Integridad renal y hepática tras la sedación prolongada con sevoflurano administrado a través del dispositivo AnaConDa(R): comparación con la sedación intravenosa con propofol en modelo animal / Renal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: a comparison with intravenous propofol sedation in an animal model

Introducción: En la actualidad la sedación de los pacientes críticos se realiza mediante agentes intravenosos. La utilización de agentes inhalatorios, como alternativa a la sedación intravenosa, se encuentra limitada por su potencial riesgo de toxicidad. El incremento de los niveles de fluoruros inorgánicos, tras su metabolización, ha sido considerado potencialmente nefrotóxico. Por otro lado, la afectación hepática después de la administración prolongada de sevoflurano no ha sido estudiada. Se evaluó la potencial toxicidad renal y hepática causada por la administración prolongada (72 h) de sevoflurano. Métodos: Estudio experimental, prospectivo, aleatorizado y controlado. Veintidós animales cerdas de la raza Landrace x Large-White fueron asignadas aleatoriamente a 2 grupos en función del régimen de sedación administrado (P: propofol por vía intravenosa; o S: sevoflurano inhalado a través del sistema AnaConDa(R), endtidal 2,5%). El grupo P se mantuvo sedado durante 108 h con propofol. Al grupo S se le administró sevoflurano durante 72 h, cambiando a propofol durante las 36 h restantes, con el objetivo de observar la cinética de los fluoruros plasmáticos tras la interrupción del sevoflurano. Se midieron la creatinina plasmática como variable principal, las concentraciones de fluoruros inorgánicos y otras variables de función renal, hepática y cardiorrespiratoria. Resultados: Ambos grupos de animales fueron comparables en el momento basal. No hubo diferencias significativas entre ambos grupos en cuanto a los valores de creatinina plasmática, urea y aclaramiento de creatinina. Los niveles de fluoruros fueron significativamente mayores en el grupo de sevoflurano. No encontramos una correlación entre las cifras de fluoruros inorgánicos y los valores de creatinina plasmática. Tampoco se observaron diferencias significativas en los parámetros de función hepática. Las variables hemodinámicas, respiratorias y gasométricas fueron comparables entre los grupos. Conclusiones: La sedación de larga duración no afecta a la función renal ni hepática, independientemente del agente utilizado (AU)

Introduction: Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72 h) of sevoflurane. Methods: For this experimental, prospective, randomized, controlled trial, 22 Landrace x Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhaled sevoflurane via the AnaConDa(TM) device (S, end-tidal 2.5 vol%). The P group remained sedated for 108 h with propofol. In the S group, sevoflurane was administered for 72 h and then changed to propofol for the remaining 36 h in order to observe the kinetics of fluoride after discontinuation of sevoflurane. Serum creatinine was the primary outcome variable, but inorganic fluoride concentrations and other renal, hepatic, and cardiorespiratory variables were also measured. Results: Both groups of animals were comparable at baseline. No differences were found between the two groups for plasma creatinine and urea or creatinine clearance throughout the study. Fluoride levels were significantly higher in the sevoflurane group. No correlation was found between inorganic fluoride and serum creatinine values. No significant differences were observed for hepatic function. Hemodynamic, respiratory, and blood gas variables were comparable between the groups. Conclusions: Long-term sedation with sevoflurane using AnaConDa(TM) or propofol does not negatively affect renal or hepatic function (AU)

Renal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: a comparison with intravenous propofol sedation in an animal model.

INTRODUCTION: Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72h) of sevoflurane. METHODS: For this experimental, prospective, randomized, controlled trial, 22 Landrace x Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhaled sevoflurane via the AnaConDa™ device (S, end-tidal 2.5 vol%). The P group remained sedated for 108h with propofol. In the S group, sevoflurane was administered for 72h and then changed to propofol for the remaining 36h in order to observe the kinetics of fluoride after discontinuation of sevoflurane. Serum creatinine was the primary outcome variable, but inorganic fluoride concentrations and other renal, hepatic, and cardiorespiratory variables were also measured. RESULTS: Both groups of animals were comparable at baseline. No differences were found between the two groups for plasma creatinine and urea or creatinine clearance throughout the study. Fluoride levels were significantly higher in the sevoflurane group. No correlation was found between inorganic fluoride and serum creatinine values. No significant differences were observed for hepatic function. Hemodynamic, respiratory, and blood gas variables were comparable between the groups. CONCLUSIONS: Long-term sedation with sevoflurane using AnaConDa™ or propofol does not negatively affect renal or hepatic function.

The effect of omental wrapping on nerve graft regeneration.

We have performed 1 cm long nerve grafts in the sciatic nerves of 60 Wistar rats. In 30 cases (n = 30) the grafts were wrapped in omentum. We have studied the nerve regeneration accomplished after 30 and 90 postoperative days from the histological and neurophysiological points of views. Survival of the omentum has been excellent. The histological assessment showed a higher blood vessel population as well as a higher count of axons in the cases where the nerve graft was wrapped in omentum. Areas with neural fibrosis, which are a sign of poor vascularisation, were smaller in the cases with omentum. The amplitude of the contraction in the gastrocnemius muscle was higher in the cases where omentum was used. The endothelial cells of the omentum synthesis fibroblast growth factors (acid and basic) which, due to their angiogenic and neuronotrophic properties, may be the cause of the beneficial effects of omentum on peripheral nerve regeneration.

[Survey of occupational dermatosis in 11 work centers]. / Encuesta de dermatosis ocupacionales en once centros de trabajo.

The development of Occupational Dermatosis Control Programme and the need for the planning of dermatological treatment as well as the prevention of such diseases makes it necessary to obtain morbidity data in different work places so as to classify them as dangerous from the occupational point of view. Eleven work places comprising 1431 workers were investigated. The existing dermatological pathology was established. It reached 48,1% of the workers investigated. Occupational dermatosis was 3,9% which is about the international average. The cases of dermatosis were treated and the workers' health improved; with sanitary instruction the environment underwent satisfactory changes which brought about the decrease of occupational risks. These surveys are a great help since they provide information about dermatological pathologies and their agents in different work places and facilitate the application of preventive measures.