[Combined general-epidural anesthesia compared to general anesthesia: a systematic review and meta-analysis of morbidity and mortality and analgesic efficacy in thoracoabdominal surgery]. / Anestesia combinada general-epidural versus anestesia general, morbimortalidad y eficacia analgésica en cirugía toracoabdominal. Revisión sistem ática-metaanálisis.

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.

Comentarios al editorial titulado “Enfermería de anestesia en España: ¿una verdad incómoda o la caja de los truenos”? / No disponible

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Pruebas de coagulación en el tratamiento con drotrecogina alfa activada. ¿Representan los valores obtenidos la realidad clínica? / Coagulation tests during treatment with drotrecogin alpha (activated): Do results reflect the clinical situation?

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[Intracranial diffusion. A complication of retrobulbar anesthesia]. / Difusión intracraneal. Una complicación de la anestesia retrobulbar.

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.