Impact of pregestational obesity on perinatal complications: update in a Latin American cohort.

OBJECTIVES: While the association between pregestational obesity and perinatal complications has been established, it is necessary to update the current understanding of its impact on maternal and foetal health due to its growing prevalence. Thus, this study aimed to investigate the association between pregestational obesity with the leading perinatal complications during the last 6 years. STUDY DESIGN: A cross-sectional study was performed in San Felipe, Chile. Anonymised data of 11,197 deliveries that occurred between 2015 and 2021 were included. METHODS: Pregestational body mass index was defined according to the World Health Organisation during the first trimester of pregnancy. The association between pregestational obesity and perinatal complications was analysed by calculating the odds ratio (OR), which was adjusted for confounding variables. Statistical differences were considered with a P-value of <0.05. RESULTS: The prevalence of pregestational obesity was 30.1%. Pregestational obesity was related to a high incidence of perinatal complications (≥3 complications; P < 0.0001). The main perinatal complications were caesarean section, large for gestational age (LGA), gestational diabetes (GD), macrosomia, hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), intrauterine growth restriction, and failed induction. Pregestational obesity was shown to be a risk factor for macrosomia (OR: 2.3 [95% confidence interval {95% CI}: 2.0-2.8]), GD (OR: 1.9 [95% CI: 1.6-2.1]), HDP (OR: 1.8 [95% CI: 1.5-2.1]), LGA (OR: 1.6 [95% CI: 1.5-1.8]), failed induction (OR: 1.4 [95% CI: 1.0-1.8]), PROM (OR: 1.3 [95% CI: 1.1-1.6]), and caesarean section (OR: 1.3 [95% CI: 1.2-1.4]). CONCLUSIONS: Pregestational obesity has been shown to be a critical risk factor for the main perinatal complications in the study population. Pregestational advice is imperative not only in preventing pregestational obesity but also in the mitigation of critical perinatal complications once they arise.

Spanish multicenter study of surgical resection of pancreatic tumors infiltrating the celiac axis: does the type of pancreatectomy affect results?

BACKGROUND: Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates. METHODS: Observational retrospective multicenter study. INCLUSION CRITERIA: patient undergoing TP, PD or DP plus CAR for a pancreatic cancer. RESULTS: Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups. CONCLUSION: It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.

A real-life analysis on the indications and prognostic relevance of perioperative chemotherapy in locally advanced resectable gastric adenocarcinoma.

BACKGROUND AND PURPOSE: Perioperative chemotherapy (periCTX) based on the "MAGIC" scheme has become a standard treatment in Europe for locally advanced oesophagogastric cancer. We assessed implementation and long-term oncological outcomes of MAGIC periCTX for locally advanced gastric cancer. METHODS: Population-based cohort study of all patients with locally advanced gastric cancer undergoing surgical resection with curative intent in Catalonia and Navarra (the first two autonomous communities included in the EURECCA Upper GI Spanish Working Group) between January 2011 and December 2013. The main variable was the percentage of patients treated with MAGIC periCTX. Kaplan-Meier analysis and Cox proportional hazards model were used to assess the survival benefit of periCTX. RESULTS: Among 814 patients, 217 (26.6%) received periCTX (especially patients more likely to receive it: aged < 70 years, with proximal tumors, low anesthetic risk, and cT3-4/cN+ clinical stage). 35% did not complete perioperative chemotherapy, with no relationship with age. PeriCTX showed no effect on postoperative morbimortality. Histological tumor regression was more often absent or poor (38.2%) than total or almost total (27.8%), although clinico-pathological lymph-node downstaging was higher than expected by staging inaccuracy (38.7% vs. 24.2%). PeriCTX was associated with a better survival only in cT3-4 and cN+ patients, showing less prognostic relevance than optimal oncological surgery with D2 lymphadenectomy. CONCLUSIONS: Only 26.6% of locally advanced resectable gastric cancer patients received PeriCTX. Pathological response was poor, although some degree of nodal downstaging was observed. Survival benefit of periCTX was limited to cT3-4 and cN+ patients, being less relevant than D2 lymphadenectomy.

Intensified neoadjuvant multimodal approach in synchronous liver metastases from gastric cancer: a single institutional experience.

BACKGROUND: Synchronous liver metastases (LM) from gastric (GC) or esophagogastric junction (EGJ) adenocarcinoma are a rare events. Several trials have evaluated the role of liver surgery in this setting, but the impact of preoperative therapy remains undetermined. METHODS: Patients with synchronous LM from GC/EGJ adenocarcinoma who achieved disease control after induction chemotherapy (ICT) and were subsequently scheduled to chemoradiotherapy (CRT) to the primary tumor and surgery assessment were retrospectively analyzed. Pathological response, patterns of relapse, progression-free survival (PFS), and overall survival (OS) were calculated. From July 2002 to September 2012, 16 patients fulfilling the inclusion criteria were identified. RESULTS: Primary tumor site was GC (nine patients) or EGJ (seven patients). LM were considered technically unresectable in nine patients. Radiological response to the whole neoadjuvant program was achieved in 13 patients. Eight patients underwent surgical resection of the primary tumor; in five of these LM were resected. A complete pathological response in the primary or in the LM was found in four and three patients, respectively. The most frequent site of relapse/progression was systemic (eight patients). Local and liver-only relapses were observed in two patients each. After a median follow-up of 91 months, the median OS and PFS were 23.0 (95% CI 13.2-32.8) and 17.0 months (95% CI 11.7-22.3). 5-year actuarial PFS is 17.6%. CONCLUSION: Our results suggest that an intensified approach using ICT followed by CRT in synchronous LM from GC/EGJ adenocarcinoma is feasible and may translate into prolonged survival times in selected patients.

Aplicación de la técnica de árboles de clasificación y regresión en la valoración ecográfica de los nódulos tiroideos / Using Classification and Regression Trees in the ultrasound evaluation of thyroid nodules

Objetivo: Evaluar la capacidad de los árboles de clasificación y regresión (CART) en la valoración ecográfica de los nódulos tiroideos malignos. Materiales y métodos: Se realizaron 404 punciones aspiración con aguja fina (PAAF) a 384 pacientes. De los nódulos analizados, se registraron las características ecográficas (localización, tamano, morfología, contorno, consistencia, ecoestructura, ecogenicidad, calcificaciones y vascularización) y los resultados de la elastografía. Se aplicó el CART para investigar la relación entre los hallazgos ecográficos, la elastografía y el cáncer de tiroides. Resultados: El análisis CART determinó que la realización de una elastografía no aporta datos relevantes y que las zonas homogéneas pueden clasificar a los nódulos tiroideos en: 1.ª zona) caracterizada por ausencia de áreas de degeneración coloide e hipoecogenicidad asociada a malignidad; 2.ª zona) diferenciada por presencia de áreas de degeneración coloide combinada con ausencia de microcalcificaciones, constituyendo un indicador fiable de benignidad de los nódulos tiroideos; y 3.ª zona) la ausencia de hipoecogenicidad y una lesión menos alta que ancha deparan un indicador fiable de benignidad. El árbol de clasificación alcanzó una sensibilidad del 87,5% y un valor predictivo negativo del 98,8%. Discusión: El CART muestra una elevada capacidad de predicción de los nódulos malignos frente a otras técnicas lineales. Conclusión: La utilización de los árboles de clasificación provee una herramienta simple para la toma de decisión clínica con el objeto de reducir las PAAF innecesarias, con una elevada sensibilidad.

Objective: To evaluate the use of Classification and Regression Trees (CART) in the ultrasound evaluation of malignant thyroid nodules. Materials and methods: A study was performed on 404 fine needle aspirates (FNA), with biopsies being performed on 384. The information collected about the thyroid nodules was: ultrasound features (location, size, morphology, contour, consistency, echo-structure, echogenicity, calcification, and vascularisation) and elastography results. The CART technique was used to investigate the relationship between ultrasound findings and the thyroid cancer. Results: The CART analysis showed that elastography does not provide any relevant data, and that the homogeneous areas could classified the thyroid nodules into: 1st area) characterised by the absence of colloid degeneration areas and a hypo-echogenicity associated with malignancy; 2nd area) differentiated by the presence of colloid degeneration areas combined with absence of microcalcifications, constituting a reliable indicator of benign thyroid nodules; and a 3rd area) the absence of hypo-echogenicity and a lesion wider than it is long that provides a reliable indicator of being benign. The optimum tree produced a sensitivity of 87.5% and negative predictive value of 98.8%. Discussion: The CART technique demonstrated a high predictive capacity for malignant nodules compared to other linear techniques. Conclusion: The use of classification trees provides us with a simple tool for clinical decision making, in order to reduce unnecessary FNA biopsies, as well as achieving a high sensitivity.

Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification.

PURPOSE: To assess the diagnostic impact of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome (PNS) based on our own pre-test risk classification (PRC). METHODS: A multicenter retrospective longitudinal study was conducted from 2006 to 2014. We designed a seven-point scoring system using the clinical syndrome characteristics [classical (CS) and non-classical syndromes (NCS)] and its location (central, peripheral, in the neuromuscular junction or combined), onconeural antibodies and tumor markers. Patients were classified as low (score 0-2), intermediate (3-4) and high (5-7) pre-test risk of PNS. FDG-PET/CT was classified as negative or positive. Final diagnosis according Graus' criteria (definite, possible or no PNS) was established. Relations between clinical and metabolic variables with the final diagnosis were studied. RESULTS: 73 patients were included, with a follow-up time of 33 months. Eleven (15 %) patients were finally diagnosed with neoplasm (8 invasive cancers). Ultimately, 13 (18 %) and 24 (33 %) subjects were diagnosed as definite or possible PNS. All the patients with final diagnosis of neoplasm had a CS (p = 0.005). PET/CT was helpful to diagnose 6/8 (75 %) invasive cancers. PET/CT findings were associated with the final diagnosis of neoplasm (p = 0.003) and the diagnosis of PNS attending to Graus' criteria (p = 0.019). PRC showed significant association with the final diagnosis of neoplasm and PET/CT results. A majority of patients (10/11) diagnosed of neoplasm had intermediate/high-risk. CONCLUSIONS: Our PRC seems to be a valid tool to select candidates for PET/CT imaging in this setting. PET/CT detected malignancy in a significant proportion of patients with invasive cancer.

Modulation of intracellular pH in human ovarian cancer.

To sustain tumor growth, the cancer cells need to adapt to low levels of oxygen (i.e., hypoxia) in the tumor tissue and to the tumor-associated acidic microenvironment. In this phenomenon, the activation of the sodium/proton exchanger 1 (NHE1) at the plasma membrane and the hypoxia-inducible factor (HIF) are critical for the control of the intracellular pH (pHi) and for hypoxia adaptation, respectively. Interestingly, both of these mechanisms end in sustaining cancer cell proliferation. However, regulatory mechanisms of pHi in human ovary tissue and in malignant ascites are unknown. Additionally, a potential role of NHE1 in the modulation of H(+) efflux in human ovarian cancer cells is unknown. In this review, we discussed the characteristics of tumor microenvironment of primary human ovarian tumors and tumor ascites, in terms of pHi regulatory mechanisms and oxygen level. The findings described in the literature suggest that NHE1 may likely play a role in pHi regulation and cell proliferation in human ovarian cancer, potentially involving HIF2α activation. Since ovarian cancer is the fifth cause of prevalence of women cancer in Chile and is usually of late diagnosis, i.e., when the disease jeopardizes peritoneal cavity and other organs, resulting in reduced patient survival, new efforts are required to improve patient-life span and for a better understanding of the pathophysiology of the disease. The potential advantage of the use of amiloride and amiloride-derivatives for cancer treatment in terms of NHE1 expression and activity is also discussed as a therapeutic approach in human ovarian cancer.

Use of different kinds of persulfate activation with iron for the remediation of a PAH-contaminated soil.

Contamination of soils by persistent pollutants is considered an important matter of increasing concern. In this work, activated persulfate (PS) was applied for the remediation of a soil contaminated with polycyclic aromatic hydrocarbons (PAHs), such as anthracene (ANT), phenanthrene (PHE), pyrene (PYR) and benzo[a]pyrene (BaP). PS activation was performed by different ways; where ferric, ferrous sulfate salts (1-5mmol·L(-1)) and nanoparticles of zerovalent iron (nZVI) were used as activators. Moreover, in order to improve the oxidation rate of contaminants in the aqueous phase, the addition of sodium dodecyl sulfate (SDS), as anionic surfactant, was tested. On the other hand, it was also studied the role of humic acids (HA), as reducing agent or surfactant, on PAHs conversion. Removal efficiencies near 100% were achieved for ANT and BaP in all the runs carried out. Nevertheless, remarkable differences on removal efficiencies were observed for the different techniques applied in case of PHE and PYR. In this sense, the highest conversions of PHE (80%) and PYR (near 100%) were achieved when nZVI was used as activator. Similar results were obtained when activation was carried out either with Fe(2+) or Fe(3+). This can be explained by the presence of quinone type compounds, as 9,10-anthraquinone (ATQ), that can promote the reduction of Fe(3+) into Fe(2+), permitting PS radicals to be generated. On the other hand, the addition of HA did not produce an improvement of the process while surfactant addition slightly increases the PAHs removal. Furthermore, a kinetic model was developed, describing the behavior of persulfate consumption, and contaminants removal under first order kinetics.

Insulin receptor isoforms: an integrated view focused on gestational diabetes mellitus.

The human insulin receptor (IR) exists in two isoforms that differ by the absence (IR-A) or the presence (IR-B) of a 12-amino acid segment encoded by exon 11. Both isoforms are functionally distinct regarding their binding affinities and intracellular signalling. However, the underlying mechanisms related to their cellular functions in several tissues are only partially understood. In this review, we summarize the current knowledge in this field regarding the alternative splicing of IR isoform, tissue-specific distribution and signalling both in physiology and disease, with an emphasis on the human placenta in gestational diabetes mellitus (GDM). Furthermore, we discuss the clinical relevance of IR isoforms highlighted by findings that show altered insulin signalling due to differential IR-A and IR-B expression in human placental endothelium in GDM pregnancies. Future research and clinical studies focused on the role of IR isoform signalling might provide novel therapeutic targets for treating GDM to improve the adverse maternal and neonatal outcomes.

Human supraphysiological gestational weight gain and fetoplacental vascular dysfunction.

OBJECTIVE: Human foetal development and growth in an environment of maternal obesity associates with high risk of cardiovascular disease and adverse neonatal outcome. We studied whether supraphysiological gestational weight gain results in human fetoplacental endothelial dysfunction and altered fetoplacental vascular reactivity. METHODS: Primary cultures of human umbilical vein endothelial cells (HUVECs) and umbilical vein rings were obtained from pregnant women (112 total of patients recruited, 7 patients dropped out) exhibiting prepregnancy normal weight that ended with a physiological (pGWG (n=67), total weight gain 11.5-16 kg, rates of weight gain ≤0.42 kg per week) or supraphysiological (spGWG (n=38), total weight gain >16 kg, rates of weight gain >0.42 kg per week) gestational weight gain (reference values from US Institute of Medicine guidelines). Vascular reactivity to insulin (0.1-1000 nmol l(-1), 5 min) in KCl-preconstricted vein rings was measured using a wire myograph. Protein levels of human equilibrative nucleoside transporter 1 (hENT1), total and Ser(1177)- or Thr(495)-phosphorylated endothelial nitric oxide synthase (eNOS) were detected by western blot or immunofluorescence, and adenosine transport (0-250 µmol l(-1) adenosine, 2 µCi ml(-1) [(3)H]adenosine, 20 s, 25 °C) was measured in the presence or absence of 1 µmol l(-1) nitrobenzylthioinosine (hENT1 inhibitor) or 10 µmol l(-1) chlorpromazine (CPZ, endocytosis inhibitor) in HUVECs. RESULTS: spGWG associates with reduced NOS activity-dependent dilation of vein rings (P=0.001), lower eNOS expression and higher Thr(495) (P=0.044), but unaltered Ser(1177)eNOS phosphorylation. hENT1-adenosine maximal transport activity was reduced (P=0.041), but the expression was increased (P=0.001) in HUVECs from this group. CPZ increased hENT1-adenosine transport (P=0.040) and hENT1 plasma membrane accumulation only in cells from pGWG. CONCLUSION: spGWG in women with a normal prepregnancy weight causes lower fetoplacental vascular reactivity owing to the downregulation of eNOS activity and adenosine transport in HUVECs. Maternal spGWG is a detrimental condition for human fetoplacental endothelial function and reducing these alterations could result in a better neonate outcome.

Insulin restores L-arginine transport requiring adenosine receptors activation in umbilical vein endothelium from late-onset preeclampsia.

INTRODUCTION: Preeclampsia is associated with impaired placental vasodilation and reduced endothelial nitric oxide synthase (eNOS) activity in the foetoplacental circulation. Adenosine and insulin stimulate vasodilation in endothelial cells, and this activity is mediated by adenosine receptor activation in uncomplicated pregnancies; however, this activity has yet to be examined in preeclampsia. Early onset preeclampsia is associated with severe placental vasculature alterations that lead to altered foetus growth and development, but whether late-onset preeclampsia (LOPE) alters foetoplacental vascular function is unknown. METHODS: Vascular reactivity to insulin (0.1-1000 nmol/L, 5 min) and adenosine (1 mmol/L, 5 min) was measured in KCl-preconstricted human umbilical vein rings from normal and LOPE pregnancies using a wire myograph. The protein levels of human cationic amino acid transporter 1 (hCAT-1), adenosine receptor subtypes, total and Ser¹¹77- or Thr495-phosphorylated eNOS were detected via Western blot, and L-arginine transport (0-1000 µmol/L L-arginine, 3 µCi/mL L-[³H]arginine, 20 s, 37 °C) was measured in the presence or absence of insulin and adenosine receptor agonists or antagonists in human umbilical vein endothelial cells (HUVECs) from normal and LOPE pregnancies. RESULTS: LOPE increased the maximal L-arginine transport capacity and hCAT-1 and eNOS expression and activity compared with normal conditions. The A(2A) adenosine receptor (A(2A)AR) antagonist ZM-241385 blocked these effects of LOPE. Insulin-mediated umbilical vein ring relaxation was lower in LOPE pregnancies than in normal pregnancies and was restored using the A(2A)AR antagonist. DISCUSSION AND CONCLUSIONS: The reduced foetoplacental vascular response to insulin may result from A(2A)AR activation in LOPE pregnancies.

Olfactory response of Haematobia irritans (Diptera: Muscidae) to cattle-derived volatile compounds.

In Chile, the horn fly, Hematobia irritans (L., 1758), is a major pest of grazing cattle and affects livestock production during the summer. Previous studies in Europe and the United States have shown that cattle flies, including H. irritans, are differentially attracted to individual cattle within herds and that volatile semiochemicals are responsible for this phenomenon. This study provides evidence that similar differential attractiveness occurs for the interaction between Chilean Holstein-Friesian cattle herds and local H. irritans populations. Thus, Holstein-Friesian dairy cattle, Bos taurus, which were of similar age and physiological condition, were shown to possess an uneven distribution of H. irritans. Heifers h6904 and h8104 were defined as low-carrier heifers and h5804, h2304 and h1404 as high-carrier heifers. Gas chromatography (GC) and coupled GC-mass spectrometric (GC-MS) analysis of samples collected from heifers revealed the presence of compounds previously reported as semiochemicals for cattle flies, including meta- and para-cresol, methylketones (C8-C11), and 6-methyl-5-hepten-2-one. Other compounds identified included carboxylic acids (butanoic, 3-methylbutanoic, pentanoic, and hexanoic acids), 1-hexanol, and 3-octanone. In Y-tube olfactometer studies, both m- and p-cresol attracted H. irritans at the highest doses tested (10(-6) g), as did the positive control 1-octen-3-ol. Of the other compounds tested, only 2-decanone and 2-undecanone produced a behavioral response, with significantly more flies being recorded in the control arm when the former compound was tested (at 10(-6) and 10(-8) g), and more flies being recorded in the treated arm for the latter compound (at 10(-7) g). This demonstration of behavioral activity with the identified compounds represents a first step for research into the application of semiochemicals in monitoring and control of cattle flies in Chile.

Guidelines for the detection and treatment of liver metastases of colorectal cancer.

The spread of the surgical treatment for hepatic metastases have been crucial in the improvement of treatment and survival of metastatic colorectal cancer. The early and accurate diagnosis of metastases and the assessment of their size are essential factors to reach the optimal results with this treatment strategy. The precise indication of the surgical technique with or without the previous administration of neoadjuvant chemotherapy is of significant importance for the choice of R0 surgery and the timing of intervention. Although there is an agreement regarding some parameters related to diagnosis techniques and surgical criteria such as the bilobar extension, the size of the remaining liver post-surgical removal and the indication of pre-operatory chemotherapy, it is necessary to consider all these factors to set up standard criteria and optimize the results. In this article we review all these parameters, from disease follow up to detect metastatic dissemination to the basic criteria for use of neoadjuvant chemotherapy, in order to suggest some general recommendations of evidence level II and recommendation grade A.

Pregnancy complications in natural family planning users.

A multicenter cohort study was designed to assess pregnancy outcome among natural family planning (NFP) users, and provide the opportunity to address complications in NFP users by planning status and by timing of conception with respect to day of ovulation. There were 877 singleton births in this sample. Complications evaluated were abnormal vaginal bleeding, urinary tract infection, vaginal infection, hypertension of pregnancy, proteinuria, glycosuria, and anemia. There was no significant difference in the mean age, number of prenatal visits or birth weight among optimally and non-optimally timed pregnancies or for planned and unplanned pregnancies. There were higher incidences of "parity 2 or more" and current smokers in the non-optimally timed pregnancies and lower incidences of prior pregnancy loss and "currently employed" in the non-optimally timed pregnancies. There was little difference in pregnancy complications with respect to pregnancy timing, with the exception of a significant increased risk of vaginal bleeding late in pregnancy among non-optimally timed conceptions (11.5%) compared to optimally timed pregnancies (5.2%, RR = 2.2, 95% CI 1.3-3.7). More differences were observed in pregnancy complication rates by planning status. Unplanned pregnancies were associated with significantly more late pregnancy bleeding, vaginal infections, proteinuria, glycosuria and medication use than planned pregnancies. Unplanned pregnancies had lower incidences of maternal anemia. Complications of pregnancy were low in this NFP population, irrespective of planned versus unplanned status. Women with planned pregnancies had even fewer complications during pregnancy than women with unplanned conceptions, suggesting that women using NFP to plan their reproduction may be at particularly low risk.

Anestesia general balanceada: tramadol-halotano / Balanced general anesthesia: tramadol-halothano

El presente es un estudio prospectivo, para evaluar la técnica de anestesia general balanceada con Tramadol Clorhidrato al 0.1 por ciento vía endovenosa por infusión más Halotano al 1 por ciento vía inhalatoria; realizado en el Departamento de Anestesiología y Reanimación del Hospital General Nacional Dos de Mayo entre los meses de Agosto a Diciembre de 1993. El trabajo incluyó 50 pacientes entre los 16 y 70 años, previamente seleccionados, donde 27 (54 por ciento) fueron de sexo masculino y 23 (46 por ciento) de sexo femenino; los cuales fueron sometidos a diferentes tipos de cirugía, entre ellos: Cirugía Abdominal: 29 (58 por ciento), Traumatológica: 7 (14 por ciento), Ginecológica: 5 (10 por ciento), Otorrinolaringológica: 1 (2 por ciento). La mayoría fueron de cirugía electiva y algunos de cirugía de emergencia. Estos pacientes estaban incluidos dentro de ASA I y II. Se observó que las variaciones de funciones vitales (PAS, PAD,PAM Y FC) no fueron significativos tanto entre los basales, inducción y durante el transoperatorio. El tiempo operatorio varió entre menos de 1 hora hasta las 5 horas. Un gran porcentaje despertó entre los 30 y los 60 minutos post-operatorio, con un despertar de buena calidad con sedación óptima y analgesia residual importante, concluyendo que el 100 por ciento de casos presentaron analgesia residual de moderada a intensa por lo menos hasta cerca de las 6 horas post-operatorios. Aunque no se encontró una relación causa-efecto específica entre los efectos secundarios y la técnica tanto quirúrgica como anestésica, se presentaron náuseas en 13 pacientes, 5 llegaron al vómito, diaforesis: 7, retención uribnaria: 3, bradicardia: 1, depresión respiratoria: 1. Efectos secundarios de escasa incidencia clínica y reversibles en todos los casos. Debemos resaltar que estos efectos secundarios se presentaron de manera independiente de la dosis de Tramadol aplicados. Podemos concluir que ésta técnica anestésica, produce un adecuado balance analgésico-quirúrgico que hace llevadera la cirugía, además de continuar con un adecuado despertar y analgesia residual importante.