Diagnóstico de la hipertermia maligna. Asignatura pendiente de la Anestesiología y Sanidad Española / Diagnosis of malignant hyperthermia-an unresolved health care issue for Spanish anesthesiologists

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[Tramadol in elastomeric continuous perfusion for analgesia after gynecologic surgery]. / Tramadol en perfusión continua mediante elastómeros para analgesia postoperatoria de cirugía ginecológica.

Quality of analgesia provided by continuous infusion of tramadol through an elastomeric infuser (Baxter PC1071) was studied in a group of 40 women undergoing laparotomy to treat non tumoral disease. After a loading dose of 100 mg of tramadol in the recovery room, the elastomeric infuser was connected, loaded with 300 mg of tramadol in 48 ml of saline. The patient was then transferred to the ward. Analgesic quality was assessed on a visual analog scale (VAS) of 1 to 10 and on a semantic scale. Side effects, the need for supplemental analgesia and the opinion of the nurse were all recorded. The highest VAS score in the 24 h period was 2.69. Pain was described as slight by 52.5% of the women, moderate by 12.5% and absent by 35%. The main side effects were nausea and vomiting (12.5%). Three patients needed supplementary analgesia. The technique was described by 85% of the nurses as good (62.5%) or very good (22.5%). Elastomeric infusers are an effective way to deliver analgesics, and tramadol proved to be a valid analgesic for continuous infusion.

[Effectiveness of somatostatin in the treatment of acute upper digestive hemorrhage]. / Eficacia de la somatostatina en el tratamiento de la hemorragia digestiva alta aguda.

Our study has been made on a retrospective basis in order to evaluate the efficacy of somatostatin (SST) in the treatment of acute haemorrhage caused by gastroduodenal ulcer. Sixty patients were allocated in 2 groups: those who received SST (n = 30), and those who did not received it (n = 30), and were treated only with conventional measures (nasogastric catheter, H2 blockers, blood or derivatives, etc.). Both groups were monitored and controlled at the Anesthesia-Intensive Care Unit. The patients in the SST group received a continuous intravenous infusion of 250 micrograms/h. These patients showed better hemodynamic parameters, and only seven needed surgery. The patients in the conventional treatment group showed worse hemodynamics, needed higher volumes of hemoderivatives, and 25 of them needed surgery. The statistical analysis of our data supports the efficacy of SST in the treatment of uncontrollable upper gastrointestinal bleeding due to gastroduodenal ulcer.