ABSTRACT
OBJECTIVES: We performed a systematic review of randomized controlled trials to compare combined general-epidural anesthesia, followed by postoperative epidural analgesia, and general anesthesia followed by postoperative parenteral analgesia without epidural analgesia in patients undergoing thoracoabdominal surgery. Outcome measures considered were mortality, length of stay in hospital and in the intensive care unit, analgesia, and morbidity. MATERIAL AND METHODS: We performed a systematic search of online databases (MEDLINE, EMBASE, the Cochrane Controlled Trials Registry and the metaRegister of clinical trials at http://www.controlled-trials.com/mrct/ mrct info es.asp). We also hand-searched the literature. Authors were contacted when deemed necessary. RESULTS: A total of 30 trials (4294 patients) were analyzed. Combined anesthesia showed significant advantages in relation to 2 variables: respiratory failure (odds ratio, 0.71; 95% confidence interval [CI], 0.58 to 0.87) and analgesia on the first day after surgery (weighted mean difference, -6.91 95% CI, -9.46 to -4.36). No significant differences were found in the other variables. CONCLUSIONS: Combined anesthesia provides better analgesia and is associated with fewer cases of postoperative respiratory failure. No significant differences were found in mortality, length of stay in hospital, or other morbidity variables.
Subject(s)
Abdomen/surgery , Analgesia , Anesthesia, Epidural/adverse effects , Anesthesia, Epidural/mortality , Anesthesia, General/adverse effects , Anesthesia, General/mortality , Thoracic Surgical Procedures/mortality , Anesthesia, Epidural/methods , Anesthesia, General/methods , Humans , Randomized Controlled Trials as TopicABSTRACT
No disponible
Subject(s)
Humans , Anesthesia/nursing , Physician Assistants/trends , Perioperative Nursing/trendsABSTRACT
No disponible
Subject(s)
Humans , Anti-Infective Agents/therapeutic use , Protein C/therapeutic use , Recombinant Proteins/therapeutic use , Sepsis/blood , Sepsis/drug therapy , Blood Coagulation TestsABSTRACT
OBJECTIVE: To determine whether adding hyaluronidase to 1% ropivacaine without adrenalin enhances peribulbar anesthesia for cataract surgery with phacoemulsification. PATIENTS AND METHODS: Prospective double-blind study of 100 patients (ASA I-III) scheduled for outpatient cataract surgery with peribulbar blockade. The patients were randomized to two groups of 50 to receive either 10 mL of 1% ropivacaine without adrenalin and without hyaluronidase (Group R) or 1% ropivacaine without adrenalin but with 10 U/mL of hyaluronidase (Group RH). We compared the presence of complete akinesia, of adequacy of surgical conditions, and of the need for reinjection. For statistical analysis we used the chi-squared test and a Student t-test for independent samples, with statistical significance at 5%. RESULTS: A block adequate for surgery was obtained in 98% of the patients in Group RH and in 86.7% of the patients in Group R (p = 0.043). Reinjection was necessary for 28.6% of Group R patients and 8.9% of Group RH patients (p = 0.14). Complete akinesia was similar in the two groups. CONCLUSIONS: The greater efficacy of a peribulbar block with the addition of 10 U/mL of hyaluronidase to 1% ropivacaine without adrenalin, in comparison to 1% ropivacaine alone, was demonstrated by a lower rate of reinjection and ocular mobility, even though no statistically significant difference in either ocular or palpebral akinesia was found.
Subject(s)
Amides/administration & dosage , Anesthetics, Combined/administration & dosage , Anesthetics, Local/administration & dosage , Hyaluronoglucosaminidase/administration & dosage , Nerve Block/methods , Phacoemulsification , Aged , Double-Blind Method , Female , Humans , Male , Prospective Studies , RopivacaineABSTRACT
Objetivos: Evaluar si la adición de hialuronidasa a la ropivacaína al 1 por ciento sin adrenalina favorece el bloqueo peribulbar en cirugía de catarata con facoemulsificación. Pacientes y Métodos: Estudio prospectivo, aletaorio y doble ciego en el que se incluyeron 100 pacientes ASA I-III, en dos grupos de 50, programados para cirugía ambulatoria de catarata con bloqueo peribulbar. Los pacientes recibieron 10 ml de ropivacaína al 1 por ciento sin adrenalina y sin hialuronidasa (Grupo R,) o ropivacaína al 1 por ciento sin adrenalina añadiendo 10 U/ml de hialuronidasa (Grupo RH). Se compararon la presencia de aquinesia completa, de un bloqueo quirúrgico que permitiera la cirugía y la necesidad de reinyección. El análisis estadístico se realizó con el test de Chi cuadrado y la t de Student para muestras independientes, con una significación estadística del 5 por ciento. Resultados: Se obtuvo bloqueo quirúrgico en el 98 por ciento de los pacientes del grupo RH y en el 86,7 por ciento de los pacientes del grupo R (p=0,043). Se reinyectó al 28,6 por ciento de los pacientes del grupo R y al 8,9 por ciento de los pacientes del grupo RH (p=0,014). La aquinesia completa fue similar en ambos grupos. Conclusiones: La adición de 10 U/ml de hialuronidasa a la ropivacaína al 1 por ciento sin adrenalina ha demostrado ser más eficaz que la ropivacaína al 1 por ciento sola puesto que disminuye el índice de reinyecciones y la movilidad ocular, aunque no se han encontrado diferencias estadísticamente significativas en cuanto a la aquinesia ocular y palpebral completas. (AU)
Subject(s)
Aged , Male , Female , Humans , Phacoemulsification , Anesthetics, Combined , Nerve Block , Prospective Studies , Double-Blind Method , Anesthetics, Local , Amides , HyaluronoglucosaminidaseABSTRACT
A 61-year-old woman who was negative for type 1 human immunodeficiency virus developed vertebral osteomyelitis and skin lesions due to sepsis by Staphylococcus aureus. Microscopic examination of the skin showed alcohol-resistant acid-fast bacilli. A polymerase chain reaction (PCR) assay for Mycobacterium tuberculosis was positive for skin and spinal samples, although the cultures were negative. The diagnosis of M. tuberculosis infection is difficult, particularly when the disease is extrapulmonary. Rapid diagnostic tests that use PCR identify the DNA of the bacillus with greater sensitivity than microscopic examination and can give results within 24 hours of receipt of a sample. We analyze the utility of PCR for diagnosing extrapulmonary tuberculosis.
Subject(s)
Shock, Septic/etiology , Tuberculosis, Cutaneous/complications , Tuberculosis, Spinal/complications , Female , Humans , Middle Aged , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Spinal/diagnosisABSTRACT
Una mujer de 61 años, seronegativa para la infección por el virus de la inmunodeficiencia humana tipo 1, desarrolló una osteomielitis vertebral y lesiones cutáneas después de una sepsis por Staphylococcus aureus. La microscopía de la biopsia de la piel mostró bacilos ácido alcohol-resistentes y la técnica de la reacción de la cadena de la polimerasa (PCR) para Mycobacterium tuberculosis fue positiva en las muestras cutánea y vertebral, pero el cultivo fue negativo. El diagnóstico de infección por Mycobacterium tuberculosis es difícil, sobre todo en los casos de tuberculosis extrapulmonar. Los test de diagnóstico rápido como la PCR, identifican el DNA de M. tuberculosis con más sensibilidad que la microscopía y ofrecen el resultado en las 24 horas de recibida la muestra en el laboratorio. Se analiza el valor de la PCR en el diagnóstico de tuberculosis extrapulmonar (AU)
Subject(s)
Middle Aged , Female , Humans , Shock, Septic , Tuberculosis, Spinal , Tuberculosis, CutaneousABSTRACT
Retrobulbar anesthesia is considered a safe, effective local-regional technique for ocular surgery. However, local complications that can arise from needle trauma during injection, include retrobulbar hemorrhage, perforation of the ocular globe and occlusion of the artery and/or the central vein of the retina. Systemic complications, such as respiratory arrest, convulsions and cardiovascular collapse, have also been reported, and although they only occur in less than 1% of cases, they are potentially life threatening. We report two cases of intracranial diffusion after retrobulbar anesthesia and describe possible mechanisms that may contribute to its development.
Subject(s)
Cataract Extraction , Mydriasis/chemically induced , Nerve Block/adverse effects , Respiratory Paralysis/chemically induced , Vocal Cord Paralysis/chemically induced , Aged , Anesthetics, Local , Bupivacaine , Female , Humans , Hyaluronoglucosaminidase , LidocaineABSTRACT
Sedation is often needed for obtaining nuclear magnetic resonance (NMR) images in children. The aim of this study was to evaluate the efficacy of propofol administered by continuous infusion to non-intubated children for whom our hospital's usual method of sedation (oral chlorohydrate 75 mg/kg at a maximum dose of 2 g plus 4 hours sleep privation the night before) had failed. Deep sedation was induced in 37 ASA I-II children aged 4 and 14 year old, with 2.5 mg/kg propofol followed by 6 mg/kg/h in continuous infusion. An additional dose of 1 mg/kg was administered if the child moved, and the perfusion was reduced to 4 mg/kg if SpO2 fell below 95%. Apnea occurred after induction in 24% (n = 9), 29% (n = 11) required additional doses of propofol, and a tendency to hypercapnia was observed as the imaging procedure progressed. Sedation failed in one child, who required general anesthesia when opisthotonos presented after the induction dose. Awakening was early and satisfactory in all patients, with a score of 2 on the Ramsay scale 15 minutes after NMR. Deep sedation with propofol is a safe and effective method of performing NMR in a child for whom other methods of sedation have failed, provided the child is ASA I-II, monitoring is exhaustive and procedure is carried out by an anesthesiologist.
