Application of ecotoxicological tools to evaluate the quality status of mangroves under restoration in the Yucatán Peninsula, Mexico.

Ecotoxicological tools, namely biomarkers and bioassays, may provide insights on the ecological quality status of mangroves under restoration. We investigated how 1) physicochemical parameters and water bioassays using Artemia franciscana; and 2) quantification of sublethal (osmoregulatory capacity, biochemical, and oxidative stress) and individual biomarkers (density, length-weight relationship [LWR], parasitic prevalence) in the sentinel fiddler crab Minuca rapax, can improve restoration indicators in mangroves from the Yucatán Peninsula, Southern Gulf of Mexico. We showed that water quality was improved with restoration, but still presented toxicity. Regarding sublethal biomarkers, M rapax from restored areas lower osmotic regulatory capacity, higher oxidative stress, and showed lipid peroxidation. As to the individual biomarkers, the density, LWR, and the prevalence of parasites in M. rapax was higher in restored areas. The use of bioassays/biomarkers were useful as early warning indicators to better assess the health of mangroves under restoration.

Assessment of aquatic food web and trophic niche as a measurement of recovery function in restored mangroves in the Southern Gulf of Mexico.

Mangroves are coastal wetlands with high biodiversity and productivity, with great interaction with coastal environments. In the face of worldwide mangrove loss, restoration projects attempt to recover ecosystem composition and functioning over time. Our objective was to examine and compare the food webs in mangrove areas with different restoration times and in a reference mangrove in Términos Lagoon, Mexico. We estimated the trophic structure, identified the carbon resources that maintain aquatic consumers through the analysis of stable isotopes, and compared the trophic niche of the restored mangroves with the reference mangrove. We analyzed environmental variables, trophic structure, and contributions of resources during three seasons: rainy, dry, and "nortes". Environmental changes and food structure changed in response to regional seasons. Bayesian mixing models indicated that food webs varied seasonally as a response to the primary productivity developed at Términos Lagoon. As expected, the assimilation of C3 plants in the reference mangrove was highest, as a primary ("nortes" season) and secondary resource (dry and rainy seasons). The restored mangroves depended mainly on allochthonous resources (seagrass, epiphytes, and phytoplankton). The assimilation of these resources highlighted the importance of connectivity and the input of sources of carbon from nearby coastal environments. Trophic niche analysis showed that the area with longer restoration time was more similar to the reference mangrove, which is evidence of the importance and efficacy of the restoration process, as well as the restoration of the ecosystem function over time.

[Acute coronary syndrome provoked by a coronary intramural hematoma]. / Hematoma intramural coronario como causa de síndrome coronario agudo.

Background: Intramural coronary hematoma (ICH) is an unusual cause of acute coronary syndrome, and it represents a diagnostic challenge, especially in young patients in which it is not considered among the differential causes of acute myocardial ischemia. Clinical case: 40-year-old female, with type 2 diabetes and no other cardiovascular risk factors, who assisted to the Emergency Room with chest pain. In her first evaluation, electrocardiographic abnormalities, and troponin I elevation were found. A cardiac catheterization was performed, in which a proximal obstruction of the left anterior descending artery was observed, and then an optical coherence tomography (OCT) confirmed the presence of an ICH without a dissection flap. A stent was implanted in the obstruction area, with adequate angiographic outcome. The patient had a satisfactory evolution and was discharged to home without evidence of systolic dysfunction and is free of cardiovascular symptoms at 6-month follow-up. Conclusions: ICH must be considered within the differential diagnosis of acute myocardial ischemia in young patients, especially females. Intravascular image diagnosis is essential for the adequate diagnosis and treatment. Treatment must be individualized considering the extent of ischemia.

Introducción: el hematoma intramural coronario (HIC) es una causa poco frecuente de síndrome isquémico coronario agudo y representa un reto diagnóstico, en especial en pacientes jóvenes en los que puede llegar a no ser contemplado dentro de las causas de isquemia cardiaca no ateroesclerótica. Caso clínico: mujer de 40 años, con diabetes tipo 2 y sin otro factor de riesgo cardiovascular, quien acudió al Servicio de Urgencias manifestando dolor torácico. En su evaluación inicial se encontraron alteraciones en el electrocardiograma y elevación de troponina I. Se decidió la realización de coronariografía donde se observó lesión severa de la arteria descendente anterior. El estudio fue complementado con una tomografía de coherencia óptica intracoronaria, la cual confirmó la presencia de HIC sin disección, por lo que se decidió implantar un stent en el segmento arterial afectado con resultado angiográfico exitoso. La convalecencia posterior evolucionó sin complicaciones, lo que posibilitó su egreso a domicilio sin disfunción sistólica en el ecocardiograma y con seguimiento sin eventualidades a los 6 meses. Conclusiones: el HIC es una entidad que debe ser considerada como una causa posible de isquemia miocárdica aguda en pacientes jóvenes y que requiere de la complementación diagnóstica con estudios de imagen intravascular. Su tratamiento debe ser individualizado en el contexto de la extensión de la isquemia.

La historia de la Hidroterapia y Balneoterapia en Europa / The history of Hydrotherapy and Balneotherapy in Europe

El agua ha sido para el hombre elemento fundamental de vida, tanto en su composición como en sus utilidades; desde el principio de los tiempos la inmersión del cuerpo en el agua y su permanencia en ella fue utilizada por el hombre, al igual que hacían los animales, como uso higiénico y como medida beneficiosa ante determinados males. Las aplicaciones del agua con fines terapéuticos constituyen uno de los más viejos procedimientos curativos de los que ha dispuesto la humanidad desde sus orígenes [Fragmento de texto]. (AU)

Exploration of Spanish Olive Oil Quality with a Miniaturized Low-Cost Fluorescence Sensor and Machine Learning Techniques.

Extra virgin olive oil (EVOO) is the highest quality of olive oil and is characterized by highly beneficial nutritional properties. The large increase in both consumption and fraud, for example through adulteration, creates new challenges and an increasing demand for developing new quality assessment methodologies that are easier and cheaper to perform. As of today, the determination of olive oil quality is performed by producers through chemical analysis and organoleptic evaluation. The chemical analysis requires advanced equipment and chemical knowledge of certified laboratories, and has therefore limited accessibility. In this work a minimalist, portable, and low-cost sensor is presented, which can perform olive oil quality assessment using fluorescence spectroscopy. The potential of the proposed technology is explored by analyzing several olive oils of different quality levels, EVOO, virgin olive oil (VOO), and lampante olive oil (LOO). The spectral data were analyzed using a large number of machine learning methods, including artificial neural networks. The analysis performed in this work demonstrates the possibility of performing the classification of olive oil in the three mentioned classes with an accuracy of 100%. These results confirm that this minimalist low-cost sensor has the potential to substitute expensive and complex chemical analysis.

Recomendaciones médicas para uveítis no infecciosas en adultos

Justificación: Las uveítis no infecciosas constituyen una importante causa de pérdida visual a nivel mundial; por su complejidad y gravedad de complicaciones requieren un abordaje temprano y multidisciplinario. En Costa Rica se desconoce hasta el momento la incidencia global de estas entidades y todavía no existe ningún consenso en cuanto a su manejo. Objetivos: Resumir las recomendaciones terapéuticas vigentes para uveítis no infecciosas en adultos y ofrecer una guía adaptada a la realidad costarricense. Métodos: Se efectuó una revisión no sistemática de bibliografía médica indexada en las plataformas PubMed y Scielo, sobre el manejo médico de las uveítis no infecciosas. De igual manera, se compararon los esquemas terapéuticos recomendados actualmente en América y Europa con el abordaje realizado en los centros hospitalarios costarricenses, para crear una guía adaptada a la realidad nacional. En la elaboración de estas recomendaciones participaron médicos especialistas de todas las clínicas multidisciplinarias especializadas en uveítis del país. Conclusiones: En Costa Rica se cuenta con la mayoría de las opciones disponibles para el tratamiento de uveítis idiopáticas en el sistema público de salud. Se logró la creación de algoritmos de tratamiento para las diferentes patologías.

Summary Background: Noninfectious uveitis represents an important cause of visual loss worldwide, which in view of the severity and complexity of complications demands an early and multidisciplinary approach to therapy. In Costa Rica there is no statistical records of incidence nor consensus of management of these entities to this date. Objectives: To summarize the therapeutic recommendations for non-infectious uveítis according to the scientific evidence and adapt them to the Costa Rican conditions. Methods: A non-systematic review of medical literature indexed on PubMed and Scielo, concerning medical and surgical management of non-infectious uveitis was carried out. Likewise, the recommended therapeutic schemes in America and Europe were compared to the approach used in the Costa Rican hospital centers. In the elaboration of these recommendations participated physicians, specialists of all multidisciplinary clinics for uveitis of the country. Conclusions: In Costa Rica, the majority of alternatives available for the treatment of idiopathic uveitis in the public health system are available. It was possible to create therapeutic algorithms for the different diseases.

Determining hydrological flow paths to enhance restoration in impaired mangrove wetlands.

The restoration of mangroves has gained prominence in recent decades. Hydrological rehabilitation has been undertaken to connect impaired mangroves with the sea, lagoons or estuaries. Because mangrove hydrodynamics occurs on the surface and interstitial spaces in the sediment, we propose to determine the hydrological flow paths to restore the hydrological regimes of the impaired mangroves. The hydrological flow paths were determined through a micro basin analysis based on microtopographic data to generate a digital elevation model. Applying this methodological approach, the hydrology of an impaired area on a barrier island in the Gulf of Mexico was restored by excavating, desilting or clearing the channels on the identified hydrological flow paths. This area was compared to one in which impaired mangroves were reconnected to the marine lagoon but disregarding the flow paths. Data collected in both areas were evaluated by flood level analysis, using two methods: (i) a simple linear regression model (SLRM) and (ii) spectral analysis (SA), also known as dominant frequency analysis. The results suggest that restoration based on the hydrological flow paths was more effective than the direct opening to the nearest main water body without accounting for the microtopography. In both areas, soil salinity and sulfides decreased after hydrological reconnection. However, a greater efficiency in the investment of time and human resources was achieved when preferential flow paths were identified and taken into account. The methodological procedures described in this study are of universal application to other mangrove restoration programs.

Contaminación enteroparasitaria de intercomunicadores en edificios de Barquisimeto y Cabudare, Venezuela / Enteroparites contamination of intercoms in buildings of Barquisimeto and Cabudare, Venezuela

Resumen Introducción. La falta de estudios en intercomunicadores como medios de propagación de enteroparásitos en Venezuela, motivó el presente estudio. Metodología. Se frotó el intercomunicador tres veces con un hisopo impregnado con solución salina 0,85% (SSI), resuspendiéndolo en un tubo con 10 ml de SSI, el cual se centrifugó a 3000 rpm por 10 minutos para luego observar el sedimente al microscopio. Resultados. El 65% de las muestras estuvieron contaminadas, encontrando 10 taxones de enteroparásitos, a saber: Blastocystis sp (49% del total de muestras examinadas), Endolimax nana (36%), lodamoeba butschlii (8%), Giardia lamblia (7%), Entamoeba coli (4%), Chilomastix mesnili (2%), Entamoeba hartmanni (2%), Trichuris trichiura (2%), Hymenolepis nana (2%) y Taenia sp (1%). Discusión. La diversidad de parásitos encontrados y su abundancia, se corresponden con lo reportado en poblaciones de la misma zona. Conclusión. La falta de higiene en la mayoría de los intercomunicadores facilitan el potencial de estos para transmitir los parásitos endémicos del estado Lara.

Abstract Introduction. The lack of studies in intercoms as means of propagation of enteroparasites in Venezuela, motivated the present study. Methodology. The intercom was rubbed three times with a swab impregnated with 0.85% saline solution (SSI), resuspending it in a tube with 10 ml of SSI, which was centrifuged at 3000 rpm for 10 minutes to then observe the pellet under a microscope. Results. 65% of the samples were contaminated, finding 10 taxa of enteroparasites, namely: Blastocystis sp (49% of the samples examined), Endolimax nana (36%), Iodamoeba butschlii (8%), Giardia lamblia (7%), Entamoeba coli (4%), Chilomastix mesnili (2%), Entamoeba hartmanni (2%), Trichuris trichiura (2%), Hymenolepis nana (2%) and Taenia sp (1%). Discussion. The diversity of parasites found and their abundance correspond to that reported in populations of the same area. Conclusion. The lack of hygiene of most of the intercoms facilitates the potential of these to transmit the endemic parasites of the Lara State.

Burnout syndrome prevalence during internship in public and private hospitals: a survey study in Mexico.

Burnout syndrome is a psychological condition that commonly affects health professionals, medical students, and others in professions with long shifts. It is defined by a high amount of emotional exhaustion, depersonalization, and low personal job satisfaction. We aimed to determine the prevalence of burnout syndrome in medical interns and establish the relationships between this condition and the time and type of hospital at which students worked during their medical internship. This was a survey study in which we used the Maslach Burnout Inventory, applied to fifth-year medical students on an internship at private and public hospitals in Mexico. The participants were 96 women (54.5%) and 80 men (45.5%), with ages ranging from 21 to 34 years old. We found burnout syndrome in 20% of these medical students 22% of the women and 18.6% of the men in the sample. Second-semester interns suffered burnout at a rate of 29%, in contrast to 15% of first-semester students. Emotional exhaustion and depersonalization scores were higher in second-semester interns who worked in public hospitals. However, the prevalence did not differ between public and private hospitals. Our study reports a higher prevalence of burnout syndrome during the second semester of internship. Students who practiced their internship in a public hospital showed higher scores in emotional exhaustion and depersonalization than those who practiced in a private hospital.

Complexation Behavior of Polyelectrolytes and Polyampholytes.

We perform grand canonical Monte Carlo simulations to study the pH titrations of isolated polyampholytes and polyelectrolyte-polyampholyte complexes in dilute solutions. Our simulations indicate that the electrostatic interactions promote the coexistence of opposite charges along the polyampholyte chain during titration. The repulsion between excess charges typically dominates the electrostatic interaction and leads to polymer stretching. Salt ions can screen the repulsion between excess charges as well as the fluctuation-induced attraction between opposite charges, and therefore make the variation between titration curves of polyampholytes and the ideal (no electrostatic interactions) curves less significant. We observe that this screening of charge repulsion decreases the chain size. The presence of pearl-necklace configuration of polyampholytes is diminished by the addition of salt. Similar simulations for the polyelectrolyte-polyampholyte system show that the resulting complexes are generally stable in the low pH region. In comparison to ideal case, electrostatic interactions strongly influence the acid-base properties of polyampholyte chains in the adsorbed state by reducing the presence of the coexistence domain of both positive and negative charges in the titration curves. We attribute the complex formation between polyelectrolyte and polyampholyte chains in the high pH region to, e.g., the high salt content. The pH variation leads to abrupt transition between adsorbed and desorbed states. Independent of charge sequence, a polyampholyte chain in a complex is usually located at one of the ends of the polyelectrolyte chain.

Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population.

OBJECTIVE: Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. METHODS: We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD. RESULTS: Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15-10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15-10.04). CONCLUSIONS: Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.

Effect of Sterols Isolated from Myrtillocactus geometrizans on Growth Inhibition of Colon and Breast Cancer Cells.

Objective. To explore the effect of peniocerol and macdougallin on HCT-15 and MCF-7 cells proliferation, cell cycle, apoptosis, and PARP cleavage. Methods. HCT-15 and MCF-7 cells were treated with various concentrations of peniocerol and macdougallin (10-80 µM) during 24 or 48 h. Crystal Violet Assay was used to evaluate the inhibition effect. Cell cycle regulation was examined by a propidium iodide method. Cell apoptosis was detected through both Annexin-V FLUOS/PI double-labeled cytometry assays and Western blot was applied to assess PARP cleavage. Results. Peniocerol and macdougallin induced growth inhibition and apoptosis in vitro in a time- and dose-dependent manner. Moreover, peniocerol and macdougallin induced arrest of cell cycle-dependent manner and increased the proportion of cells in G0/G1 phase. PARP cleavage in HCT-15 and MCF-7 cells was induced by treatment with peniocerol and macdougallin after 36 hours. Conclusions. Our results showed that the mechanism of cytotoxicity displayed by peniocerol and macdougallin is related to cell cycle arrest and apoptosis in both cell lines. This is a significant observation because it helps to understand the way some oxysterols isolated from Myrtillocactus geometrizans develop their biological activities against cancer cells.

Proton pump inhibitors in gastroesophageal reflux disease: "a custom-tailored therapeutic regimen".

The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs.Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses.

"Diseñando un traje a la medida": los inhibidores de la bomba de protones en la enfermedad por reflujo gastroesofágico / Proton pump inhibitors in gastroesophageal reflux disease: "a custom-tailored therapeutic regimen"

La Clasificación de Montreal divide la enfermedad por reflujo gastro-esofágico (ERGE) en síndromes esofágicos sintomáticos y con daño a la mucosa y en síndromes extraesofágicos con asociación establecida al ácido y asociación propuesta. En síntomas ERGE típicos el tratamiento con inhibidores de la bomba de protones (IBP) es satisfactorio (> 90%) a 8 semanas en la mayoría de los casos. Las tasas de respuesta a los IBP en la ERGE son muy variables; ya que también dependen de un adecuado diagnóstico clínico de la enfermedad; la endoscopia diferencia el fenotipo macroscópico de la ERGE. La variedad no erosiva (prevalencia 50-70%) tiene una tasa de respuesta sintomática diferente ya que el ácido no es causa suficiente para explicar los síntomas. Las posibles explicaciones a la falla al tratamiento son el apego al tratamiento, alteraciones en el metabolismo y características de IBP y diagnóstico inadecuado. Los síntomas refractarios se relacionan con neutralización del contenido por el uso crónico de IBP. Las manifestaciones extraesofágicas se asocian con otros mecanismos fisiopatológicos como la disfunción del sistema nervioso autónomo. En estas entidades es necesario establecer la relación o no con el ácido para determinar el uso con IBP o considerar otros fármacos. Es decir, necesitamos responder a las preguntas en quien, para qué, cómo y por cuánto tiempo, para diseñar un "traje a la medida". Por último, la seguridad y la tolerabilidad a IBP son factores a considerar en pacientes de edad avanzada que requieren su uso crónico y que generalmente tienen enfermedades crónicas concomitantes (AU)

The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs. Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses (AU)

Leaching of heavy metals from E-waste in simulated landfill columns.

In recent history the volume of electronic products purchased by consumers has dramatically escalated. As a result this has produced an ever-increasing electronic waste (E-waste) stream, which has generated concerns regarding the E-waste's potential for adversely impacting the environment. The leaching of toxic substances from obsolete personal computers (PCs) and cathode ray tubes (CRTs) of televisions and monitors, which are the most significant components in E-waste stream, was studied using landfill simulation in columns. Five columns were employed. One column served as a control which was filled with municipal solid waste (MSW), two columns were filled with a mixture of MSW and CRTs, and the other two were filled with MSW and computer components including printed wire boards, hard disc drives, floppy disc drives, CD/DVD drives, and power supply units. The leachate generated from the columns was monitored for toxic materials throughout the two-year duration of the study. Results indicate that lead (Pb) and various other heavy metals that were of environmental and health concern were not detected in the leachate from the simulators. When the samples of the solids were collected from underneath the E-waste in the columns and were analyzed, significant amount of Pb was detected. This indicates that Pb could readily leach from the E-waste, but was absorbed by the solids around the E-waste materials. While Pb was not observed in the leachate in this study, it is likely that the Pb would eventually enter the leachate after a long term transport.

[Bochdalek's hernia in adults]. / Hernia de Bochdalek en el adulto.

Bochdalek hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side, and is most often seen in infants, rare in the adult. In a bibliographical review of the literature we found 100 cases reported of Bochdalek hernia in the adult. We present the case of a 52 year old man with Bochdalek hernia, he presented gastric symptoms of upper gastrointestinal bleeding. Upper gastrointestinal barium study showed the stomach inside the thoracic cavity, endoscopy showed ischemical changes in gastric mucosa The surgical repair was done through left thoracotomy without surgical complications, four years later the patient is asymptomatic.

Intubación orotraqueal sin relajante muscular en paciente adulto para cirugía electiva / Orotracheal intubation without the use of muscle relaxants in adult patients for elective surgery

Se trata de un estudio prospectivo, longitudinal, descriptivo, experimental, donde se evaluó la vía aérea y las condiciones de intubación traqueal, administando fentanyl y propofol en 40 pacientes programados para cirugía mayor electiva valorados ASA I-II. Durante la laringoscopia se valoró la apertura glotica según Cormack-Lehane, así como los cambios en la frecuencia cardiaca y presión arterial, antes y después de la intubación, se valoraron otras maniobras para facilitar la misma. Los resultados fueron analizados mediante la prueba de t de student con diferencia significativa menor de 0.005. No existieron cambios importantes en la frecuencia cardiaca y presión arterial antes y después de la intubación, en sólo un paciente hubo necesidad de utilizar relajantes musculares. Concluimos que en pacientes con anatomía normal de la vía aérea y estado físico I-II, la utilización de fentanyl y propofol es una alternativa para la intubación traqueal, evitando así los efectos indeseables de los relajantes musculares o sus antagonistas

Anestesia mixta: bloque epidural más intubación orotraqueal bajo midazolam en infusión continua para cirugía mayor electiva / Combined anesthesia: epidural blockade and orothracheal intubation with continous infusion of midazolam for elective major surgery

Se valoró el efecto hipnótico del midazolam en infusión continua intravenosa (ICI) en pacientes sometidos a cirugía mayor electiva (CME) bajo bloqueo epidural (BPD) y orointubación. Se estudiaron 30 pacientes ASA I-II, se registró su FC, TA sistólica y diastólica en estado basal y se comparó con los signos vitales transanestésicos como indicadores de profundidad anestésica, se evaluó la calidad de recuperación. El mantenimiento fue con midazolam (0.25 µg/kg/min), O2 al 100 por ciento y lidocaína epidural. Los resultados se sometieron a la prueba de T para grupos independientes, media y desviación estándar, con significancia p<0.005. El midazolam en ICI es un agente hipnótico adecuado, en esta técnica que demostró ser segura, cursó con estabilidad hemodinámica y evitó el uso de halogenados