Tranexamic acid use in severely injured patients, is it always appropriate?

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.

Ácido tranexámico en el paciente politraumatizado grave, ¿está siempre indicado? / Tranexamic acid use in severely injured patients, is it always appropriate?

Recientemente se ha sugerido la administración de ácido tranexámico sólo en aquellos pacientes con hiperfibrinólisis documentada con métodos viscoelásticos, ya que los pacientes politraumatizados graves pueden presentar una disminución de la fibrinólisis. Sin embargo, las últimas guías clínicas sobre el manejo de la hemorragia y coagulopatía tras un trauma recomiendan el uso de ácido tranexámico en todo paciente sangrante, o con posibilidad de sangrar, lo más precozmente posible sin esperar los resultados de los métodos viscoelásticos. Presentamos el caso de un trauma cerrado grave que recibió ácido tranexámico prehospitalariamente y desarrolló un embolismo pulmonar inmediato.(AU)

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.(AU)

Tranexamic acid use in severely injured patients, is it always appropriate? / Ácido tranexámico en el paciente politraumatizado grave, ¿está siempre indicado?

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.

[Clinical presentation of the spectrum of myelin oligodendocryte glycoprotein antibody disease]. / Características clínicas del espectro de la enfermedad asociada a los anticuerpos contra la glucoproteína del oligodendrocito asociada a la mielina.

INTRODUCTION: Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a rare and practically new entity in medicine. In developing countries, there are still important limitations for the detection of anti-MOG antibodies by cell-based assay, so knowing the clinical characteristics of the different phenotypes and their differences with other demyelinating pathologies of the central nervous system is essential in order to make a proper diagnostic and therapeutic approach of the patients. AIM: To present an update regarding the clinical characteristics of the disease spectrum, being the first article in Spanish that gathers the most frequent phenotypes and provides a clear description of what should be considered to identify each of these phenotypes. DEVELOPMENT: This disease is characterized by having a monophasic or recurrent course, with optic neuritis being the most frequent presentation phenotype in general population and disseminated acute encephalomyelitis the most frequent in children. Other phenotypes described in this review are transverse myelitis, focal cortical encephalitis and cerebral stem syndromes, as well as the proposed criteria for the diagnosis of the disease associated with MOG antibody disease. CONCLUSION: Currently there are no studies that seek to characterize the Spanish-speaking population with this disease, or review articles in Spanish, so it is important to disseminate knowledge and develop research in this area.

TITLE: Características clínicas del espectro de la enfermedad asociada a los anticuerpos contra la glucoproteína del oligodendrocito asociada a la mielina.Introducción. La enfermedad asociada a anticuerpos contra la glucoproteína del oligodendrocito asociado a la mielina (MOG) es una entidad infrecuente y prácticamente nueva en la medicina. En países en desarrollo, aún hay importantes limitaciones para la detección de los anticuerpos anti-MOG mediante ensayo basado en células, por lo que conocer las características clínicas de los diferentes fenotipos y sus diferencias con otras patologías desmielinizantes del sistema nervioso es fundamental, y con ello realizar un abordaje diagnóstico y terapéutico adecuado de los pacientes. Objetivo. Presentar una actualización en cuanto a las características clínicas del espectro de la enfermedad. Éste es el primer artículo en castellano que reúne los fenotipos más frecuentes y brinda una descripción clara de lo que se debe tener en cuenta en cada uno de ellos. Desarrollo. Esta entidad se caracteriza por tener un curso monofásico o recurrente. La neuritis óptica es el fenotipo de presentación más frecuente en la población general, y la encefalomielitis aguda diseminada, la más frecuente en los niños. Otros fenotipos que se describen en la presente revisión son la mielitis transversa, la encefalitis cortical y los síndromes de tallo cerebral, así como los criterios propuestos para el diagnóstico de la enfermedad asociada a anticuerpos anti-MOG. Conclusiones. En la actualidad no existen estudios que busquen caracterizar a la población hispanoparlante con esta enfermedad ni artículos de revisión en lengua castellana, por lo que es importante difundir conocimiento y desarrollar investigación en esta área.

Luteoprotective role of equine chorionic gonadotropin (eCG) during pregnancy in the mare.

The effects of repeated cloprostenol administration were compared in mares impregnated by horses and mares impregnated by donkeys in order to assess the role of eCG on the development of pregnancy-associated resistance to the luteolytic and abortifacient effects of PGF2α. Eleven mares impregnated by donkey (mule pregnancy) and 9 mares impregnated by horse (horse pregnancy) were used. Six mares with mule pregnancy and four with horse pregnancy were injected with cloprostenol (0.25 mg) when they were between day 65 and day 75 of pregnancy, and the treatment was repeated 48, 72 and 96 h latter. The rest of the mares remained as controls. Concentrations of eCG were 10 times higher (p < 0.001) in mares impregnated by horses than in mares impregnated by donkeys, and they were not affected by cloprostenol treatment. Luteolysis was completed 30 h after the first cloprostenol injection in mule pregnancies, while mares with horse pregnancies required 96 h and three cloprostenol injections to complete luteolysis. Regression analysis revealed significant associations between eCG concentrations at time 0 and the time required for completion of luteolysis (p < 0.001), foetal death (p < 0.01) and foetal expulsion (p < 0.05). It is concluded that high eCG concentrations in mares impregnated by horses protect the corpora lutea of pregnancy against the luteolytic effects of PGF2α. Low eCG concentrations in mares carrying mule foetuses afford them less protection against the luteolytic effect of PGF2α, and this may be a cause of the increased foetal mortality that occurs between days 60 and 90 of pregnancy in these mares.

Luteogenic and luteotropic effects of eCG during pregnancy in the mare.

The role of eCG during pregnancy was evaluated through the study of the temporal relationships between changes in eCG and progesterone concentrations and the formation of supplementary corpora lutea (SCL) in mares impregnated with donkey semen (mule pregnancies) or with horse semen (equine pregnancies). Concentrations of eCG were higher (p<0.01) in equine than in mule pregnancies between weeks 6.5 and 13. Progesterone concentrations were higher in equine than in mule pregnancies between weeks 9 and 17. All animals developed at least one SCL, but more SCL accumulated during equine pregnancies than during mule pregnancies (1.9 ± 0.2 vs 1.2 ± 0.1; p<0.01). In equine pregnancies, the mares that formed a second SCL had higher eCG concentrations (p<0.05) during the two weeks preceding its formation than those mares remaining with only one SCL. Mares that formed a third SCL had higher (p<0.5) eCG levels than those remaining with one or two SCL. Mares with equine pregnancies that formed three SCL had higher progesterone concentrations (p<0.05) than those that formed only one or two SCL. No differences were found in progesterone or eCG concentrations between mares with mule pregnancies that accumulated different numbers of SCL during pregnancy (p>0.05). It is concluded that eCG stimulates both the development of new SCL and the function of existing CL. While these effects are clearly expressed in mares impregnated by horses, the low eCG concentrations during mule pregnancies reduce the impact of this hormone on CL formation and function.

Endocrine alterations around the time of abortion in mares impregnated with donkey or horse semen.

The objective of this study was to monitor and compare the concentrations of equine chorionic gonadotropin (eCG), progesterone and estrone sulphate during normal and failed pregnancies of mares impregnated with donkey or horse semen, relating their individual endocrine profiles to the time of pregnancy loss, and to the histopathologic findings in the aborted fetuses and placenta. Mares (n=54) were used, 32 of them impregnated with donkey semen and 22 impregnated with horse semen. Blood samples were taken twice a week from Day 35 to 120 of pregnancy. Ultrasonographic observations of the fetus were carried out twice a week. The incidence of abortion in mares impregnated with donkey semen (30%) was greater (P<0.05) than the 5% observed in mares impregnated with horse semen. From Week 8 to the end of the sampling period, the mean progesterone concentrations of mares with normal mule pregnancies were less (P<0.05) than those of mares with normal pregnancies with equine fetuses. The concentrations of eCG were less (P<0.05) in mule pregnancies from Week 6. Estrone sulphate concentrations were only different (P<0.05) between types of pregnancy on Weeks 13 and 14, being in this case greater with the mule pregnancies. Most of the abortions of mule fetuses were associated with lesser progesterone concentrations than the average for mares with successful mule pregnancies. Four of the abortions of mule fetuses and the only abortion of horse fetus occurred in mares with lesser progesterone and very low eCG concentrations, and were classified as caused by luteal impairment secondary to eCG deficiency; estrone sulphate concentrations were less than normal or absent before these abortions. Two mares aborted after several weeks of low progesterone concentrations in the presence of eCG concentrations that were normal for mule pregnancies, suggesting primary luteal deficiency. In three mares carrying a mule fetus, the concentrations of progesterone and estrone sulphate decreased abruptly immediately before fetal death, suggesting luteolysis due to active prostaglandin F2 alpha (PGF2alpha) secretion. It is concluded that the greater incidence of abortion in mares impregnated by donkeys is associated with different kinds of luteal malfunction. Deficiency of eCG may be a primary cause of many of these cases, either by failing to stimulate enough luteal progesterone secretion and/or by failing to protect the corpora lutea (CL) of pregnancy from endogenous PGF2alpha secretion.

Integrating the issues of global animal and public health into the veterinary education curriculum: a Latin American perspective.

This paper describes the development of a consensus profile for the Latin American veterinarian, and its adoption as the basis for curricular change by veterinary schools in the region. The process has been conducted by three Pan American organisations: the Pan American Association of Veterinary Science, the Pan American Federation of Veterinary Schools, and the Pan American Council of Veterinary Education, with strong backing bythe Food and Agriculture Organization of the United Nations. Recommendations for curricular harmonisation have been issued that will facilitate student and academic exchanges and, above all, will guarantee that the graduates from participating colleges have the knowledge, competencies and skills to adequately perform in the different fields of veterinary medicine, including those most relevant to global animal and public health.

Current approaches to veterinary school accreditation in Latin America.

This paper describes the development of veterinary school accreditation in Mexico and six South American countries. There is wide variation in the organisation of accreditation systems between countries, with different levels of involvement of national veterinary associations on the definition and/or operation of accreditation processes. There is also variation in the specificity of the standards used to evaluate veterinary education. In addition, the extent of implementation of accreditation mechanisms ranges from a country such as Mexico, where the first accreditation of a veterinary programme occurred more than ten years ago (there are now 15 accredited programmes), to countries such as Peru and Bolivia, which have not yet implemented an accreditation process for veterinary schools.

Impact of naturally acquired Taenia solium cysticercosis on the hormonal levels of free ranging boars.

In chronically infected BALBc/AnN male mice, Taenia crassiceps cysticercosis induces changes in the host's sex steroids hormone that lead to their estrogenization and deandrogenization, with possible repercussions on their susceptibility to infections. Here reported are the serum steroid levels in free range cysticercotic male boars. Therefore, the possible effects of Taenia solium cysticerci over the pig steroid levels were evaluated. Herein are described the sex steroids and cortisol levels of non-cysticercotic (n=25) and cysticercotic (n=22) adult boars, as diagnosed by tongue inspection, all free-ranging in a typical village of an endemic rural area in Mexico. A significant reduction of testosterone (P=0.022) and a likely one of 17beta-estradiol (P=0.08) levels were found in the cysticercotic boars in comparison with those non-cysticercotic, whilst no significant differences in the cortisol and DHEA levels were detected. Serum levels of specific antibodies did not correlate with infection nor with the levels of any of the hormones measured. Results suggest that T. solium cysticercosis significantly affects the hormonal status of its porcine host independently of their antibody response.

Trigeminal nerve palsy and Horner's syndrome following epidural analgesia for labor: a subdural block?

Horner's syndrome is a rare complication of epidural analgesia for labor. Much more uncommon is trigeminal nerve palsy. Both complications may be attributed to a subdural localization of the catheter, as we demonstrated clinically by a repeat injection and patchy sympathetic block and with the typical image on epidurography.

Social rank and response to the "male effect" in the Australian Cashmere goat.

The present study was conducted to determine if the social status of Australian Cashmere goats affects their response to the male effect in terms of LH secretion, ovulation and expression of estrus. Australian Cashmere goats were kept isolated from the males during 5 months. The index of success (SI) of each goat was calculated to establish their social rank. In the first experiment, the ten most dominant and the 10 most subordinate goats were separated from the original herd and housed in two pens (5 dominant and 5 subordinate animals in each pen). An androgenized wether was then introduced into each pen. Luteinizing hormone (LH) was measured every 20 min from 2h before to 4h after introduction of the male in the goats of first pen and from 4 to 8h after male introduction in the second pen. In the second experiment, the remaining 50 goats were exposed in their original pen to two androgenized wethers. Their association index with the males (AI) was calculated for each of these 50 goats, and the intervals from exposure to the males to the onset of estrus and to ovulation were determined. During the first 4h after male introduction, the dominant goats had more LH pulses (0.65+/-0.06 compared with 0.3+/-0.09; P<0.05) and greater LH mean concentrations (1.79+/-0.14 ng/ml compared with 1.30+/-0.15 ng/ml, P=0.05) than the subordinate animals. Although not significantly different, the AI was 35% greater for high and medium ranking goats than for low ranking animals (0.031+/-0.004, 0.032+/-0.005 and 0.023+/-0.005, respectively, P>0.05). Although the number of goats ovulating in response to male exposure was similar between dominance groups (high: 100%, medium: 94% and low ranking: 92%), the high and medium dominance goats showed a greater incidence of expression of estrus than low-dominance goats (94.4%, 89.5% and 53.8%, respectively, P<0.05). It is concluded that the social rank of the Australian Cashmere goat influences their response to the male effect in terms of early LH secretion and expression of estrus.

Effect of fluorogestone acetate on embryo recovery and quality in eCG-superovulated goats with premature luteal regression.

The objective of this study was to evaluate if treatment of eCG-superovulated goats with fluorogestone acetate (FGA) would increase the number and quality of embryos recovered. Goats (n = 25) were given an intravaginal sponge containing 45 mg FGA for 12 days, with 1000 IU eCG and 7.5mg of Luprostiol (a PGF(2 alpha) analog) given -48 and 0 h relative to sponge removal. Goats were mated by natural service every 12h during estrus and surgical embryo collection was done 6 days after the last mating. There were two treatment groups; those in the FGA group (n = 13) had a FGA sponge from 8h after mating to embryo collection, whereas goats in the control group (n = 12) did not receive any post-mating treatment. Premature luteal regression occurred in 61.5% (8/13) and 83.3% (10/12) of the goats in the FGA and the control groups, respectively (P > 0.05). Corpus luteum life span averaged 4 days in goats with premature luteolysis. The mean (+/- S.E.) number of transferable embryos was 5.7 +/- 1.6 in the FGA group and 0.1 +/- 0.1 in the control group (P < 0.05). Within the FGA group, the embryo recovery rate was similar in goats with premature luteal regression compared to those with normal luteal function, although non-transferable embryos were only found in goats with premature luteal regression. In conclusion, post-breeding treatment with FGA increased embryonic survival in eCG-superovulated goats, even though it did not prevent premature luteal regression.

Effect of short-term treatment with bovine somatotropin at estrus on conception rate and luteal function of repeat-breeding dairy cows.

We studied the effect of recombinant bovine somatotropin (rbST) at the time of estrus on progesterone concentrations and conception rates of repeat-breeding Holstein cows. We used repeat-breeding cows of varied parity (n = 510). All the animals were clinically healthy and had had at least three unsuccessful services before entering the study. After detection of estrus, the cows were randomly assigned to either a treated (n = 201) or a control (n = 309) group. The animals in the treated group were given rbST (500 mg s.c.) at the time of estrus and again 10 d later. Artificial insemination was performed 12 h after the first detection of estrus. In order to evaluate the effect of rbST on luteal function, blood samples were taken from 10 cows in each group every 3 d for 18 d, starting on the day of insemination (Day 0) to determine progesterone concentrations. Conception rates were significantly higher (P < 0.05) in the cows treated with rbST (29.3%) than in the control cows (16.9%). The effects of rbST were maximal in cows with 8 or more previous unsuccessful services and in cows with 2 to 4 calvings. Progesterone concentrations tended to be higher in nonpregnant cows that were treated with rbST than in those that were not treated. The difference between groups was significant (p < 0.05) on Day 18 after insemination. In pregnant cows there were no significant differences in progesterone concentrations between treated and nontreated animals at any time. Treatment with rbST at estrus improved the conception rate of repeat-breeding Holstein cows. This effect was associated with an increase in circulating progesterone concentrations on Day 18.

Effect of an inverse subtropical (19 degrees 13'N) photoperiod on ovarian activity, melatonin and prolactin secretion in Pelibuey ewes.

Twenty-one Pelibuey ewes were used from December 21, 1996 to December 21, 1998. Fourteen of them had never been exposed to artificial photoperiod, and they were maintained on natural photoperiod until March 21, 1997, when they were assigned to natural photoperiod (control group, n=8) or to inverse photoperiod (n=6). The other seven animals had been kept on a long photoperiod (16L:8D) from October 21, 1996 to December 21, 1996, when they entered the present study and were subjected to a gradual decrease in photoperiod, so that they reached an equinox photoperiod (12L:12 D) on March 21, 1997. At that time, they were assigned to natural photoperiod (n=3) or to inverse photoperiod (n=4). Blood samples for progesterone determination were taken twice a week from all the animals. During the second year of the study, prolactin was measured in the samples from five animals in inverse photoperiod and from five control ewes. Hourly samples were obtained to determine the 24-h melatonin profile of five animals from each group on September 21, 1997, December 21, 1997, March 21, 1997, and June 21, 1997. Exposure to inverse photoperiod resulted in a gradual shift on the annual reproductive cycle, so that the second ovulatory season was advanced by 5 months in the ewes kept on inverse photoperiod as compared to the control ewes (P<0.05). There were wide variations in the dates for the onset and the end of the ovulatory season within the inverse photoperiod groups, and three animals in this groups maintained ovulatory activity for at least 18 consecutive months. The duration of melatonin secretion was directly related to the length of the dark period (P<0.05), and this response was not affected by the calendar date. Prolactin concentrations were directly related to daylength, however, they were also affected by calendar date, being lower in the inverse group as compared to the corresponding time of the annual photoperiodic cycle of ewes on natural photoperiod. It is concluded that reproductive activity, melatonin secretion and prolactin secretion of Pelibuey ewes respond to the small variations in photoperiod that are present at 19 degrees 13'N, and that under natural conditions, photoperiod appears to be the main regulator of ovarian activity at this latitude. However, other factors such as temperature or humidity may act as modulators, and their relative importance could increase at more equatorial latitudes.

Premature luteal regression in goats superovulated with PMSG: effect of hCG or GnRH administration during the early luteal phase.

Twenty-two goats were superovulated with PMSG; 84 h after the onset of estrus the goats were treated with saline solution (control group n = 7), hCG (hCG group, n = 7), or GnRH (GnRH group, n = 8). The ovaries of all the goats were laparoscopically examined 3 and 6 d after the onset of estrus. In each case the CL were counted and classified according to their appearance as normal-looking or as regressing. Blood samples for progesterone determination were collected every 12 h from Day 1 to Day 6. Premature luteal regression was considered to have occurred if progesterone concentrations declined to less than 1 ng/mL by Day 6. According to progesterone concentrations, 57.5, 0 and 37.5% of the goats underwent premature luteal regression in the control, hCG and GnRH groups, respectively. Progesterone concentrations were higher in the hCG group than in the other groups on Days 5 and 6 post estrus (P < 0.05). The control group was the only one in which there was a significant (P < 0.05) increase in the number of regressing CL between Day 3 (1.6 +/- 1.4) and Day 6 (7.3 +/- 1.4). It was also the only group in which there was a significant decrease in the number of normal-looking CL between Day 3 (12.6 +/- 2.1) and Day 6 (2.6 +/- 2.1). On Day 6 the animals treated with hCG had significantly more normal-looking CL (12.0 +/- 2.3) than those in the control group (2.6 +/- 2.1). The number of large follicles present on the ovaries on Day 6 post estrus had negative correlations with progesterone concentrations (P = 0.05) and with the number of normal-looking CL (P < 0.05). It is concluded that the administration of hCG 84 h after the onset of estrus prevents premature luteal regression in goats superovulated with PMSG.

Predictive value of palpation per rectum for detection of the CL in Zebu cattle as evaluated by progesterone concentrations and ultrasonography.

The main objective of this study was to calculate the predictive value of the positive and negative diagnosis of the presence of a corpus luteum by palpation per rectum in Zebu cattle. Gyr breed (n = 16) heifers were palpated by a veterinarian every 3 d during March and April, and every 5 days during May. The presence or absence of a CL was recorded for 442 examinations. A blood sample was obtained after each examination, and a functional CL was considered to be present if plasma progesterone concentrations were above 1 ng/ml. Progesterone results were used as the reference to calculate the sensitivity and specificity of palpation per rectum for the diagnosis of a functional CL on different months. Predictive values for the positive and negative diagnoses were calculated using different hypothetical rates of the prevalence of CL. To evaluate the morphological basis of an erroneous diagnosis, ultrasonographic scanning of the ovaries was performed in 264 cases and the physical presence or absence of a CL was registered. The calculations were repeated using the ultrasonographic findings as the reference to evaluate the sensitivity and specificity of the diagnosis of a structural CL by per rectum palpation. Several heifers were not cyclic in March but began to cycle during the study. Thus, the prevalence of both functional and structural CL increased with time. As a result, the proportion of palpation diagnoses classified as true positives increased in May, while the proportion of true negatives decreased. Although the values of sensitivity and specificity remained constant from month to month, the predictive values changed markedly in May, when the predictive value of the positive test increased while the predictive value of the negative test decreased. These changes were due to differences in the prevalence of a CL and not to differences in the palpable characteristics of CLs in different months. The prevalence of a structural CL was always higher than that of a functional CL. The Cohen's Kappa test for concordance revealed better correspondence between palpation per rectum and ultrasound (k = 0.82) than between progesterone and either ultrasound (k = 0.68) or palpation (k = 0.66). These results show that a large proportion of the errors imputed to deficient palpation when progesterone concentrations are used as a reference are in fact the result of lack of correspondence between the physical and functional presence of a CL.

[Application of the laryngeal mask in pediatric anesthesiology]. / Aplicación de la mascarilla laríngea en anestesia pediátrica.

To analyze problems with inserting, maintaining and removing a laryngeal mask in children, as well as to assess the possible involvement of certain factors (experience with the laryngeal mask, type of anesthesia, duration of surgery, type of surgery, obesity, etc.) in favoring the development of complications. One hundred eighty-nine children undergoing a variety of surgical procedures under general anesthesia were studied; patients with full stomachs and/or a history of hiatus hernia were excluded. The agent used for anesthetic induction and the method of ventilation were chosen by the anesthesiologist responsible for each case. Variables monitored in all patients were continuous ECG, heart rate, systolic and diastolic arterial pressure, capnography, pulse oximetry, airways pressure and respiratory rate. Values were recorded at five times: before induction (T1), immediately after induction (T2), after placement of the laryngeal mask (T3), before removing the laryngeal mask (T4) and after removing the laryngeal mask (T5). Correct insertion was achieved on the first try in 85%. The remaining 15% required 2 or more tries. There were no cases in which a tracheal tube or face mask were required. We found no correlation between type or duration of surgery and the occurrence of complications. Complications were more frequent when the laryngeal mask was placed by inexperienced personnel, when inhalational anesthetics were used for induction and maintenance, and when a No. 1 laryngeal mask was used. Adequate ventilation was provided for the patients who required it with an airways pressure between 8 and 18 cmH2O, arterial oxygen saturation over 98% and end-expiratory CO2 pressure under 35 mmHg. Cardiovascular repercussions were slight and hemodynamic stability was good.(ABSTRACT TRUNCATED AT 250 WORDS)

[Total intravenous anesthesia in general surgery]. / Anestesia total intravenosa en cirugía general.

To evaluate unwanted side effects expressed in hemodynamic parameters, postanesthetic recovery and quality of intravenous total anesthesia (IVTA) with propofol, fentanyl and atracurium. A prospective study in 292 patients undergoing general surgery. Fifty-three percent of the patients were ASA I, 32.2% were ASA II and 14.8% were ASA II, representing a wide range of ages, weights and heights. Mean time of anesthesia was 108.25 +/- 56.96 min. Anesthesia was achieved with propofol 0.108 +/- 0.027 mg/kg/min, fentanyl 0.093 +/- 0.035 microgram/kg/min and atracurium 0.011 +/- 0.0034 mg/kg/min. Slight pain was evident at injection in 1.7% of the patients. Greater hemodynamic instability was recorded at induction, with mean decreases in systolic and diastolic arterial pressures of 16% and 10%, respectively, with scarcely any response to intubation and extubation. Anesthetic recovery was recorded at 5.95 +/- 4.97 min, with surgical amnesia in 100% of the patients. Nausea was seen in 3.42% and vomiting in 1.7%. Patient evaluation of anesthetic technique was "good" in 60.3% and "excellent" in 39.7%. Propofol dose was significantly (p < 0.05) correlated with age (r = -0.33) and time of anesthesia (r = -0.4). IVTA with propofol and fentanyl in general surgery provides adequate maintenance of anesthesia for surgery and recovery, with good hemodynamic stability. In older patients and longer times of anesthesia, the total dose of propofol administered decreases, with negative effect on time and quality of recovery. Total dose of propofol administered is not significantly correlated with either time or quality of recovery.