Réplica al artículo: "Comparación de bolus de fentanilo con perfusión de remifentanilo en el control de la respuesta hemodinámica a la laringoscopia e intubación orotraqueal: estudio prospectivo, randomizado y doble ciego". Respuesta / No disponible

No disponible

[Obstetric bleeding: an update]. / La hemorragia obstétrica. Actualización.

Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.

Remifentanilo intravenoso en el parto de un óbito fetal / No disponible

No disponible

La hemorragia obstétrica. Actualización / Obstetric bleeding: an update

La hemorragia obstétrica masiva sigue siendo una delas causas más frecuentes de morbi-mortalidad maternaen todo el mundo. La hemorragia postparto primaria esla más frecuente siendo la atonía uterina su etiologíamás común. Es prioritario garantizar la estabilidadhemodinámica de la paciente y corregir las alteracionesde la coagulación. Si el tratamiento farmacológico resultainsuficiente se deben emplear métodos invasivos comola radiología vascular intervensionista o la ligadura delos vasos arteriales. La histerectomía es la última opcióncuando fracasan las medidas anteriores. Para que el pronósticosea favorable, ya no sólo en términos de mortalidadsino en mantener la fertilidad de la madre y minimizarla morbilidad, es fundamental que cada unidadmaternal cuente con un protocolo de actuación bien definidoy multidisciplinar que facilite el diagnóstico y eltratamiento inmediato(AU)

Massive bleeding in obstetrics still ranks among themost frequent causes of maternal morbidity andmortality worldwide. The most frequent type isprimary postpartum hemorrhage, which is usually theresult of an atonic uterus. The clinical priorities are toassure hemodynamic stability and to correctcoagulation abnormalities. If pharmacologictreatment cannot achieve these goals, invasivemethods such as interventional vascular radiology orartery ligation must be used. Hysterectomy is the lastresort when the previous methods fail. For the bestprognosis, in terms of preventing death, maintainingmaternal fertility and minimizing morbidity, everymaternity ward should have a well-definedmultidisciplinary protocol that facilitates diagnosisand immediate treatment(AU)

[Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial]. / Comparación de bolus de fentanilo con perfusión de remifentanilo en el control de la respuesta hemodinámica a la laringoscopia e intubación orotraqueal: estudio prospectivo, randomizado y doble ciego.

OBJECTIVES: To compare the efficacy and safety of fentanyl and remifentanil in the prevention of hemodynamic responses to direct laryngoscopy and orotracheal intubation, and to compare the effects of these techniques on peripheral blood oxyhemoglobin saturation in normotensive women undergoing scheduled gynecologic surgery. MATERIAL AND METHODS: Prospective clinical trial in ASA 1-2 patients undergoing gynecologic surgery. The patients were randomized to 2 groups: the remifentanil group received a perfusion of 1 microg x kg(-1) x min(-1) until intubation whereas the fentanyl group received a bolus dose of 2 microg x kg(-1). Etomidate (0.3 mg x kg(-1)) and rocuronium bromide (0.6 mg x kg(-1)) were used for anesthetic induction. Seven serial measurements of systolic, diastolic, and mean arterial pressure were recorded in addition to heart rate and peripheral blood oxyhemoglobin saturation at the following times: baseline, denitrogenation, postinduction, and 3 more times at consecutive 2-minute intervals. RESULTS: Fifty-four patients were enrolled. A statistically significant attenuation of the postintubation hemodynamic response was observed in the remifentanil group. The effect was evident on arterial pressure (P=.0001) and heart rate (P=.031) with respect to baseline values. That protective effect was not seen in the fentanyl group. No differences in peripheral blood oxyhemoglobin saturation were observed. CONCLUSIONS: Remifentanil provides greater hemodynamic control than fentanyl at the doses utilized. No adverse effects attributable to these opioids were observed in either group.

Comparación de bolus de fentanilo con perfusión de remifentanilo en el control de larespuesta hemodinámica a la laringoscopia e intubación orotraqueal: estudioprospectivo, randomizado y doble ciego / Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial

OBJETIVOS: Comparar la eficacia y seguridad del fentanilocon remifentanilo en la prevención de la respuestahemodinámica asociada a la laringoscopia directa eintubación orotraqueal, y su repercusión sobre la saturaciónperiférica de oxígeno en mujeres normotensasprogramadas para cirugía ginecológica.MATERIAL Y MÉTODO: Estudio clínico prospectivo enpacientes ASA I-II sometidas a cirugía ginecológica. Sedistribuyeron de forma aleatoria en dos grupos: grupoR, remifentanilo 1 μg Kg–1 min–1 hasta la intubación ygrupo F, fentanilo 2 μg Kg–1. Para la inducción anestésicautilizamos etomidato (0,3 mg Kg–1) y bromuro derocuronio (0,6 mg Kg–1). Se realizaron siete medicionesseriadas de la presión arterial sistólica, diastólica ymedia, frecuencia cardiaca y saturación periférica deoxígeno durante los periodos: control, desnitrogenación,postinducción, postintubación y posteriormente cada dosminutos tres determinaciones consecutivas.RESULTADOS: Se incluyeron 54 pacientes. El grupo R mostróun efecto estadísticamente significativo de atenuación dela respuesta hemodinámica postintubación tanto en la presiónarterial (p = 0,0001), como en la frecuencia cardiaca(p = 0,031) respecto de su valor basal. Sin embargo, con elgrupo del fentanilo (grupo F), no se observó dicho efecto protector.No se observaron diferencias en la saturación periféricade oxígeno en ambos grupos durante el estudio.CONCLUSIONES: A las dosis utilizadas, el remifentanilocomparativamente con el fentanilo, ofrece mayor controlhemodinámico. No se observaron efectos secundarios enambos grupos atribuibles a los opiáceos(AU)

OBJETIVES: To compare the efficacy and safety offentanyl and remifentanil in the prevention ofhemodynamic responses to direct laryngoscopy andorotracheal intubation, and to compare the effects ofthese techniques on peripheral blood oxyhemoglobinsaturation in normotensive women undergoingscheduled gynecologic surgery.MATERIAL AND METHODS: Prospective clinical trial inASA 1-2 patients undergoing gynecologic surgery. Thepatients were randomized to 2 groups: the remifentanilgroup received a perfusion of 1 μg·kg-1·min-1 untilintubation whereas the fentanyl group received a bolusdose of 2 μg·kg-1. Etomidate (0.3 mg·kg-1) and rocuroniumbromide (0.6 mg·kg-1) were used for anesthetic induction.Seven serial measurements of systolic, diastolic, and meanarterial pressure were recorded in addition to heart rateand peripheral blood oxyhemoglobin saturation at thefollowing times: baseline, denitrogenation, postinduction,and 3 more times at consecutive 2-minute intervals.RESULTS: Fifty-four patients were enrolled. Astatistically significant attenuation of the postintubationhemodynamic response was observed in the remifentanilgroup. The effect was evident on arterial pressure(P=.0001) and heart rate (P=.031) with respect tobaseline values. That protective effect was not seen in thefentanyl group. No differences in peripheral bloodoxyhemoglobin saturation were observed.CONCLUSIONS: Remifentanil provides greaterhemodynamic control than fentanyl at the doses utilized.No adverse effects attributable to these opioids wereobserved in either group(AU)

[Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia]. / Estudio aleatorio, doble ciego sobre la utilización de diferentes dosis de bupivacaína hiperbara con o sin fentanilo, en cesáreas con anestesia subaracnoidea.

OBJECTIVES: To compare the effects of spinal anesthesia with different doses of hyperbaric bupivacaine with or without fentanyl in patients undergoing cesarean section. MATERIAL AND METHODS: Prospective study enrolling 50 ASA 1-2 patients undergoing cesarean section, randomized to 5 treatment groups. Groups A, B, C, and D received 15 microg of fentanyl and group X received no fentanyl. The doses of hyperbaric bupivacaine given in each group were as follows: 10 mg in Group A, 11 mg in group B, 12 mg in group C, 13 mg in group D, and 14 mg in group X. RESULTS: Patients in groups A and B had greater hemodynamic stability than patients in groups C, D, or X (P < 0.05). The incidence of hypotension was 70% in group C and 80% in groups D and X. The sensory block reached level T4 in groups D and X and the motor block was complete in all cases. Postoperative analgesia lasted longer in group D with a mean (SD) duration of 202 (25) minutes than in group X with a mean duration of 194 (19) minutes. Assessment on a visual analog scale was under 3 in all groups except group A, where 2 patients required administration of propofol. CONCLUSIONS: Acceptable operative conditions with a low incidence of hypotension are provided with an 11 mg dose of hyperbaric bupivacaine.

Estudio aleatorio, doble ciego sobre la utilización de diferentes dosis de bupivacaína hiperbara con o sin fentanilo, en cesáreas con anestesia subaracnoidea / Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia

OBJETIVOS: Comparar los efectos de la anestesia subaracnoidea, en pacientes sometidas a cesárea, empleando distintas dosis de bupivacaína hiperbara con o sin fentanilo. MATERIAL Y MÉTODOS: Estudio prospectivo con 50 pacientes ASA I-II sometidas a cesárea y distribuidas aleatoriamente en cinco grupos. Los grupos A, B, C y D con 15 μg de fentanilo y el grupo X sin fentanilo. Grupo A: 10 mg de bupivacaína hiperbara y fentanilo; grupo B: 11 mg de bupivacaína hiperbara y fentanilo; grupo C: 12 mg de bupivacaína y fentanilo; gupo D:13 mg de bupivacaína y fentanilo y grupo X: 14 mg de bupivacaína hiperbara sin fentanilo. RESULTADOS: Las pacientes de los grupos A y B presentaron mayor estabilidad hemodinámica frente a los pacientes de los grupos C, D y X (p < 0,05). La incidencia de hipotensión en estos grupos fue del 70% (grupo C) y del 80% (grupos D y X). En los grupos D y X se alcanzó un nivel de bloqueo sensitivo T4 y un bloqueo motor completo en todos los casos. La duración de la analgesia postoperatoria fue mayor en el grupo D que en el X (202 ± 25 min frente 194 ± 19 min). La EVA intraoperatoria se mantuvo por debajo de 3 en todos los grupos excepto en el grupo A, donde en 2 pacientes fue necesaria la administración de propofol. CONCLUSIONES: Con dosis de 11 mg de bupivacaína hiperbara (grupo B) obtenemos unas aceptables condiciones intraoperatorias, con una baja incidencia de hipotensión

OBJECTIVES: To compare the effects of spinal anesthesia with different doses of hyperbaric bupivacaine with or without fentanyl in patients undergoing cesarean section. MATERIAL AND METHODS: Prospective study enrolling 50 ASA1-2 patients undergoing cesarean section, randomized to 5 treatment groups. Groups A, B, C, and D received 15 μg of fentanyl and group X received no fentanyl. The doses of hyperbaric bupivacaine given in each group were as follows: 10 mg in Group A, 11 mg in group B, 12 mg in group C, 13 mg in group D, and 14 mg in group X. RESULTS: Patients in groups A and B had greater hemodynamic stability than patients in groups C, D, or X (p<0.05). The incidence of hypotension was 70% in group C and 80% in groups D and X. The sensory block reached level T4 in groups D and X and the motor block was complete in all cases. Postoperative analgesia lasted longer in group D with a mean (SD) duration of 202 (25) minutes than in group X with a mean duration of 194 (19) minutes. Assessment on a visual analog scale was under 3 in all groups except group A, where 2 patients required administration of propofol. CONCLUSIONS: Acceptable operative conditions with a low incidence of hypotension are provided with an 11 mg dose of hyperbaric bupivacaine

Parche hemático en paciente con cefalea post-punción dural / Blood patch in a patient with postdural puncture headache

No disponible

No disponible

Extracción de un alfiler en la vía aérea de un paciente pediátrico: técnica anestésica / Removal of a pin from an infant's airway: anesthetic technique

No disponible

No disponible

[Anesthesia in a patient with Treacher-Collins syndrome]. / Anestesia en un paciente con síndrome de Treacher-Collins.

Treacher Collins syndrome is a form of mandibulofacial dysostosis characterized by deafness, hypoplasia of facial bones (mandible, maxilla and cheek bone), antimongoloid slant of palpebral fissures, coloboma of the lower lid and bilateral anomalies of auricle. The condition may be associated with other malformations (cardiovascular system). The major problem in anesthesia lies on the maintenance of a free airway and intubation. During postoperative period, pharyngeal and laryngeal edema may develop even after pharyngoplasty. Cases of sleep apnea, respiratory distress and even sudden death have been reported.