomy or pneumonectomy. Anesthetic induction and maintenance was provided with propofol, atracurium and alfentanil. Lumbar epidural analgesia (L2-L3) with morphine was provided for group A patients with 2 to 4 mg upon excision of tissue and for group B with 2 to 4 mg during anesthetic induction. The following variables were recorded: arterial blood gas concentrations, heart rate, SpO2, EtCO2, postanesthetic recovery, arterial gases, side effects and pain on a visual analogue scale. Top-up analgesia was provided by intravenous metamizole and/or epidural morphine. For statistical analysis we used ANOVA, chi-square tests and Student-Newman-Keuls tests. RESULTS: The need for propofol and alfentanil during anesthesia, and for morphine and metamizole after surgery were statistically greater in group A. Pain 18 hours after surgery was also greater in group A. No significant differences between groups for other variables was observed. CONCLUSIONS: Preemptive analgesia with lumbar epidural morphine in addition to the general anesthesia described here seems to provide higher-quality analgesia with few side effects, reducing the need for propofol and alfentanil during surgery and for postoperative morphine and metamizole.

[Intramucosal intraoperative gastric pH (pHi) during cardiac surgery] surgery]. / pH intramucoso gástrico (pHi) durante el intraoperatorio de cirugía cardíaca.

OBJECTIVE: To evaluate the monitoring of intramucosal pH (pHi) and standard pH (pHs) during heart surgery with extracorporeal circulation (ECC) and moderate hypothermia. The correlations of pHi and pHs and the postoperative APACHE III score after surgery were analyzed. PATIENTS AND METHODS: Sixteen patients with cardiac output > 0.4 scheduled for coronary bypass surgery, or aortic or mitral valve replacement were studied. Arterial pH (pHa), pHi and pHs were measured and the difference between pHa and pHi was calculated before starting ECC (T0), during ECC and hypothermia (T1) and after termination of ECC (T2). The APACHE III score was recorded 18 h after surgery. RESULTS: No significant differences between the pHi and pHs were observed in these patients. pHi was significantly higher during ECC with hypothermia (T1) than at baseline (T0). pHi and pHs were significantly correlated during the study period. There was no correlation between the APACHE III score in the immediate postoperative period and either pHi or pHs during surgery. CONCLUSION: Periods of splanchnic hypoxia (pHi < 7.32) during heart surgery with moderate hypothermia were not seen in patients with cardiac output > 0.4. pHs is a reliable measurement of pHi. There is no relation between APACHE III scores in the early postoperative period and pHi or pHs levels during surgery.