RESUMEN
Irrespective of the type of surgery, patient monitoring, including ECG-automated non-invasive blood pressure measurements, SpO2, FIO2 and capnography, is compulsory. Sedation: no initial bolus injection of propofol; continuous infusion of propofol at a rate of 1 to 4 mg.kg-1.h-1, using a syringe pump, combined with a short-acting opioid such as alfentanil. General anaesthesia: initial bolus injection of propofol between 2 and 3.5 mg.kg-1, combined with 10 mg of lidocaine in the same syringe; maintenance with a syringe pump: 6 to 9 mg.kg-1.h-1 combined with an opioid, with or without coadministration of muscle relaxants. Intubation avoiding respiratory depression: syringe pump with a fast infusion rate (50 to 100 mg.min-1), which allows induction with propofol and intubation without co-administration of muscle relaxants.
Asunto(s)
Anestesia Intravenosa/métodos , Enfermedades Otorrinolaringológicas/cirugía , Propofol , Enfermedades Estomatognáticas/cirugía , Adenoidectomía , Tolerancia a Medicamentos , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Laringectomía , Tonsilectomía , Extracción DentalRESUMEN
The properties of propofol in emulsion given by continuous intravenous infusion to spontaneously breathing patients have been well studied. Thirty randomized voluntary premedicated patients undergoing dental extraction were anaesthetized with propofol (2.5 mg X kg-1 IVD, and 9 mg X kg-1 X h-1) or with propanidid (9 mg X kg-1 IVD, and 60 mg X kg-1 X h-1), supplemented with nitrous oxide in oxygen and fentanyl. Induction, maintenance and recovery times had the same characteristics. Highly significant differences occurred between the two groups regarding the increase in heart rate, apnoea and recovery time. This study showed that propofol was an eminently suitable agent for continuous intravenous anaesthesia in spontaneously breathing patients for dental surgery.
Asunto(s)
Anestesia Dental , Anestesia Intravenosa , Anestésicos , Fenoles , Propanidida , Extracción Dental , Adolescente , Adulto , Periodo de Recuperación de la Anestesia , Ensayos Clínicos como Asunto , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Propofol , Factores de TiempoAsunto(s)
Cateterismo , Mano/irrigación sanguínea , Anestesia , Aneurisma/etiología , Arterias , Cateterismo/efectos adversos , Cateterismo/métodos , Cuidados Críticos , Embolia/etiología , Humanos , Infecciones/etiología , Periodo Intraoperatorio , Pletismografía , Trombosis/etiología , UltrasonidoRESUMEN
Mönckeberg's sclerosis is characterized by medial arterial calcifications. This disease usually occurs in old people and the lesions are observed in distal lower limb arteries. The evolution is generally asymptomatic. The other arteries are uncommonly affected. This report concerns a patient with exceptionally extensive disease and simultaneous asymptomatic arterial hypertension. Blood pressure measured non invasively represents the force required to compress the brachial artery, and not the real blood pressure. In such patients, blood pressure should be monitored during anaesthesia through arterial cannulation.
Asunto(s)
Arteriosclerosis/fisiopatología , Determinación de la Presión Sanguínea , Calcinosis/fisiopatología , Hipertensión/diagnóstico , Anciano , Arterias/patología , Arteriosclerosis/complicaciones , Calcinosis/complicaciones , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Masculino , Manometría , Factores de TiempoRESUMEN
A 49 year old woman presented a very serious infectious state with respiratory failure, on the third postoperative day following splenectomy for a traumatic ruptured spleen. Despite massive antibiotic treatment and treatment of the respiratory failure, the patient died. The responsibility of the splenectomy in this infection with many different organisms and the failure of antibiotics is discussed.
Asunto(s)
Infecciones Bacterianas/etiología , Bazo/inmunología , Esplenectomía/efectos adversos , Accidentes de Tránsito , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Bazo/lesionesRESUMEN
The result of Allen's test was compared with the variations in the Doppler flow recording of the thumb artery after compression of the radial artery in 76 volunteers. In five cases, manual compression let to a disappearance systolic flow, showing an absence of collateral ulnar circulation. In fifteen cases, the systolic flow was greatly reduced in the thumb. It is interesting to find that 14.6 per cent of the subjects have their two hands in a different classification (asymmetric subjects). In 99.34 per cent of the cases the results of these two methods was the same. The routine use of Allen's test before radial artery catheterization is fully justified by these results.
Asunto(s)
Cateterismo , Antebrazo/irrigación sanguínea , Mano/irrigación sanguínea , Ultrasonografía , Adolescente , Adulto , Anciano , Arterias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo RegionalRESUMEN
The authors report the cases of five cirrhotic patients who underwent peritoneo-venous bypass via a Le Veen valve. Coagulation studies revealed on the one hand a worsening in certain pre-existent abnormalities (thrombocytopaenia, decrease in plasma coagulation factor levels), and secondly a frank increase in F.B.P and positivation of the transfer test. Clinically, two haemmorrhagic syndromes were seen, one of which was fatal. At no time was euglobulin lysis time less than 30 minutes. The administration of small doses of heparin corrected these laboratory abnormalities in all patients and stopped haemorrhage in one. These findings as a whole indicate that in these five cases the bypassing of ascites fluid led to a state of disseminated intravascular coagulation.
Asunto(s)
Coagulación Intravascular Diseminada/etiología , Cirrosis Hepática/cirugía , Derivación Peritoneovenosa/efectos adversos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Pruebas de Coagulación Sanguínea , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Having employed routinely the monitor of cerebral function in cardiac surgery operations for about a year, the authors now present an analysis of the variations in the traces of a group of 57 patients. They have found, when there is no major haemodynamic consequence associated with the induction of anaesthesia, and when there are no difficulties of a surgical or a technical nature accompanying the artificial extra-corporeal circulation, that the monitor curve stays perfectly stable. On the other hand, all sudden haemodynamic changes result in hypotension (haemorrhage, dysrhythmia, and a fall in flow in the extracorporeal circulation) that is reflected in the level of the monitor curve which also falls. They conclude, using examples of certain variations, that the monitor curve is a supplementary form of surveillance and that the trace recorded simultaneously with the anaesthetic sheet allows retrospective analysis of the haemodynamic events to be performed for each operation.