ABSTRACT
Las técnicas de refuerzo vertebral, como la vertebroplastia y la cifoplastia percutáneas, son técnicas mínimamente invasivas empleadas en el tratamiento de las fracturas-aplastamientos vertebrales. Las técnicas anestésicas empleadas durante estos procedimientos son variadas y con diversos resultados. Presentamos una serie de 6 casos, vertebroplastias y cifoplastias, realizados con anestesia subaracnoidea hipobárica metamérica, en los que la estabilidad hemodinámica y la analgesia obtenidas fueron satisfactorias (AU)
Vertebral reinforcement techniques, such as percutaneous vertebroplasty and kyphoplasty, are minimally invasive procedures used in the treatment of fractured or collapsed vertebras. The anaesthetic techniques employed during these procedures are diverse and with variable results. We report 6 cases, vertebroplasty and kyphoplasty using subarachnoid metameric anaesthesia with a hypobaric technique. Haemodynamic stability and analgesia were satisfactory in all of them
Subject(s)
Humans , Subarachnoid Space , Anesthetics/administration & dosage , Vertebroplasty/methods , Kyphoplasty/methods , Spinal Diseases/surgery , Bupivacaine/administration & dosage , Patient Positioning/methodsABSTRACT
Vertebral reinforcement techniques, such as percutaneous vertebroplasty and kyphoplasty, are minimally invasive procedures used in the treatment of fractured or collapsed vertebras. The anaesthetic techniques employed during these procedures are diverse and with variable results. We report 6 cases, vertebroplasty and kyphoplasty using subarachnoid metameric anaesthesia with a hypobaric technique. Haemodynamic stability and analgesia were satisfactory in all of them.
Subject(s)
Anesthesia, Spinal/methods , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Vertebroplasty , Aged , Aged, 80 and over , Bone Cements , Female , Head-Down Tilt , Humans , Kyphoplasty , Male , Middle Aged , Patient Acceptance of Health Care , Pressure , Prone PositionABSTRACT
Introducción: Tras el alta se necesita mejorar la comunicación entre la unidad de cirugía sin ingreso y el domicilio de los pacientes para ofrecer la misma calidad asistencial y los mismos cuidados que en la cirugía con ingreso. El objetivo principal del presente estudio es validar el impacto clínico, asistencial y de gestión del sistema de m-Salud de control domiciliario telefónico asistido con imágenes de telefonía móvil y pulsioximetría en el periodo postoperatorio tras intervenciones de cirugía ambulatoria. Material y métodos: Este trabajo presenta los resultados de un estudio prospectivo randomizado de un sistema móvil-health para la monitorización postoperatoria de pacientes en los primeros días del postoperatorio en el domicilio. Se seleccionaron de forma aleatoria 310 pacientes intervenidos de cirugía ambulatoria comparables en complejidad quirúrgica. Evaluamos dos grupos: el grupo piloto (llevaba móvil con transmisión de imágenes del postoperatorio)y el grupo control (sin móvil).Resultados: Los resultados muestran que el control telefónico protocolizado por sí mismo (con o sin imágenes de telefonía móvil) es eficiente en términos de calidad de la información recibida así como en la resolución de complicaciones menores domiciliarias. El grupo piloto requirió mayor tiempo de atención que el grupo control. Conclusiones: Aunque no hayamos observado diferencias entre los dos grupos estudiados consideramos que harían falta estudios posteriores para determinar con mayor exactitud el tipo de paciente idóneo para el control mediante la imagen y pulsioximetría (..) (AU)
Introduction: The rationale behind the need to improve the communication between the ambulatory surgery unit and the patients at home after discharge from ambulatory surgery is to offer a healthcare quality at home comparable to hospital care. Nowadays this improvement is needed, taking into account that more complex operations and patients with higher co morbidity are being included in these programs. The main objective of the study is to validate the clinical impact and management system of a domiciliary control m-health device assisted by mobile phone images and pulsioximetry after ambulatory surgery. Material and methods: This paper presents the results of a randomized prospective study of an m-Health system for post-operative monitoring of patients in the early ambulatory surgery home postoperative process. About 310 patients, with surgeries comparable in complexity, were randomly selected and included in either the intervention or the control group. Results: The results shows that the phone control protocol at home in postoperative process is very efficient in terms of the quality of information received and also in the resolution of late minor complications even compared with the most traditional ways of care. The timing of control of intervention group was longer than the control group. Conclusions: Although we have not observed differences between the two groups studied believe that further studies would be needed to determine more precisely the type of patient suitable for mobile image control and pulsioximetry. In this study is considered necessary to explain clearly instructions and household tips by the relevant personnel before discharge. In the other hand the patients they should known the help paths (direct phone number) in case of necessity (..) (AU)
Subject(s)
Humans , Telemedicine , Continuity of Patient Care/organization & administration , Postoperative Complications/prevention & control , Prospective Studies , Cell Phone , Evaluation of the Efficacy-Effectiveness of InterventionsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Fentanyl/analysis , Fentanyl/pharmacokinetics , Fentanyl/therapeutic use , Opioid-Related Disorders/complications , Receptors, Opioid/therapeutic use , Hemodynamics , Confidence Intervals , Laryngoscopy/methodsSubject(s)
Analgesia, Obstetrical/methods , Delivery, Obstetric/methods , Fetal Death , Fetus , Piperidines/administration & dosage , Adult , Analgesia, Epidural , Contraindications , Disseminated Intravascular Coagulation/prevention & control , Female , Humans , Infusions, Intravenous , Labor, Induced , Misoprostol , Oxytocics , Pregnancy , RemifentanilABSTRACT
Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.
Subject(s)
Postpartum Hemorrhage , Female , Humans , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/therapyABSTRACT
No disponible
Subject(s)
Humans , Female , Pregnancy , Adult , Anesthesia, Obstetrical/methods , Labor, Obstetric , StillbirthABSTRACT
La hemorragia obstétrica masiva sigue siendo una delas causas más frecuentes de morbi-mortalidad maternaen todo el mundo. La hemorragia postparto primaria esla más frecuente siendo la atonía uterina su etiologíamás común. Es prioritario garantizar la estabilidadhemodinámica de la paciente y corregir las alteracionesde la coagulación. Si el tratamiento farmacológico resultainsuficiente se deben emplear métodos invasivos comola radiología vascular intervensionista o la ligadura delos vasos arteriales. La histerectomía es la última opcióncuando fracasan las medidas anteriores. Para que el pronósticosea favorable, ya no sólo en términos de mortalidadsino en mantener la fertilidad de la madre y minimizarla morbilidad, es fundamental que cada unidadmaternal cuente con un protocolo de actuación bien definidoy multidisciplinar que facilite el diagnóstico y eltratamiento inmediato(AU)
Massive bleeding in obstetrics still ranks among themost frequent causes of maternal morbidity andmortality worldwide. The most frequent type isprimary postpartum hemorrhage, which is usually theresult of an atonic uterus. The clinical priorities are toassure hemodynamic stability and to correctcoagulation abnormalities. If pharmacologictreatment cannot achieve these goals, invasivemethods such as interventional vascular radiology orartery ligation must be used. Hysterectomy is the lastresort when the previous methods fail. For the bestprognosis, in terms of preventing death, maintainingmaternal fertility and minimizing morbidity, everymaternity ward should have a well-definedmultidisciplinary protocol that facilitates diagnosisand immediate treatment(AU)
Subject(s)
Humans , Female , Adult , Hemorrhage/complications , Uterine Inertia/etiology , Hysterectomy , Misoprostol/therapeutic use , Embolization, Therapeutic/methods , Uterine Inertia/therapy , Risk Factors , Hemorrhage/etiology , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/therapy , Obstetric Labor Complications/diagnosis , Hemorrhage/drug therapy , Uterine Inertia/physiopathology , Indicators of Morbidity and Mortality , Hemodynamics , Hemodynamics/physiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Funnel Chest/complications , Funnel Chest/diagnosis , Funnel Chest/surgery , Anesthesia, General/methods , Hemangioendothelioma/complications , Hemangioendothelioma/diagnosis , Hemangioendothelioma/surgery , Lidocaine/pharmacology , Lidocaine/therapeutic useABSTRACT
BACKGROUND: Intraoperative monitoring of cerebral ischemia with shunting during carotid endarterectomy (CEA) remains controversial. Our objective was to evaluate the sensitivity and specificity of BIS changes during carotid clamping in relation to shunted patients in awake CEA. METHODS: Eighty CEAs under cervical block were included. There were two patient groups: with clinical signs of cerebral ischemia (shunted patients) and without signs of cerebral ischemia (nonshunted patients). Data were based on bispectral index (BIS) values and neurological monitoring at different surgery time points, with special attention paid during carotid clamping. BIS values were compared between shunted and nonshunted patients. Sensitivity and specificity, along with positive and negative predictive values of a percentage BIS value decrease during carotid clamping from baseline BIS values, were calculated in both patient groups. RESULTS: Shunting was performed in 11 patients with cerebral ischemia at carotid clamping. Mean BIS values were 82.82+/-11.98 in shunted patients and 92.31+/-5.42 in nonshunted patients at carotid clamping (p<0.001). Relative decreased BIS values in relation to basal BIS values were 13.57% in shunted patients and 3.68% in nonshunted patients (p<0.05). The percentage decrease in BIS was 14%, sensitivity was 81.8% (95% CI 49.9-96.8), and specificity was 89.7% (95% CI 79.3-95.4). CONCLUSION: BIS monitoring during carotid clamping is an easy, noninvasive method which correlates with cerebral ischemia in patients undergoing CEA. A decrease>or=14% from the basal BIS value presents a high negative predictive value, and ischemia is unlikely without a decrease. Nonetheless, a decrease may not always indicate cerebral ischemia with a low positive predictive value.
Subject(s)
Brain Ischemia/diagnosis , Carotid Artery Diseases/surgery , Consciousness Monitors , Consciousness , Electroencephalography/instrumentation , Endarterectomy, Carotid/methods , Monitoring, Intraoperative/instrumentation , Wakefulness , Aged , Brain Ischemia/etiology , Carotid Artery Diseases/psychology , Constriction , Endarterectomy, Carotid/adverse effects , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Time FactorsABSTRACT
OBJECTIVES: To compare the efficacy and safety of fentanyl and remifentanil in the prevention of hemodynamic responses to direct laryngoscopy and orotracheal intubation, and to compare the effects of these techniques on peripheral blood oxyhemoglobin saturation in normotensive women undergoing scheduled gynecologic surgery. MATERIAL AND METHODS: Prospective clinical trial in ASA 1-2 patients undergoing gynecologic surgery. The patients were randomized to 2 groups: the remifentanil group received a perfusion of 1 microg x kg(-1) x min(-1) until intubation whereas the fentanyl group received a bolus dose of 2 microg x kg(-1). Etomidate (0.3 mg x kg(-1)) and rocuronium bromide (0.6 mg x kg(-1)) were used for anesthetic induction. Seven serial measurements of systolic, diastolic, and mean arterial pressure were recorded in addition to heart rate and peripheral blood oxyhemoglobin saturation at the following times: baseline, denitrogenation, postinduction, and 3 more times at consecutive 2-minute intervals. RESULTS: Fifty-four patients were enrolled. A statistically significant attenuation of the postintubation hemodynamic response was observed in the remifentanil group. The effect was evident on arterial pressure (P=.0001) and heart rate (P=.031) with respect to baseline values. That protective effect was not seen in the fentanyl group. No differences in peripheral blood oxyhemoglobin saturation were observed. CONCLUSIONS: Remifentanil provides greater hemodynamic control than fentanyl at the doses utilized. No adverse effects attributable to these opioids were observed in either group.
Subject(s)
Fentanyl/administration & dosage , Gynecologic Surgical Procedures , Hemodynamics/drug effects , Hypnotics and Sedatives/administration & dosage , Intubation, Intratracheal/adverse effects , Laryngoscopy/adverse effects , Piperidines/administration & dosage , Adult , Androstanols/administration & dosage , Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Blood Pressure/drug effects , Double-Blind Method , Etomidate/administration & dosage , Female , Fentanyl/therapeutic use , Heart Rate/drug effects , Humans , Hypnotics and Sedatives/therapeutic use , Infusions, Intravenous , Injections, Intravenous , Middle Aged , Neuromuscular Nondepolarizing Agents/administration & dosage , Oxyhemoglobins/analysis , Piperidines/therapeutic use , Remifentanil , RocuroniumABSTRACT
OBJETIVOS: Comparar la eficacia y seguridad del fentanilocon remifentanilo en la prevención de la respuestahemodinámica asociada a la laringoscopia directa eintubación orotraqueal, y su repercusión sobre la saturaciónperiférica de oxígeno en mujeres normotensasprogramadas para cirugía ginecológica.MATERIAL Y MÉTODO: Estudio clínico prospectivo enpacientes ASA I-II sometidas a cirugía ginecológica. Sedistribuyeron de forma aleatoria en dos grupos: grupoR, remifentanilo 1 μg Kg1 min1 hasta la intubación ygrupo F, fentanilo 2 μg Kg1. Para la inducción anestésicautilizamos etomidato (0,3 mg Kg1) y bromuro derocuronio (0,6 mg Kg1). Se realizaron siete medicionesseriadas de la presión arterial sistólica, diastólica ymedia, frecuencia cardiaca y saturación periférica deoxígeno durante los periodos: control, desnitrogenación,postinducción, postintubación y posteriormente cada dosminutos tres determinaciones consecutivas.RESULTADOS: Se incluyeron 54 pacientes. El grupo R mostróun efecto estadísticamente significativo de atenuación dela respuesta hemodinámica postintubación tanto en la presiónarterial (p = 0,0001), como en la frecuencia cardiaca(p = 0,031) respecto de su valor basal. Sin embargo, con elgrupo del fentanilo (grupo F), no se observó dicho efecto protector.No se observaron diferencias en la saturación periféricade oxígeno en ambos grupos durante el estudio.CONCLUSIONES: A las dosis utilizadas, el remifentanilocomparativamente con el fentanilo, ofrece mayor controlhemodinámico. No se observaron efectos secundarios enambos grupos atribuibles a los opiáceos(AU)
OBJETIVES: To compare the efficacy and safety offentanyl and remifentanil in the prevention ofhemodynamic responses to direct laryngoscopy andorotracheal intubation, and to compare the effects ofthese techniques on peripheral blood oxyhemoglobinsaturation in normotensive women undergoingscheduled gynecologic surgery.MATERIAL AND METHODS: Prospective clinical trial inASA 1-2 patients undergoing gynecologic surgery. Thepatients were randomized to 2 groups: the remifentanilgroup received a perfusion of 1 μg·kg-1·min-1 untilintubation whereas the fentanyl group received a bolusdose of 2 μg·kg-1. Etomidate (0.3 mg·kg-1) and rocuroniumbromide (0.6 mg·kg-1) were used for anesthetic induction.Seven serial measurements of systolic, diastolic, and meanarterial pressure were recorded in addition to heart rateand peripheral blood oxyhemoglobin saturation at thefollowing times: baseline, denitrogenation, postinduction,and 3 more times at consecutive 2-minute intervals.RESULTS: Fifty-four patients were enrolled. Astatistically significant attenuation of the postintubationhemodynamic response was observed in the remifentanilgroup. The effect was evident on arterial pressure(P=.0001) and heart rate (P=.031) with respect tobaseline values. That protective effect was not seen in thefentanyl group. No differences in peripheral bloodoxyhemoglobin saturation were observed.CONCLUSIONS: Remifentanil provides greaterhemodynamic control than fentanyl at the doses utilized.No adverse effects attributable to these opioids wereobserved in either group(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Gynecologic Surgical Procedures/methods , Hemodynamics , /administration & dosage , Hypnotics and Sedatives/administration & dosage , Heart Rate , Intubation, Intratracheal/adverse effects , Laryngoscopy/adverse effects , Piperidines/administration & dosage , Androstanols/administration & dosage , Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Blood Pressure , Double-Blind Method , Etomidate/administration & dosage , Infusions, Intravenous , Injections, Intravenous , Oxyhemoglobins/analysis , Prospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Stroke/complications , Electrocardiography , Cerebral Hemorrhage/physiopathologySubject(s)
Cardiac Output, Low/etiology , Electroencephalography , Hypertension/complications , Myocardial Stunning/etiology , Subarachnoid Hemorrhage/complications , Adult , Brain Edema/etiology , Cardiac Output, Low/diagnosis , Cardiac Output, Low/physiopathology , Glomerulonephritis/complications , Hemianopsia/etiology , Humans , Myocardial Stunning/diagnosis , Myocardial Stunning/physiopathology , Pleural Effusion/etiology , Pulmonary Edema/etiology , Recurrence , Subarachnoid Hemorrhage/surgeryABSTRACT
OBJETIVO: Evaluar la efectividad y seguridad del uso de un sistema de bomba elastomérica con una solución de Ketorolaco 270 mg y Tramadol 300 mg en suero fisiológico por vía subcutánea a 1 ml/hora en el tratamiento del dolor postoperatorio moderado-severo en Cirugía Ambulatoria Ortopédica. MATERIAL Y MÉTODOS: Se realiza un estudio retrospectivo sobre 250 pacientes sometidos a diversas intervenciones de Cirugía Ortopédica Ambulatoria. Después de la intervención son conectados al infusor subcutáneo Multitrate 2C1154K (Baxter®) con la pauta propuesta durante tres días. Los parámetros analizados son: Score Telefónico basado en estado general, dolor, sangrado, tolerancia, cumplimiento del tratamiento, fiebre > a 38º C y estado de la herida. Según el Score Telefónico obtenido la evolución se clasifica en Grupo I: evolución normal, correcto nivel de analgesia y buen estado general del paciente; Grupo II: necesidad de nueva llamada y Grupo III: necesita atención médica. Se evalúa la necesidad de analgesia de rescate y la descripción de los efectos secundarios. RESULTADOS: Llamadas del Grupo I: 95,2%; Grupo II: 4%; llamadas del Grupo III: 0,8%. Necesidad de analgesia de rescate: 12,2%. Efectos secundarios: mareo: 1,7%; cefalea 1,4%; vómitos: 1,4%; náuseas: 0,8%; picor: 0,8%; sueño: 0,8%; arrancado 0,5%; no efectos secundarios: 92,6%. CONCLUSIONES: El uso de analgesia invasiva domiciliaria por vía subcutánea, mediante una infusión de 1 ml/hora de una mezcla de Ketorolaco y Tramadol es eficaz y seguro para el control del dolor moderado-severo en Cirugía Ortopédica Ambulatoria (AU)
AIM: To evaluate the feasibility and security of the use of an elastomeric pump with 270 mg of Ketorolac and 300 mg of Tramadol in a saline solution for subcutaneous administration at a rate of 1 ml/hour for analgesic treatment of moderate pain in Orthopaedic Ambulatory Surgery. MATERIAL AND METHODS: A retrospective study with 250 patients was performed. At the end of surgery, Multitrate 2C1154K (Baxter®) subcutaneous infusor was connected for three days. We analysed a Phone Score based on: general status, pain level, bleeding, diet, treatment fulfillment, fever > 38º C and satisfactory wound evolution. According to the Phone Score obtained we divided the evolution into three groups: Group I: normal evolution, correct level of analgesia and good general state of patient; Group II: new call needed; Group III: medical treatment needed. Supplemental oral analgesia and secondary effects were also evaluated. RESULTS: (95.2%) of calls were in Group I; (4%) were in Group II and (0.8%) in Group III. The need of supplemental oral analgesia was 12.2%. The secondary effects observed were: dizziness: (1.7%); headache: (1.4%); vomiting: (1.4%); nausea: (0.8%); itching: (0.8%); drowsiness: (0.8%); accidental removal: (0.5%); no secondary effects: (92.6%). CONCLUSION: the use of the elastomeric pump Multitrate 2C1154K (Baxter®) for subcutaneous administration of Ketorolac 270 mg and Tramadol 300 mg at 1 ml/hour ratio is useful and safe for moderate postoperative pain control in Orthopaedic Ambulatory Surgery (AU)
