[Explicit and implicit memory during inhalation and intravenous anesthesia]. / Memoria explícita e implícita durante anestesia inhalatoria e intravenosa.

OBJECTIVE: Patients rarely report memory or knowledge of surgery after general anesthesia. During apparently adequate surgical anesthesia, however, information processing of high level functions, such as language comprehension and learning, can continue unconsciously. Our objective is to assess whether different anesthetic techniques (two inhalational and two intravenous) guarantee the absence of both types of memory. PATIENTS AND METHOD: One hundred patients were randomly assigned to receive the following anesthetic procedures: desflurane/N2O (group 1), isoflurane/N2O (group 2), fentanyl/N2O (group 3) and total intravenous anesthesia (group 4). A cassette with the same music was played in all cases, and an order requiring a nonverbal response was given to 15 randomly chosen patients in each group. Response was evaluated at a visit 24 to 48 hours after surgery. Fifteen patients, therefore, constituted the study group for each anesthetic procedure, and 10 patients formed the control group. We assessed the presence of explicit memory in a structured interview, and implicit memory by way of the relation between the number of times the nonverbal order was obeyed and the time of the interview. RESULTS: Explicit memory was absent in all patients. The presence of implicit memory was confirmed, however, in the isoflurane (p = 0.02) group. Significant differences between the isoflurane group and both the desflurane and total intravenous anesthesia groups (p = 0.03) were found. CONCLUSION: Explicit memory was absent with all four anesthetic techniques used in our study. Implicit memory was more difficult to inhibit, however, with isoflurane/N2O.

Evolution of the antimicrobial susceptibility of B. fragilis group at the university hospital of Seville (Spain) between 1977 and 1995.

A susceptibility survey of the B. fragilis group divided into three periods was carried out between 1977 and 1995 at the University Hospital of Seville (Spain) using the agar dilution method. No chloramphenicol, imipenem or meropenem-resistant strains were found. Metronidazole-resistant strains (2%) were isolated only in the first period. The most active beta-lactam drugs were piperacillin and ceftizoxime (resistance rate 16%), followed by ticarcillin mezlocillin and azlocillin (25%) and cefotaxime, cefotetam, and cefmetazol (around 40%). All strains tested were resistant to ampicillin and 4% to ampicillin/sulbactam. Cefoxitin resistance increased from 10% in the first two periods to 21% in the third and that of clindamycin from 12% in 1982 to 29% in 1987 and 50% in 1995.

[Effect of the local anesthetic on visceral pain in cesarean sections done under intradural anesthesia]. / Influencia del anestésico local en el dolor visceral de cesáreas bajo anestesia intradural.

OBJECTIVES: To evaluate the influence of local anesthetic on the incidence and severity of visceral pain during cesarean section performed under subarachnoid anesthesia. PATIENTS AND METHOD: This was a randomized double blind study of 90 parturients undergoing scheduled or emergency cesareans. The women were distributed among three groups according to local anesthetic used: 2% isobaric mepivacaine in group 1, 0.5% hyperbaric bupivacaine in group 2, and 0.5% isobaric bupivacaine with adrenalin in group 3. The total anesthetic dose was selected based on height, and pain was defined as silent and dull, or a sensation of pressure that was poorly defined, diffuse or referred to another area and accompanied or not by nausea and/or vomiting. Pain was assessed on a visual analog scale at various moments during surgery. Other variables recorded were metameric level of blockade, hemodynamic function and presence of nausea and/or vomiting. RESULTS: One patient in each group was excluded. The incidences of visceral pain and 95% confidence intervals were as follows: 38% (23-56%) in group 1 and 10% (3.5-25%) in groups 2 and 3 (p = 0.002). The metameric level of blockade differed significantly among the groups. The highest level (T1-5) was reached in group 1 but level was the most consistent (T3-5) in group 2. Systolic arterial pressures in all groups were significantly lower than baseline levels 5 min after puncture and the decrease was greatest in group 3. The highest incidence (p = 0.01) of nausea and/or vomiting occurred in the isobaric bupivacaine group. CONCLUSION: Use of hyperbaric bupivacaine offers advantages over the other techniques, as it assures more consistent attainment of metameric level, an incidence of visceral pain that is lower than that of isobaric mepivacaine, and fewer hemodynamic repercussions than isobaric bupivacaine with vasoconstrictor.

[Anesthetic implications in antiphospholipid syndrome. 2 clinical cases]. / Implicaciones anestésicas en el síndrome antifosfolípido. Dos casos clínicos.

Anti-phospholipid syndrome, originally called anticardiolipin syndrome, is characterized by the presence of anti-phospholipid antibodies and a marked tendency to both arterial and venous thrombosis. The little information available on the implications of this syndrome for anesthesia derive from the recent description of the disease. We describe 2 patients, each with 1 of the 2 forms of antiphospholipid syndrome that have been described to date, and each needing surgery for a different reason. The first was a 24-year-old woman who was admitted to the hospital with diarrhea, fever and metrorrhagia in her fifth month of pregnancy. Blood tests revealed a weakly positive title of anti-cardiolipin antibodies. Steroid and antiplatelet therapy was begun. Delivery was at 35 weeks by elective cesarean with epidural anesthesia due to oligoamnios. The second patient was 52-year-old woman with a history of 13 miscarriages, cerebrovascular accident and deep venous thrombosis. She had been diagnosed as having systemic lupus erythematosus with anti-phospholipid syndrome and was receiving corticoid and antiplatelet therapy. She had been admitted on 2 occasions for epistaxis, purpura in the lower extremities and severe thrombocytopenia. The last condition did not respond well to immunosuppressant therapy and a splenectomy was therefore performed with the patient under general anesthesia. In both cases recovery was good in spite of the serious complications of anesthetic management.

[Evolution of the sensitivity of Bacteroides group fragilis at the Sevilla University Hospital (1983-1987)]. / Evolución de la sensibilidad de Bacteroides grupo fragilis en el Hospital Universitario de Sevilla (1983-1987).

The evolution of antimicrobial susceptibility of Bacteroides fragilis over a five year period is described. We have studied 30 selected strains isolated each year at the University Hospital of Sevilla (total: 150 strains). We did not find any resistant strain to chloramphenicol, metronidazole or imipenem. Resistance to piperacillin (8%) and cefoxitin (13%) remain constant over the study period. Resistance to cefmetazole, cefotaxime, mezlocillin, ofloxacin, clindamycin and moxalactam ranges from 24% to 37%. A rise in the percentage of resistant strains to ticarcillin (from 17% to 30%) and ceftizoxime (from 0% to 40%) was also seen during the study period. Bacteroides thetaiotaomicron was the overall more resistant species, and B. fragilis the more sensitive.