Eficacia del bloqueo del ganglio impar en dolor pélvico y perineal de etiología ginecológica rebelde a tratamiento médico-quirúrgico / Efficiency of ganglion impar blockade in perineal and pelvic pain of gynecological etiology refractory to medical-surgical treatment

El dolor visceral vehiculizado por las fibras del sistema nervioso simpático en el área perineal y pélvica, tanto de etiología benigna como maligna, puede tratarse de forma eficaz con la neurolisis del ganglio de Walter, impar o sacroccocígeo. Otras posibles indicaciones de esta técnica son la proctalgia fugaz y la enteritis. Este bloqueo raramente puede eliminar el dolor de características somáticas y neuropáticas. Tras su realización habitualmente obtenemos una importante disminución de la dosis necesaria de los agentes analgésicos opioides y no opioides, lo que conlleva un alivio de los efectos secundarios desfavorables y una maximización de su efecto analgésico. La realización de esta técnica percutánea se puede considerar de baja complejidad y con escasos efectos secundarios.Se exponen cinco casos de dolor pélvico, perineal y coccígeo de diferente etiología con mala respuesta al tratamiento farmacológico convencional y la respuesta y evolución de éstos tras realización de bloqueo del ganglio impar con radiofrecuencia, anestésicos locales y neurolisis con fenol (AU)

Visceral pain transmitted by fibers of the sympathetic nervous system in the perineal and pelvic area, whether of benign or malignant etiology, can be effectively treated with neurolysis of the ganglion of Walther, also known as the ganglion impar or sacrococcygeus ganglion. Other possible indications for this technique are shooting anal pain and enteritis. This blockade can rarely eliminate somatic pain or neuropathic features. After this technique has been performed, the required dose of opioid and non-opioid analgesic agents is usually substantially reduced, leading to relief of adverse effects and maximizing analgesic action. The performance of this percutaneous technique can be considered to be of low complexity and with minimal side effects.We describe five cases of pelvic, perineal and coccygeal pain of different etiologies and poor response to conventional drug treatment, as well as the response and clinical course of these patients after completion of ganglion impar blockade with radiofrequency, local anesthetics and phenol neurolysis (AU)

Pseudoaneurisma subclavio izquierdo iatrogénico / No disponible

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[Identification of the epidural space: usual practice among Spanish anesthesiologists]. / Identificación del espacio epidural en la práctica habitual de los anestesiólogos españoles.

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it.

Identificación del espacio epidural en la práctica habitual de los anestesiólogos españoles / Identification of the epidural space: usual practice among Spanish anesthesiologists

OBJETIVO: Indagar los métodos de identificación del espacio epidural que utilizan los anestesiólogos españoles en su práctica habitual. MATERIAL Y MÉTODOS: Mediante una encuesta por Internet se interrogó a los anestesiólogos españoles acerca de los métodos con los que habían aprendido la técnica durante su período de formación, el método que utilizan con mayor frecuencia en la actualidad y el método que consideraban más conveniente para el aprendizaje de los anestesiólogos en período de formación. RESULTADOS: Respondieron la encuesta 617 anestesiólogos. Las técnicas más frecuentes con las que aprendieron a realizar la anestesia epidural fueron: pérdida de resistencia con aire (LOR-A = 58,5%), LOR con solución salina (LOR-S = 31,9%); LOR con salino + burbuja de aire (LOR-B = 6,1%), método de la gota pendiente = 2,4%. El 14,2% de quienes aprendieron la técnica con LOR-A ha cambiado de método, al igual que el 28,4% de quienes aprendieron con LOR-S. Actualmente utilizan LOR-A = 59,2%, LOR-S = 32,4% y LOR-B = 6%. Para el aprendizaje de los nuevos médicos internos residentes (MIR), los encuestados recomiendan: LOR-A (48,5%) y LOR-S (37,8%). La técnica de LOR-B es aconsejada por una proporción de anestesiólogos mucho mayor de la que lo emplean en su práctica habitual (12,6%). El 26,4% de quienes utilizan la técnica de LOR-A recomiendan a los MIR que utilicen otro método. CONCLUSIONES: El método de identificación del espacio epidural más utilizado en España es el de LOR-A; sin embargo, más de una cuarta parte de sus usuarios no lo aconsejan (AU)

OBJECTIVE: To determine what methods are habitually used by Spanish anesthesiologists to identify the epidural space. MATERIAL AND METHODS: Spanish anesthesiologists were asked to fill in an Internet questionnaire about the methods they had learned during residency training for identifying the epidural space, the method they currently use most often, and the one they consider best for residents to learn during training. RESULTS: Responses were received from 617 anesthesiologists. The techniques the respondents had learned during training were loss of resistance to air (LOR-A), 58.5%; LOR to saline (LOR-S), 31.9%; LOR and air bubble (LOR-B), 6.1%; and the hanging drop method, 2.4%. Those who had learned the LOR-A technique had changed in 14.2% of the cases, as had 28.4% of those who learned the LOR-S procedure. LOR-A is currently used by 59.2% of the respondents, LOR-S is used by 32.4%, and LOR-B by 6%. The respondents recommended that new residents physicians learn the LOR-A (48.5%) and LOR-S (37.8%) techniques. The LOR-B is recommended by 12.6% a much larger percentage of anesthesiologists than it is habitually used by. Of those who use the LORA technique habitually, 26.4% recommend that new residents use a different procedure. CONCLUSIONS: The procedure used most often by Spanish anesthesiologists to identify the epidural space is the LOR-A technique; however, over a quarter of Spanish users of LOR-A do not recommend it (AU)

[Subdural empyema due to Mycoplasma hominis after a cesarean section under spinal anesthesia]. / Empiema subdural por Mycoplasma hominis tras cesárea bajo anestesia epidural.

The isolation of Mycoplasma hominis in cultured biopsy material from a subdural empyema is a very rare finding. Likewise, subdural empyema complicating epidural anesthesia is an uncommon event after cesarean delivery. We report the case of a 32-year-old patient who presented a throbbing headache when standing 48 hours after undergoing cesarean delivery under spinal anesthesia. On the fifth day after surgery, the headache worsened, fever developed, and an abscess was detected at the abdominal wall; antibiotic treatment was prescribed. When fever and headache persisted and abdominal infection had been ruled out, nuclear magnetic resonance imaging of the head revealed subdural empyema. Emergency surgery to drain pus was carried out twice. Mycoplasma hominis was isolated from a blood-agar culture of the exudate. The patient recovered fully after combined surgical and antibiotic treatment.

Empiema subdural por Mycoplasma hominis tras cesárea bajo anestesia epidural / Subdural empyema due to Mycoplasma hominis after a cesarean section under spinal anesthesia

El aislamiento de Mycoplasma hominis en un cultivo de material de un empiema subdural es un hallazgo muy infrecuente.Asimismo,es poco frecuente encontrar un empiema subdural como complicación de una anestesia epidural en una cesárea. Presentamos el caso clínico de una paciente de 32 años de edad que, tras ser sometida a cesárea bajo anestesia epidural, presentó a las 48 h del postoperatorio cefalea pulsátil en bipedestación. Al quinto día del postoperatorio presentó exacerbación de la cefalea y fiebre, evidenciándose además un absceso de pared abdominal que precisó tratamiento antibiótico. Ante la persistencia de la fiebre y la cefalea, y descartándose infección de origen abdominal, se practicó una resonancia magnética nuclear a nivel craneal que puso en evidencia la existencia un empiema subdural. Fue intervenida quirúrgicamente de urgencias en dos ocasiones para el drenaje del material purulento; poniendo de manifiesto el cultivo de dicho material, en un medio agar-sangre, la presencia de Mycoplasma hominis .Tras el tratamiento quirúrgico al que se asoció una antibioterapia adecuada se produjo la recuperación completa de la paciente

The isolation of Mycoplasma hominis in cultured biopsy material from a subdural empyema is a very rare finding. Likewise, subdural empyema complicating epi- dural anesthesia is an uncommon event after cesarean delivery. We report the case of a 32-year-old patient who pre- sented a throbbing headache when standing 48 hours after undergoing cesarean delivery under spinal anesthesia. On the fifth day after surgery, the headache worsened, fever developed, and an abscess was detected at the abdominal wall; antibiotic treatment was prescribed. When fever and headache persisted and abdominal infection had been ruled out, nuclear magnetic resonance imaging of the head revealed subdural empyema. Emergency surgery to drain pus was carried out twice. Mycoplasma hominis was isolated from a blood-agar culture of the exudate. The patient recovered fully after combined surgical and antibiotic treatment

[Analysis of bibliographic citations received by Spanish anesthesiologists for work indexed by Science Citation Index, 1988-2002]. / Análisis de las citas bibliográficas recibidas por las publicaciones de los anestesiólogos españoles (incluidas en el Science Citation Index) en el período 1988-2002.

OBJECTIVE: To analyze the international impact of articles published by authors in Spanish anesthesiology departments. METHOD: Citable articles indexed by Science Citation Index between 1988 and 2002 and authored by members of Spanish departments of anesthesiology were considered. Citations were counted 2 years and 5 years after publication. Authors and institutions were ranked according to number of citations received. We also determined the journals Spanish anesthesiologists most often chose for publishing their work. RESULTS: Of the 322 citable articles identified, 61.8% were cited in the 2 years following publication (total 587 citations), and 79.5% were cited within 5 years (total 1472 citations). The most frequently cited articles received 17 citations in 2 years and 45 in 5 years after publication. Articles from the Department of Anesthesiology of Hospital Clinic i Provincial of Barcelona received the largest number of citations (333 citations in 5 years). The author with the highest rate of citations received 11.57 per article. The author with the largest number of citations received 86. Anesthesia & Analgesia was the journal publishing the largest number of articles by Spanish anesthesiologists (35 articles). CONCLUSION: This citation analysis shows the international impact of publications by Spanish anesthesiologists.

Consideraciones anestésicas en el síndrome de prader-willi para cirugía mayor de cifoscoliosis / On anesthesia for major scoliosis surgery in Prader-Willi syndrome

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Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.