ABSTRACT
El síndrome de dolor miofascial (SDM) es una patología muscular dolorosa que se define como dolor local o referido asociado a la presencia de nódulos palpables hipersensibles en el trayecto de ese músculo y constituye una patología frecuente en las consultas de dolor crónico.La toxina botulínica es una exotoxina producida por el Clostridium botulinum, cuyos serotipos A, B y F tienen utilidad clínica (fundamentalmente tipo A- Botox®, Dysport®). Se trata de una de las neurotoxinas más potentes que existen. Se utiliza como uso compasivo en el tratamiento del síndrome de dolor miofascial. El efecto beneficioso analgésico del uso de la toxina se origina de reducir la hiperactividad muscular pero estudios recientes sugieren que esta neurotoxina puede tener efectos analgésicos directos diferentes de sus acciones neuromusculares. Su uso no está exento de riesgos. Los efectos adversos se relacionan con la migración de la toxina y son en general leves o moderados y pasajeros. Se han descrito casos de debilidad muscular prolongada e incluso cuadros de miastenia gravis, síndrome de Eaton Lambert desencadenados por el uso de la toxina.Presentamos el caso clínico de un varón afecto de síndrome de dolor miofascial del cuadrado lumbar y psoas tratado con infiltraciones con toxina botulínica. Tras la mejoría del cuadro clínico muscular se desarrolla diplopía y ptosis palpebral reiterante, siendo diagnosticado de miastenia gravis. Revisamos la etiopatogenia del síndrome de dolor miofascial y de la miastenia gravis, así como el uso de la toxina botulínica y sus relaciones entre ellos Concluimos que es necesaria una anamnesis detallada previa a la utilización de toxina botulínica sobre patología muscular o signos de debilidad muscula (AU)
Myofascial pain syndrome is a painful muscle condition which is defined as local or referred pain associated with hypersensitive palpable nodules in the way of that muscle and is a frequent pathology in consultations on chronic pain.Botulinum toxin is an exotoxin produced by Clostridium botulinum, of which serogroups A, B and F have clinical utility (mainly type A- Botox®, Dysport®). This is one of the most potent neurotoxins and is administered compassionatelly in the treatment of myofascial pain syndrome. The toxin has a beneficial analgesic effect by reducing muscle hyperactivity but recent studies suggest that this neurotoxin may also induce analgesia by non-neuromuscular actions. Its use is not without risks. Adverse effects are related to the migration of the toxin and are usually mild or moderate and transient. There have been reports of prolonged muscle weakness and diseases like myasthenia gravis or Lambert Eaton syndrome triggered by the use of the toxin.We report a case of a male patient with myofascial pain syndrome whose psoas and quadratus muscles were treated with injections of botulinum toxin. Following the improvement in clinical muscle situation, repetitive diplopia and ptosis developed and the patient was diagnosed of myasthenia gravis.We review the pathogenesis of myofascial pain syndrome and myasthenia gravis and the use of botulinum toxin and relationships between them.We conclude that a detailed history is required prior to the use of botulinum toxin on patients with muscle pathology or signs of muscle weakness (AU)
Subject(s)
Aged , Humans , Male , Middle Aged , Myasthenia Gravis/drug therapy , Botulinum Toxins, Type A/therapeutic use , Myofascial Pain Syndromes/drug therapy , Neurotoxins/therapeutic use , Diplopia/complications , Diplopia/drug therapy , Blepharoptosis/complications , Blepharoptosis/drug therapy , Anesthesia, Local , Adrenal Cortex Hormones/therapeutic useABSTRACT
BACKGROUND: We designed an endotracheal probe for measuring inspired and expired gas fractions during pediatric general anesthesia. OBJECTIVE: To compare the gas fractions measured by means of intratracheal and extratracheal monitoring. MATERIAL AND METHODS: The study included ASA 1 patients between the ages of 7 and 12 years under inhaled anesthesia with mechanical ventilation. The following parameters were recorded inside and outside the trachea: inspired and expired oxygen, nitric oxide (N2O) and sevoflurane fractions; the expired and inspired fraction gradients; PaCO2; and end-tidal carbon dioxide (ETCO2). Measurements were taken by an airflow sensor (Pedi-Lite) in the circuit before the point of connection to the endotracheal tube and by an intratracheal probe placed between the tube and the carina. Both sensors were connected to the same monitor. Measurements were taken on intubation and 5, 10, 15, 20, 30, 40, 50, and 60 minutes thereafter. PaCO2 was recorded at the same time. The recorded values were analyzed using the t test and the Pearson product moment correlation coefficient (r), and regression models were constructed using analysis of variance. RESULTS: Seventy-one patients were enrolled in the study. The mean difference (SD) ETCO2 was 5 (3) mm Hg higher according to endotracheal measurement (P < .005), and that measurement was almost identical (+/-13 mm Hg) to the PaCO2 (P < or = .5). The inspired/expired gradients of endotracheal measurement of oxygen and N2O were 3 (2) points higher (P < .05) than the gradients of extratracheal measurements. In the case of sevoflurane gradients, however, the extratracheal values were higher (mean difference, 0.6 [0.2] points, P < .05). The inspired/expired oxygen and N2O gradients became equal after 18 (3) minutes; the sevoflurane gradients became equal after 8 (2) minutes. CONCLUSIONS: Intratracheal and extratracheal measurements of the inspired and expired fractions of mixed gases provide different results.
Subject(s)
Anesthesia, Inhalation/methods , Manometry/instrumentation , Models, Theoretical , Monitoring, Physiologic/instrumentation , Positive-Pressure Respiration , Trachea , Anesthetics, Inhalation , Child , Equipment Design , Female , Gases , Hemodynamics , Humans , Intubation, Intratracheal , Male , Methyl Ethers , Nitrous Oxide , Preanesthetic Medication , Prospective Studies , Respiratory Mechanics , Sevoflurane , Single-Blind Method , Spirometry/instrumentationABSTRACT
INTRODUCCIÓN: Diseñamos una sonda endotraqueal para medir fracciones inspiradas y espiradas de los gases de la mezcla durante anestesia general pediátrica. OBJETIVOS: Comparar los gases analizados en el circuito, mediante monitorización intra y extratraqueal, y comprobar sus posibles diferencias. MATERIAL Y MÉTODOS: Pacientes de 7 a 12 años; ASA I; bajo anestesia inhalatoria en ventilación mecánica. Se analizan dentro y fuera de la tráquea, fracciones inspiradas (Fi) y espiradas (Fe) de O2/N2O/Sevoflurano; la relación Fe/Fi; presión arterial de CO2 (PaCO2); y end tidal CO2 (ETCO2); mediante medición previa al tubo endotraqueal (TET) desde pedi-lite, y mediante sonda en tráquea, anterior a la carinay posterior al TET. Ambos dispositivos fueron conectadosal mismo monitor. Se realizaron mediciones en inicio, 5,10, 15, 20, 30, 40, 50 y 60 minutos tras ntubación, y de PaCO2 en los mismos tiempos. Se compararon valoresmedios (T Student), coeficiente correlación de Pearson (r), y se determinaron modelos de regresión (ANOVA).RESULTADOS: Incluimos 71 pacientes. La diferencia media (DE) de ETCO2 fue 5(±3) mmHg superior para la medición endotraqueal (p < 0,005), casi coincidente (±1,3 mmHg) con la PaCO2 (p ≤ 0,5). Los gradientes (DE) de Fi-Fe O2/N2O fueron 3 (±2) puntos superiores en la mediciónendotraqueal (p < 0,05). Sin embargo, sevoflurano presentódiferencia media extratraqueal superior 0,6 (±0,2) puntos(p < 0,05). Conforme avanza el tiempo anestésico, losgradientes Fi-Fe O2/N2O, se equiparan transcurridos 18(±3) minutos, para sevoflurano esto sucede en 8 (±2) minutos. CONCLUSIONES: Las fracciones inspiradas y espiradas de los gases de la mezcla son distintos, según se realice la medición intra o extratraqueal (AU)
BACKGROUND: We designed an endotracheal probe for measuring inspired and expired gas fractions during pediatric general anesthesia. OBJECTIVE: To compare the gas fractions measured by means of intratracheal and extratracheal monitoring. MATERIAL AND METHODS: The study included ASA 1 patients between the ages of 7 and 12 years under inhaled anesthesia with mechanical ventilation. The following parameters were recorded inside and outside the trachea: inspired and expired oxygen, nitric oxide (N2O) and sevoflurane fractions;the expired and inspired fraction gradients; PaCO2; andend-tidal carbon dioxide (ETCO2). Measurements were takenby an airflow sensor (Pedi-Lite) in the circuit before the point of connection to the endotracheal tube and by an intratracheal probe placed between the tube and the carina. Both sensors were connected to the same monitor. Measurements were taken on intubation and 5, 10, 15, 20, 30, 40, 50, and 60 minutes thereafter. PaCO2 was recorded at the same time. The recorded values were analyzed using the t test and the Pearson product moment correlation coefficient (r), and regression models were constructed using analysis of variance. RESULTS: Seventy-one patients were enrolled in the study. The mean difference (SD) ETCO2 was 5 (3) mm Hg higher according to endotracheal measurement (P < .005), and that measurement was almost identical (±1.3 mm Hg) to the PaCO2 (P ≤ .5). Theinspired/expired gradients of endotracheal measurement of oxygen and N2O were 3 (2) points higher (P< .05) than the gradients of extratracheal measurements. In the case of sevoflurane gradients, however, the extratracheal values were higher (mean difference, 0.6 [0.2] points, P < .05). The inspired/expired oxygen and N2O gradients became equal after 18 (3) minutes; the sevoflurane gradients became equal after 8 (2) minutes. CONCLUSIONS: Intratracheal and extratracheal measurements of the inspired and expired fractions of mixed gases provide different results (AU)
Subject(s)
Humans , Male , Female , Child , Monitoring, Intraoperative/methods , Anesthesia, Inhalation/methods , Pulmonary Gas Exchange , Anesthetics, Inhalation/pharmacokinetics , Intubation, IntratrachealABSTRACT
Se presentan las implicaciones anestésicas de las enfermedades de rara aparición dependientes del aparato digestivo que agrupan un gran número de patologías, muchas de ellas presentes en el nacimiento, y que no excluyen la llegada a la edad adulta. Los signos más importantes de su curso clínico se presentan como cuadros de desnutrición o malnutrición y muchas de ellas, en edades avanzadas, cursan con cuadros de malabsorción. Así mismo, se presentan las enfermedades derivadas de la ausencia de vitaminas y componentes esenciales, como los minerales, que pueden presentarse como cuadros clínicos abigarrados y de difícil diagnóstico. Las implicaciones anestésicas, como se verá, dependen de una multiplicidad de factores y de la gravedad de la enfermedad específica. Nuestro grupo de trabajo sobre Anestesia en Enfermedades de Rara Aparición ha desarrollado un complejo estudio, del que relatamos aquí un esquema de los síndromes y enfermedades más importantes
We explain the anaesthetic implications in gastroenteric uncommon diseases that include a great number of pathological entities that can be presented since the birth, but also could be manifested in the adult age. The most important signs of their clinical courses appear like undernourishment or malnutrition medical profile and many of them, in elderly or middle-aged people, attend with malabsortion syndromes. Also diseases derived from vitamin absence and essential components appear, like minerals, which can be manifested like clinical signs of difficult diagnosis. The anaesthetic implications depend on a multiplicity of factors and the gravity of the specific disease. Our Anaesthesia Work Group in Uncommon Diseases has developed a difficult study. We related here an abstract of the main syndromes and diseases
