ABSTRACT
Desde la introducción de la mascarilla laríngea, su uso se ha expandido especialmente en el contexto de la cirugía ambulatoria. La mascarilla laríngea representa el patrón oro de los dispositivos supraglóticos, y es la referencia con la que los nuevos dispositivos deben ser comparados. La presente revisión es una actualización de las principales indicaciones de la mascarilla laríngea en usos avanzados, incluyendo el abordaje de la vía aérea difícil en el paciente intervenido de forma ambulatoria. Así mismo se incluye una revisión de las indicaciones, aportaciones, y ventajas de la mascarilla laríngea Supreme aplicadas al contexto de la cirugía sin ingreso (AU)
Since the introduction of the original laryngeal mask airway(LMA) in the nineties in our country, its use has expanded especially in the context of outpatient surgery. The LMA remains the gold standard of the supraglotic devices and the standard by which all other devices should be compared. This review is an update of the main indications of the LMA in advanced applications, including addressing the difficult airway in the patient operated on an outpatient basis. Also includes a review of the information, contributions, and advantages of the LMA supreme applied to the context of day surgery (AU)
Subject(s)
Humans , Laryngeal Masks , Anesthesia/methods , Ambulatory Surgical Procedures/methods , Anesthesia, Endotracheal/instrumentationABSTRACT
La vía aérea difícil continúa siendo una de las causas más importantes de morbimortalidad anestésica. En los últimos años han surgido numerosos dispositivos con el objetivo de facilitar el manejo de la vía aérea, especialmente la vía aérea difícil: los dispositivos extraglóticos y, más recientemente, los videolaringoscopios. Este continuo desarrollo ha obligado a una frecuente revisión de los algoritmos de abordaje de la vía aérea, acorde con el vertiginoso avance tecnológico que vivimos en la actualidad. La mayoría de estos algoritmos toman como punto de partida la dificultad de intubación traqueal convencional y se desarrollan en función de una óptima ventilación con máscara facial, pero ¿existe algún algoritmo que plantee la utilización de un dispositivo extraglótico como abordaje inicial de la vía aérea independientemente de la previsión o no de intubación traqueal difícil? Presentamos el caso de una paciente sin criterios de vía aérea difícil, sometida en un corto espacio de tiempo a dos cirugías de mama. En la primera de ellas presentó una intubación traqueal difícil con importante manipulación de la vía aérea, resuelta mediante el laringoscopio Airtraq®. En la segunda intervención, el abordaje inicial se realizó con una máscara laríngea, sin dificultad alguna (AU)
The difficult airway remains one of the most important reasons of anaesthetic comorbidity. Over the last few years many device shave been developed for the difficult airway. Extraglotic devices and more recently the video laryngoscopes have become part of the armamentarium of difficult airway trolleis. This has forced continuous reviews of the difficult airway protocols. Most of these algorithms take as their starting point, the difficulty of conventional tracheal intubation and they develop in terms of optimal facial mask ventilation, but, is there any algorithm arising from the use of a extraglotic device as the initial airway approach, irrespective of the forecast or not of difficult tracheal intubation? We present the case of a patient without criteria of difficult airway, undergone two breast surgeries in a short period of time. In the first one, she presented a difficult tracheal intubation with significant manipulation of the airway, resolved by the Airtraq® laryngoscope. In the second intervention, the initial approach was performed with a laryngeal mask, with no difficulty (AU)
Subject(s)
Humans , Anesthesia/methods , Laryngeal Masks , Laryngoscopy/methods , Airway Obstruction/prevention & control , Video-Assisted Surgery/methodsABSTRACT
Manejo anestésico-quirúrgico de un paciente portador de un desfibrilador automático implantable en un programa de cirugía ambulatoria, mediante anestesia epidural y sedoanalgesia basada en remifentanilo (AU)
Anesthetic and surgical management of a patient with an automatic implantable defibrillator in an outpatient surgery program,by epidural anesthesia and sedoanalgesia based on remifentanil (AU)
Subject(s)
Humans , Male , Middle Aged , Defibrillators, Implantable , Ambulatory Surgical Procedures/methods , Anesthesia, Conduction/methods , Continuity of Patient Care , Peroneal Nerve/injuriesABSTRACT
1 It has been hypothesized that craniovascular 5-HT receptors mediating dilatation of cranial vessels undergo sensitization on decreased serotonergic transmission in migraine. This study analysed the effect of chemical lesion of the 5-HT system in the brain with 5,7-dihydroxytryptamine (5,7-DHT) on 5-HT receptor-mediated dilator responses to 5-carboxamidotryptamine (5-CT) in the middle meningeal artery of anaesthetized rats. 5-CT has recently been shown to elicit dilator responses in this cranial vessel via 5-HT(7) receptors and, to a much lesser extent, 5-HT(1B/1D) receptors. 2 Pretreatment with 5,7-DHT produced a drastic and selective decrease of 5-HT levels in the brain (78 +/- 6% and 94 +/- 2% in dorsal raphe and hypothalamic paraventricular nuclei, respectively) compared with controls (1% ascorbic acid). 3 Topical application of 5-CT (1-1000 microm) to exposed dura mater encephali produced concentration-dependent decreases in diastolic blood pressure and dilator responses in the middle meningeal artery that were similar in vehicle- and 5,7-DHT-pretreaed animals. 4 Hypotensive and meningeal dilator responses to 5-CT were unaltered by the 5-HT(1B/1D) receptor antagonist, GR-127935 (1 mg kg(-1), i.v.), but were strongly inhibited by the 5-HT(7) receptor antagonist, SB-269970 (1 mg kg(-1), i.v.), with similar efficacy, in both groups of animals. Treatment with GR-127935 + SB-269970 (1 mg kg(-1), i.v. each), produced a stronger inhibitory effect than individual treatments on hypotensive but not on meningeal responses to 5-CT. Meningeal 5-HT(7) receptor-mediated responses (i.e. in GR-127935-pretreated animals) were unchanged by 5,7-DHT pretreatment. 5 Results suggest that the sensitivity of craniovascular 5-HT(7) receptors mediating dilatation is unaffected by a decrease of 5-HT levels in the brain. A neuronal involvement of 5-HT in migraine seems more likely, therefore.
Subject(s)
Anesthesia , Meningeal Arteries/physiology , Receptors, Serotonin/physiology , Serotonin/deficiency , Vasodilation/physiology , 5,7-Dihydroxytryptamine/pharmacology , Animals , Blood Pressure/drug effects , Blood Pressure/physiology , Cerebrovascular Circulation/drug effects , Cerebrovascular Circulation/physiology , Dopamine/metabolism , Heart Rate/drug effects , Male , Meningeal Arteries/drug effects , Meninges/blood supply , Meninges/drug effects , Norepinephrine/metabolism , Oxadiazoles/pharmacology , Paraventricular Hypothalamic Nucleus/drug effects , Paraventricular Hypothalamic Nucleus/metabolism , Phenols/pharmacology , Piperazines/pharmacology , Raphe Nuclei/drug effects , Raphe Nuclei/metabolism , Rats , Rats, Wistar , Receptor, Serotonin, 5-HT1B/physiology , Receptor, Serotonin, 5-HT1D/physiology , Serotonin/analogs & derivatives , Serotonin/metabolism , Serotonin/pharmacology , Serotonin 5-HT1 Receptor Antagonists , Serotonin Antagonists/pharmacology , Serotonin Receptor Agonists/pharmacology , Sulfonamides/pharmacology , Vasodilation/drug effectsABSTRACT
No disponible
Subject(s)
Humans , Pain/etiology , Pain/surgery , Pain/physiopathology , Catheterization/methods , Catheterization , Neurosurgery/methods , Neurosurgery/organization & administration , Ambulatory Care/methods , Ambulatory Care/trends , Ambulatory Surgical Procedures/methods , Pain Measurement/classification , Pain Measurement/psychology , Analgesia/methods , Analgesia , Anesthetics, Local/agonists , Anesthetics, Local/pharmacokinetics , Anesthetics, Local/therapeutic useABSTRACT
No disponible
Subject(s)
Child , Humans , Anesthesia, Conduction/methods , Peripheral Nerves , UltrasonographyABSTRACT
Los beneficios de la anestesia regional están bien documentados, sin embargo, existe un índice de fracasos y un riesgo potencial de complicaciones, fundamentalmente debido al hecho de realizar gran parte de las técnicas a ciegas. La introducción de la ultrasonografía como guía para la realización de técnicas regionales, incluyendo a la población pediátrica, disminuye el porcentaje de fallos y la aparición de complicaciones. Este artículo nos introduce en la anestesia regional pediátrica guiada por ultrasonografía y su aplicación en cirugía ambulatoria (AU)
The benefits of the regional anaesthesia are well documented, nevertheless, it does not manage to be imposed to the general anaesthesia by the high index of failures and the potential risk of serious complications, partly due to the fact of realizing the techniques blindly. Nevertheless, the recent discoveries support the use of the ultrasounds as guide for the accomplishment of regional anaesthesia, including the paediatric population. This article tries to introduce us in the regional paediatric anaesthesia guided for ultrasonography and its application in ambulatory surgery (AU)
Subject(s)
Child , Humans , Anesthesia, Conduction/methods , Peripheral Nerves , UltrasonographyABSTRACT
OBJECTIVE: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction. MATERIAL AND METHODS: We carried out a single-blind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed. RESULTS: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects. CONCLUSION: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction.
Subject(s)
Ambulatory Surgical Procedures , Anterior Cruciate Ligament/surgery , Autonomic Nerve Block/methods , Infusion Pumps , Pain, Postoperative/drug therapy , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/therapeutic use , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Autonomic Nerve Block/instrumentation , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Drug Therapy, Combination , Elastomers , Home Nursing , Humans , Infusions, Intravenous , Narcotics/administration & dosage , Narcotics/therapeutic use , Pain Measurement , Pain, Postoperative/prevention & control , Prospective Studies , Single-Blind Method , Tramadol/administration & dosage , Tramadol/therapeutic useABSTRACT
OBJETIVOS: Investigar la eficacia, viabilidad y seguridad del bloqueo femoral continuo como técnica analgésica para cirugía ambulatoria de reconstrucción de ligamento cruzado anterior, ya que el dolor postoperatorio es una de las complicaciones más frecuentes en cirugía ortopédica ambulatoria. MATERIAL Y MÉTODOS: Estudio prospectivo simple. Pacientes estado físico ASA I-II, a los que se realizó tratamiento del dolor postoperatorio mediante bloqueo continuo del nervio femoral con bupivacaína 0,125%, a través de un dispositivo elastomérico dentro de un abordaje multimodal. El dolor postoperatorio fue evaluado mediante escala numérica y verbal desde el periodo postoperatorio inmediato hasta las primeras 48 horas. Se valoran los efectos secundarios y el grado de satisfacción de los pacientes. RESULTADOS: Se incluyeron 63 pacientes. El bloqueo continuo del nervio femoral fue eficaz (en las primeras 24 horas postoperatorias un porcentaje superior al 90% no presentó dolor o éste fue leve, sin necesidad de rescate en el 92% de los casos) y seguro como analgesia postoperatoria, con ausencia de efectos secundarios significativos. CONCLUSIÓN: El bloqueo continuo del nervio femoral con bupivacaína 0,125% administrada a través de sistemas elastoméricos es una opción de manejo del dolor postoperatorio eficaz y segura en cirugía ambulatoria de reconstrucción de ligamento cruzado anterior (AU)
OBJECTIVE: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction. MATERIAL AND METHODS: We carried out a singleblind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed. RESULTS: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects. CONCLUSION: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction (AU)
Subject(s)
Humans , Pain, Postoperative/therapy , Nerve Block/methods , Bupivacaine , Anterior Cruciate Ligament/surgery , Ambulatory Surgical Procedures/methods , Orthopedic Procedures/methods , Femoral Nerve , Prospective StudiesABSTRACT
La anestesia regional guiada por ultrasonidos está empezando a convertirse en una técnica rutinaria. Los ultrasonidos de alta resolución brindan una imagen de los nervios periféricos y sus estructuras adyacentes, a tiempo real, y ofrece una observación clara de la aplicación de los anestésicos locales y su distribución durante el procedimiento. Por lo tanto, la principal ventaja del empleo de la ultrasonografía para anestesia regional es que mejora la calidad y el éxito de los bloqueos nerviosos mientras que por otro lado disminuye las complicaciones. Esta revisión introduce al lector en el conocimiento de los fundamentos teórico-prácticos de la anestesia regional guiada por ultrasonidos en adultos sometidos a cirugía mayor ambulatoria (AU)
Ultrasound-guided regional anesthesia is becoming a routine technique. High-resolution ultrasound can provide peripheral nerves imaging and adjacent structures, in direct real-time, and it gives a clear observation of the application and distribution of local anaesthetics during the procedure. Therefore the main advantage of the use of ultrasonography in regional anesthesia is that it improves the quality and the succeeding of the nerve blocks while on the other hand it avoids the complications. This review introduces the reader to the knowledge of the theoretical- practical foundations of ultrasound-guided regional anesthesia in adults undergoing ambulatory surgery (AU)
Subject(s)
Humans , Ambulatory Surgical Procedures/methods , Anesthesia, Conduction/methods , Nerve Block/methods , Ultrasonography/methodsABSTRACT
Peripheral nerve blocks have aroused increasing interest in recent years, leading to a rise in the rate of complications. At the same time noteworthy technical advances have been made in areas such as nerve stimulation and ultrasound imaging, and local anesthetics have become safer. Nevertheless, the risk of anesthetic-related systemic toxicity, which manifests with neurological symptoms that tend to be forerunners of cardiovascular ones, can not be ignored. We report 2 cases of systemic toxicity due to the use of a mixture of local anesthetics during nerve blocks for outpatient surgery.
Subject(s)
Anesthetics, Local/toxicity , Nerve Block/adverse effects , Peripheral Nervous System , Adult , Female , Humans , Middle AgedABSTRACT
Existe en los últimos años un interés creciente de los anestesiólogos por los bloqueos nerviosos periféricos, lo cual puede conllevar un incremento en la frecuencia de aparición de complicaciones. Al mismo tiempo hubo grandes avances tecnológicos (neuroestimulación, ultrasonografía ) y se incorporaron anestésicos locales cada vez más seguros, sin embargo, no podemos obviar el riesgo de toxicidad sistémica asociado, que habitualmente se manifiesta con síntomas neurológicos que suelen preceder a los cardiovasculares. Presentamos dos casos de toxicidad sistémica utilizando mezclas de anestésicos locales durante la realización de bloqueos nerviosos periféricos en cirugía ambulatoria
Peripheral nerve blocks have aroused increasing interest in recent years, leading to a rise in the rate of complications. At the same time noteworthy technical advances have been made in areas such as nerve stimulation and ultrasound imaging, and local anesthetics have become safer. Nevertheless, the risk of anesthetic-related systemic toxicity, which manifests with neurological symptoms that tend to be forerunners of cardiovascular ones, can not be ignored. We report 2 cases of systemic toxicity due to the use of a mixture of local anesthetics during nerve blocks for outpatient surgery
