[Anesthetic considerations in laparoscopy for removal of a kidney from a live donor]. / Consideraciones anestésicas en la nefrectomía laparoscópica de donante vivo para trasplante renal.

Kidney transplantation is the main therapeutic alternative for patients with end-stage renal failure. However, the main constraint at present is the lack of available organs. Removal of a kidney from a live donor is a better option than conventional transplantation of a cadaver-donated organ. Among the advantages are a shorter waiting time for the organ recipient and greater assurance of graft quality and survival. The postoperative conditions made possible by laparoscopic surgery have encouraged the donation of tissues by live donors. Anesthetic treatment for patients undergoing laparoscopic surgery must be based on an understanding of the pathophysiologic changes that occur in this type of procedure so that complications can be prevented. This review provides an update of progress in laparoscopic surgery and the repercussions of anesthetic management, particularly with respect to anesthesia for kidney donors.

[Cerebrospinal fluid drainage in endovascular repair of thoracic aortic lesions: preliminary report of experience with 5 patients]. / Tratamiento endovascular de lesiones en aorta torácica con drenaje de líquido cefalorraquídeo. Experiencia inicial en cinco pacientes.

Endovascular repair of thoracic or thoracoabdominal aortic lesions as an alternative to open surgery, to avoid the high complication and mortality rates associated with the conventional approach, does not eliminate the risk of postoperative paraplegia. We report on a series of 5 patients with different thoracic aortic lesions who underwent endovascular stent-graft repair procedures. We describe measures to drain cerebrospinal fluid to prevent ischemic spinal cord injury. We also review the anesthetic management of patients undergoing this type of surgery.

Tratamiento endovascular de lesiones en aorta torácica con drenaje de líquido cefalorraquídeo. Experiencia inicial en cinco pacientes / Cerebrospinal fluid drainage in endovascular repair of thoracic aortic lesions: preliminary report of experience with 5 patients

El tratamiento endovascular de lesiones a nivel deaorta torácica o toracoabdominal como alternativa a lacirugía abierta convencional (en prevención de la elevadamorbilidad y mortalidad de la misma) no está exentadel riesgo potencial de paraplejía postoperatoria de estaúltima.Presentamos una serie de cinco pacientes, con distintaslesiones a nivel de aorta torácica, sometidos a cirugíaendovascular reparadora por medio de endoprótesis ylas medidas de protección medular desarrolladas con elfin de prevenir una eventual isquemia medular mediantedrenaje de líquido cerfalorraquídeo. Asimismo realizamosuna revisión del manejo anestésico para este tipode abordaje quirúrgico

Endovascular repair of thoracic or thoracoabdominalaortic lesions as an alternative to open surgery, to avoidthe high complication and mortality rates associatedwith the conventional approach, does not eliminate therisk of postoperative paraplegia.We report on a series of 5 patients with different thoracicaortic lesions who underwent endovascular stentgraftrepair procedures. We describe measures to draincerebrospinal fluid to prevent ischemic spinal cordinjury. We also review the anesthetic management ofpatients undergoing this type of surgery

[Severe hemodynamic deterioration during epidural anesthesia for endovascular treatment of thoracic aortic stenosis]. / Deterioro hemodinámico severo durante la anestesia epidural para el tratamiento endovascular de una estenosis de aorta torácica.

A 72-year-old woman diagnosed with critical descending aortic stenosis was scheduled for endovascular treatment by angioplasty and implantation of an aortic stent. Her medical history included arterial hypertension, lipid metabolic disorder, obesity, Takayasu disease, dermatopolymyositis, and alleged allergy to iodine contrast and local anesthetics. After the allergies were ruled out, it was decided to use a regional anesthetic technique to avoid the postoperative complications of general anesthesia and achieve better hemodynamic control during surgery. Surgery was carried out under epidural anesthesia and intravenous sedation. After angioplasty and during self-expansion of the stent, the patient's hemodynamics deteriorated rapidly; she lost consciousness and required orotracheal intubation and immediate resuscitation measures. The literature describes in detail the management of patients with thoracic aortic lesions, including the most appropriate way to provide anesthesia. General anesthesia seems to be preferred, although care is taken to individualize the decision. We analyze this case of a patient with severe thoracic aortic stenosis undergoing endovascular treatment under epidural anesthesia.

Deterioro hemodinámico severo durante la anestesia epidural para el tratamiento endovascular de una estenosis de aorta torácica / Severe hemodynamic deterioration during epidural anesthesia for endovascular treatment of thoracic aortic stenosis

Una mujer de 72 años, diagnosticada de estenosis crítica de aorta torácica descendente, es propuesta para tratamiento endovascular con angioplastia e implante de prótesis aórtica. Como antecedentes personales presentaba: hipertensión arterial, dislipemia, obesidad, enfermedad de Takayasu, dermatopolimiositis y una dudosa alergia a contraste yodado y anestésicos locales. Tras descartar las alergias, se decidió recurrir a una técnica locorregional, con el fin de evitar la morbilidad postoperatoria de la anestesia general y conseguir un mejor control hemodinámico intraoperatorio. La intervención se desarrolló bajo anestesia epidural y sedación intravenosa; tras realizar la angioplastia se procedió a la fijación y autoexpansión de la prótesis, momento en el cual se produjo un deterioro hemodinámico brusco de la paciente, con pérdida de conciencia, que obligó a la intubación orotraqueal y medidas de resucitación inmediatas. La literatura que describe con detalle el manejo y la técnica anestésica más apropiada para el tratamiento endovascular de lesiones a nivel de la aorta torácica, parece decantarse por la anestesia general, aunque siempre individualizando cuidadosamente cada caso. Presentamos una paciente con estenosis aórtica torácica severa, sometida a tratamiento endovascular bajo anestesia epidural

A 72-year-old woman diagnosed with critical descending aortic stenosis was scheduled for endovascular treatment by angioplasty and implantation of an aortic stent. Her medical history included arterial hypertension, lipid metabolic disorder, obesity, Takayasu disease, dermatopolymyositis, and alleged allergy to iodine contrast and local anesthetics. After the allergies were ruled out, it was decided to use a regional anesthetic technique to avoid the postoperative complications of general anesthesia and achieve better hemodynamic control during surgery. Surgery was carried out under epidural anesthesia and intravenous sedation. After angioplasty and during self-expansion of the stent, the patient's hemodynamics deteriorated rapidly; she lost consciousness and required orotracheal intubation and immediate resuscitation measures. The literature describes in detail the management of patients with thoracic aortic lesions, including the most appropriate way to provide anesthesia. General anesthesia seems to be preferred, although care is taken to individualize the decision. We analyze this case of a patient with severe thoracic aortic stenosis undergoing endovascular treatment under epidural anesthesia

[Headache caused by cerebral angiopathy during labor with epidural analgesia]. / Cefalea por angiopatía cerebral durante el trabajo de parto con analgesia epidural.

A 29-year-old woman presented projectile vomiting followed by frontal headache, immediately upon receiving epidural analgesia for labor. The clinical picture persisted until expulsion. Although no leaking of spinal fluid into the needle or epidural catheter had been observed, post-dural puncture headache was diagnosed. The postpartum persistence of symptoms and the patient's generally worsening condition indicated the need for more thorough physical examination, which revealed signs of neurological involvement. Those findings and imaging studies (computed tomography of the brain, transcranial Doppler and magnetic resonance angiography) established a final diagnosis of postpartum cerebral angiopathy. Although epidural analgesia is increasingly requested by women entering labor, it is not a risk-free procedure. We describe a relatively unknown clinical entity, postpartum cerebral angiopathy, that developed during epidural analgesia for labor and that was initially believed to be a complication of the analgesic technique.

Cefalea por angiopatía cerebral durante el trabajo de parto conanalgesia epidural / Headache due to cerebral angiopathy during labor with epidural analgesia

Una mujer de 29 años, sometida a analgesia epidural durante el trabajo de parto presentó, como complicación inmediata un cuadro de vómitos en escopetazo con posterior cefalea de localización frontal, persistiendo el cuadro hasta el período expulsivo. A pesar de no evidenciarse salida de líquido cefalorraquídeo por la aguja de punción ni por el catéter epidural, se diagnosticó inicialmente, de cefalea pospunción dural. La persistencia de los síntomas, asociado a un empeoramiento del estado general de la paciente durante los días posteriores al parto, obligó a una exploración física más exhaustiva que reveló signos de focalidad neurológica. Estos signos apoyados por los hallazgos radiológicos (TAC cerebral, Doppler transcraneal y angiorresonancia), establecieron finalmente, el diagnóstico de vasculopatía cerebral postparto. La analgesia epidural es una técnica cada vez más solicitada por las mujeres gestantes en el momento en que se inicia el trabajo del parto, sin embargo no es una anestesia exenta de riesgos. En este caso presentamos una entidad clínica, relativamente poco conocida, la vasculopatía cerebral postparto, que se presenta en el transcurso de una anestesia epidural en una mujer gestante y que inicialmente es considerada como una complicación de la técnica anestésica. (AU)

Fruitlax: management of constipation in children with disabilities.

Seven children, with a variety of disabilities, who had experienced chronic constipation, participated in a study of the use of Fruitlax, a natural laxative. Using an AB single-subject design, data were collected for each child for a baseline period A (2 weeks) and for an intervention period B (minimum of 3 weeks), which included the addition of Fruitlax to the subjects' diets. Whereas each child experienced some change in bowel pattern (consistency, effort required to have a bowel movement, color, amount, frequency, and number of bowel movements per day), the particular change was different for each child. Fruitlax does appear to be a useful natural laxative for some children; however, additional research with a larger sample is required. The Glenrose Stool Consistency Tool was developed for use in this study. Further work is needed in the use of the tool by clients, their families, and health care workers.

Effectiveness of a handwashing program.

A pilot study to develop and evaluate a program to teach 13 Grade 1 children with disabilities about handwashing was conducted at Glenrose School, which is located within Glenrose Rehabilitation Hospital. Children aged 6 to 8 years were taught how and when to wash their hands. Handwashing skills were evaluated before the teaching began, immediately following the teaching program, and at 1, 3, and 5 months postteaching. The children's handwashing skills did improve, with the girls generally scoring higher than the boys on both washing techniques and times of washing on all the testing occasions. Although the children had fewer visits to the doctor, took fewer prescribed antibiotics, and had fewer infectious illnesses than they did for the same time period the previous year, other variables, in addition to the teaching program, may have contributed to the outcome. A revised handwashing program is now included in the Grade 1 curriculum.