[Hormonal response and two special techniques of postoperative analgesia in pediatric surgery]. / Respuesta hormonal con dos técnicas distintas de analgesia postoperatoria en cirugía pediátrica.

AIMS: We studied neuroendocrine response in the postoperative pain relief in pediatric patients treated with two analgesic techniques (conventional intravenous analgesia and patient controlled analgesia). MATERIAL AND METHODS: A double blind study was made in 30 patients, 6-14 year-old children, under total intravenous anesthesia for programmed surgery. An intravenous analgesia dose of 0.5 mg/Kg was given 10 minutes before operation was finished. Postoperative analgesia was achieved by two techniques: A. Patient controlled analgesia (PCA), and B. Conventional intravenous analgesia every 6 hours. Hormones measurements were made (catecholamines, cortisol, ACTH and beta-endorphin), hemodynamic monitoring (blood pressure and heart rate), and pain measurement (Hannallah's score) in both pre and postoperative times (1, 6 and 24 hours after operation). RESULTS: Pain score was low and without significant differences in both groups (p > 0.05). beta-endorphin level decreased in both groups, and a cortisol and catecholamine level increase was noticed at 6 hours after operation; these changes were less significant in PCA group (p < 0.001). ACTH level did not change significantly in both groups. Hemodynamic monitoring measurements were not significantly different. CONCLUSIONS: Both analgesic techniques were appropriate to postoperative pain relief in pediatric patients. Low pain score shows better conditions to attend these patients. We suggest PCA technique is better to treat postoperative stress response following pediatric surgery.

[Can we change the patient's image of the anesthesiologist?]. / Podemos modificar la imagen que tiene el paciente del anestesiólogo?

OBJECTIVE: To determine whether provision of an information sheet during the preanesthesia visit to the patient, and general recommendations for anesthesia, can change patients' image of the anesthesiologist. PATIENTS AND METHODS: Two groups of 100 patients each were studied before outpatient surgery. Group 1 (given no information) answered a questionnaire before an interview with the anesthesiologist. Group 2 (who were given information) answered the same questionnaire, which was accompanied by an information sheet explaining the nature of anesthesia, possible risks, operating room and postoperative procedures. RESULTS: In group 1,67% identified the anesthesiologist as a physician. In group 2, 99% (p < 0.05) were able to do so. In group 1, 48% believed that the anesthesiologist works under the surgeon's orders, while only 27% (p < 0.05) thought so in group 2. The chief of the postanesthesia intensive care unit was thought to be a member of the nursing staff by 48% in group 1, whereas 95% (p < 0.05) in group 2 identified the chief as an anesthesiologist. CONCLUSIONS: The image of anesthesiology and the anesthesiologist can be improved by systematically providing an information sheet to patients who are scheduled for presurgical study.

[Renal function in the immediate postoperative period of abdominal and ophthalmic surgery]. / Función renal en el postoperatorio inmediato de cirugía abdominal y oftálmica.

OBJECTIVES: To study changes in kidney function immediately after abdominal or eye surgery and to assess the roles of vasoactive substances: antidiuretic hormone (ADH), renin and aldosterone and natriuretic factors (atrial natriuretic peptide [ANP] and digoxin-like immunoreactive factor [DLIF]) in renal function. PATIENTS AND METHODS: We distributed 23 patients into 2 groups. Group A contained 16 subjects undergoing high abdominal surgery (cholecystectomy) under general anesthesia, and group B included 7 patients undergoing cataract extraction and intraocular lens implantation with peribulbar anesthesia. The first blood sample was taken before anesthetic induction; the first urine sample had been taken 24 hours prior to surgery. The second blood and urine samples were taken 2 hours after the patient's arrival in the intensive care recovery ward. RESULTS: Patients undergoing abdominal surgery experienced significant decreases in diuresis (p < 0.01) and sodium excretion (p < 0.05) and increases of potassium in urine (p < 0.01) and urinary osmolarity, accompanied by high ADN (p < 0.01) and aldosterone (p < 0.01) levels in both blood (p < 0.05) and urine. Renin, ANP and DLIF did not change significantly in patients receiving peribulbar anesthesia. CONCLUSIONS: The increases in ADH and aldosterone levels that occur as a response to stress in abdominal surgery are implicated in the antidiuretic and antinatriuretic effects observed in the postoperative period. Renin, ANP and DLIF do not seem to be responsible for kidney dysfunction.