ABSTRACT
El marco legal del anestesiólogo en Cirugía Mayor Ambulatoria está cobrando relativa importancia en los últimos años. Cada vez más los profesionales vamos tomando conciencia de las implicaciones legales en las que podemos incurrir al realizar nuestro trabajo diario. El análisis de sentencias judiciales en España demuestra que es una especialidad con altas cuantías indemnizatorias. Es muy importante que los anestesiólogos conozcamos todo lo relativo a las normas de los servicios y centros donde desarrollamos nuestra labor asistencial, de igual manera debemos conocer las normas de los colegios profesionales y de las sociedades científicas, y las leyes de ámbito regional y estatal que afectan a nuestro trabajo (AU)
The legal framework anesthesiologist at Ambulatory Surgery, is gaining on importance in recent years, more and more professionals will become aware of the legal implications you may incur while performing our daily work. Analysis of court decisions in Spain shows that anesthesiology is a specialty with high compensatory amounts. It is very important that anesthesiologists know everything about standards of services and facilities where we do care work, just as we must know the rules of professional associations and scientific societies, and the laws of regional and state level that affect our work (AU)
Subject(s)
Humans , Anesthesiology/legislation & jurisprudence , Ambulatory Surgical Procedures/methods , Legislation, Medical/trends , Patient Safety/legislation & jurisprudence , Liability, LegalABSTRACT
OBJECTIVE: To determine the incidence of paresthesia during lumbar puncture performed with the patient in different positions. MATERIAL AND METHODS: A single-blind prospective study of patients scheduled for elective cesarean section, randomized to 3 groups. In group 1 patients were seated in the direction of the long axis of the table, with heels resting on the table. In group 2 they were seated perpendicular to the long axis of the table, with legs hanging from the table. In group 3 they were in left lateral decubitus position. Lumbar punctures were performed with a 27-gauge Whitacre needle. RESULTS: One hundred sixty-eight patients (56 per group) were enrolled. Paresthesia occurred most often in group 3 (P = .009). We observed no differences in blood pressure after patients moved from decubitus position to the assigned position. Nor did we observe between-group differences in blood pressure according to position taken during puncture. CONCLUSION: Puncture undertaken with the patient seated, heels on the table and knees slightly bent, is associated with a lower incidence of paresthesia than puncture performed with the patient seated, legs hanging from the table. Placing the patient's heels on the table requires hip flexion and leads to anterior displacement of nerve roots in the dural sac. Such displacement would increase the nerve-free zone on the posterior side of the sac, thereby decreasing the likelihood of paresthesia during lumbar puncture. A left lateral decubitus position would increase the likelihood of paresthesia, possibly because the anesthetist may inadvertently not follow the medial line when inserting the needle.
Subject(s)
Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Cesarean Section , Paresthesia/etiology , Postoperative Complications/etiology , Posture , Punctures/adverse effects , Adult , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Back , Dura Mater/injuries , Female , Humans , Leg , Paresthesia/prevention & control , Postoperative Complications/prevention & control , Pregnancy , Prospective Studies , Punctures/methods , Spinal Nerve Roots/injuriesABSTRACT
OBJETIVO: Determinar la incidencia de parestesiasdurante la punción lumbar según la posición adoptadapor el paciente.MATERIAL Y MÉTODO: Estudio simple ciego, prospectivoy aleatorizado en pacientes programadas para cesáreaelectiva distribuidas en 3 grupos. Grupo 1: pacientesentada en la dirección del eje largo de la cama apoyandosus talones sobre la misma; grupo 2: paciente sentadaen dirección perpendicular al eje largo de la cama,con las piernas colgando; y grupo 3: paciente en decúbitolateral izquierdo. Las punciones lumbares se realizaroncon aguja 27-G Whitacre.RESULTADOS: Se incluyeron 168 pacientes (56 por grupo).Las parestesias fueron más frecuentes en el grupo 3(p = 0,009). No objetivamos cambios entre los valores depresión arterial en decúbito y tras adoptar la posición depunción. Tampoco encontramos diferencias entre gruposen la presión arterial según la postura adoptada para realizarla punción.DISCUSIÓN: La punción en sedestación apoyando lostalones sobre la cama, con ligera flexión de rodillas presentamenor número de parestesias que la punción realizadaen sedestación pero con las piernas colgando. Lostalones sobre la cama producen una flexión de la caderacon un desplazamiento de las raíces nerviosas dentro delsaco dural a una posición más anterior. Este desplazamientoaumentaría el área libre de raíces nerviosas en lazona posterior del saco dural disminuyendo la posibilidadde parestesias durante las punciones lumbares. Laposición en decúbito lateral izquierdo aumentaría laposibilidad de parestesias, posiblemente porque la agujase desvía de la línea media de forma inadvertida (AU)
OBJECTIVE: To determine the incidence of paresthesiaduring lumbar puncture performed with the patient indifferent positions.MATERIAL AND METHODS: A single-blind prospectivestudy of patients scheduled for elective cesarean section,randomized to 3 groups. In group 1 patients were seatedin the direction of the long axis of the table, with heelsresting on the table. In group 2 they were seatedperpendicular to the long axis of the table, with legshanging from the table. In group 3 they were in leftlateral decubitus position. Lumbar punctures wereperformed with a 27-gauge Whitacre needle.RESULTS: One hundred sixty-eight patients (56 pergroup) were enrolled. Paresthesia occurred most often ingroup 3 (P = .009). We observed no differences in bloodpressure after patients moved from decubitus position tothe assigned position. Nor did we observe between-groupdifferences in blood pressure according to position takenduring puncture.CONCLUSION: Puncture undertaken with the patientseated, heels on the table and knees slightly bent, isassociated with a lower incidence of paresthesia thanpuncture performed with the patient seated, legs hangingfrom the table. Placing the patient's heels on the tablerequires hip flexion and leads to anterior displacement ofnerve roots in the dural sac. Such displacement wouldincrease the nerve-free zone on the posterior side of thesac, thereby decreasing the likelihood of paresthesiaduring lumbar puncture. A left lateral decubitus positionwould increase the likelihood of paresthesia, possiblybecause the anesthetist may inadvertently not follow themedial line when inserting the needle (AU)
Subject(s)
Humans , Female , Pregnancy , Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Spinal Puncture/adverse effects , Paresthesia/chemically induced , Cesarean Section/methods , Modalities, PositionSubject(s)
Bronchoscopes , Intubation, Intratracheal/instrumentation , Laryngoscopes , Adult , Fiber Optic Technology , Humans , Male , Video RecordingABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Intubation, Intratracheal/methods , Airway Obstruction/complications , Bronchoscopy , Arthroscopy/methodsABSTRACT
OBJETIVO: Determinar el porcentaje de parestesiasusando diferentes técnicas de punción subaracnoideacon una aguja Whitacre 27-G.MATERIAL Y MÉTODO: Se realizaron diferentes técnicasde punción subaracnoidea en 224 cesáreas electivas.Estudio simple ciego, prospectivo y aleatorizado distribuido en 4 grupos de 56 pacientes cada uno. Grupo-1: punción epidural-subaracnoidea combinada, usandoaguja espinal con fiador; grupo 2: punción epiduralsubaracnoidea combinada, usando aguja espinal sin fiador; grupo 3: punción subaracnoidea con fiador; grupo 4: punción subaracnoidea con fiador hasta milímetros antes de llegar al saco dural, en que se retira el fiador.RESULTADOS: Los pacientes que presentaron parestesiasfueron 23, 11, 16 y 5 en los grupos 1, 2, 3 y 4 respectivamente. Las parestesias afectaron a diferentes raíces nerviosas. En 2, 11, 29 y 13 casos afectaron a lasraíces nerviosas cuarta y quinta lumbar, primera ysegunda sacra respectivamente. El riesgo de parestesiasfue 7; 2,5 y 4 veces mayor en los grupos 1, 2 y 3 con respecto al grupo 4.CONCLUSIONES: La punción epidural-subaracnoideacombinada presenta mayor número de parestesias que lapunción subaracnoidea simple, posiblemente porque lapunción lumbar se realiza sobre un saco dural, previamente deformado por el efecto tienda que origina previamente la aguja epidural. La punción subaracnoidealenta e ininterrumpida, retirando el fiador milímetrosantes de llegar al saco dural origina un menor númerode parestesias
OBJECTIVE: To determine the incidence of paresthesiawith different spinal puncture techniques using a 27-gauge Whitacre needle.MATERIAL AND METHODS: Spinal puncture wasperformed in 224 elective cesarean sections usingdifferent techniques in this single-blind, prospectivetrial. Patients were randomized to 4 groups: group 1,combined epidural and subarachnoid puncture using anintroducer needle; group 2, combined epidural andsubarachnoid puncture without an introducer; group 3,subarachnoid puncture with an introducer; and group 4,subarachnoid puncture with an introducer to within afew millimeters of the dural sac, at which point theintroducer was withdrawn.RESULTS: Paresthesia developed in 23, 11, 16 and 5patients in groups 1, 2, 3 and 4, respectively. Variousnerve roots were affected. In 2 and 11 cases the fourth and fifth lumbar nerve roots were affected; in 29 and 13 cases, the first and second sacral nerve roots were involved. In comparison with group 4, the risk of paresthesia was 7, 2.5 and 4 times greater in groups 1, 2 and 3, respectively.CONCLUSIONS: Combined epidural-subarachnoidpuncture leads to a higher incidence of paresthesia incomparison with simple spinal puncture, probablybecause the lumbar puncture is performed on a duralsac that has been previously deformed due to the "tenteffect" caused by the epidural needle. Fewer cases ofparesthesia occur when the subarachnoid puncture isslow and steady and the introducer needle is withdrawnmillimeters before it reaches the dural sac
