[Frequency of bacterial contamination of epidural and plexus catheters in postoperative analgesia]. / Catéteres epidurales y plexulares para analgesia postoperatoria: tasa de contaminación bacteriana.

OBJECTIVE: There is little available information regarding contamination of perineural catheters. Incidence ranges from 5% to 57%, depending on the location of the catheter. The objective of this prospective study was to evaluate the incidence and predisposing factors of bacterial contamination of these catheters. PATIENTS AND METHODS: The study included 47 patients who had an epidural (24 patients) or perineural (23 patients) catheter inserted for a minimum of 48 hours. We recorded details of the patients' characteristics, difficulty of insertion and duration of placement of the catheter, antibiotic treatment received, and signs of local or systemic infection immediately after surgery. When the catheters were removed, cultures were prepared using the Maki method. A descriptive analysis was performed and the frequency of contamination was determined using various parameters. RESULTS: The incidence of contamination was 28% (13 patients): 5/24 (21%) in epidural catheters, 6/17 (35%) in femoral catheters, and 2/6 (33%) in brachial and sciatic plexus catheters. Colonization was not influenced by the patients' characteristics, technical difficulties in placing the catheter, prophylactic antibiotic treatment, or the characteristics of the infusion administered. None of the patients presented clinical signs of infection. The most commonly isolated microorganism was Staphylococcus epidermidis, found in 10 patients (69% of the colonized catheters). CONCLUSIONS: Although infection of perineural catheters is exceptional when they are placed for 2 or more days, contamination is very common. Epidemiological studies are required to evaluate the variables involved.

Catéteres epidurales y plexulares para analgesia postoperatoria: tasa de contaminación bacteriana / Frequency of bacterial contamination of epidural and plexus catheters in postoperative analgesia

OBJETIVOS: Existen pocos datos acerca de la contaminaciónde catéteres dispuestos en posición perineural. Suincidencia se sitúa entre el 5% y el 57% en base a lalocalización del catéter. Planteamos este estudio prospectivo para evaluar la incidencia y factores predisponentes de la contaminación bacteriana de estos.PACIENTES Y MÉTODOS: Se incluyeron 47 pacientes aquienes se les colocó un catéter epidural (24 pacientes) o perineural (23 pacientes) por un periodo mínimo de 48horas. Se recogieron las características de los pacientes, dificultad de inserción y tiempo de colocación del catéter, antibioticoterapia recibida y signos de infección local o sistémica en el postoperatorio inmediato. Tras la retirada delcatéter se realizó el cultivo mediante el método de Maki. Se realizó un análisis descriptivo y se determinó la frecuencia de contaminación en función de distintos parámetros.RESULTADOS: La incidencia de contaminación fue de 13pacientes (28%): 5/24 (21%) en epidurales, 6/17 (35%) enlos femorales y 2/6 (33%) en los plexos braquial y ciático. La colonización no se vio influenciada por las características de los pacientes, las dificultades técnicas en colocación del catéter, la antibioticoterapia profiláctica, ni por las características de la infusión administrada. Ningúnpaciente presentó clínica sugestiva de infección. El microorganismo más frecuentemente aislado fue Staphylococcus epidermidis en 10 pacientes (69% de los colonizados).CONCLUSIONES: Si bien la infección de los catéteresperineurales es excepcional cuando se mantienen durantedos o más días, su contaminación es muy frecuente. Serequieren estudios epidemiológicos amplios para evaluarlas variables implicadas

OBJECTIVE: There is little available informationregarding contamination of perineural catheters. Incidence ranges from 5% to 57%, depending on the location of the catheter. The objective of this prospective study was to evaluate the incidence and predisposing factors of bacterial contamination of these catheters.PATIENTS AND METHODS: The study included 47 patientswho had an epidural (24 patients) or perineural (23patients) catheter inserted for a minimum of 48 hours. Werecorded details of the patients’ characteristics, difficulty of insertion and duration of placement of the catheter, antibiotic treatment received, and signs of local or systemic infection immediately after surgery. When the catheters were removed, cultures were prepared using the Maki method. A descriptive analysis was performed and the frequency of contamination was determined using various parameters.RESULTS: The incidence of contamination was 28% (13patients): 5/24 (21%) in epidural catheters, 6/17 (35%) in femoral catheters, and 2/6 (33%) in brachial and sciatic plexus catheters. Colonization was not influenced by the patients’ characteristics, technical difficulties in placing the catheter, prophylactic antibiotic treatment, or the characteristics of the infusion administered. None of the patients presented clinical signs of infection. The most commonly isolated microorganism was Staphylococcus epidermidis, found in 10 patients (69% of the colonized catheters).CONCLUSIONS: Although infection of perineural cathetersis exceptional when they are placed for 2 or more days,contamination is very common. Epidemiological studies arerequired to evaluate the variables involved

Dolor postoperatorio y unidades de dolor agudo / Postoperative pain and acute pain units

No disponible

Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine.

BACKGROUND: Transient Neurological Symptoms (TNS) syndrome following subarachnoid anaesthesia was initially associated with hyperbaric lidocaine 50 mg/ml, but has also been reported with most local anaesthetics, including hyperbaric mepivacaine 40 mg/ml. The aim of this study was to determine the incidence of TNS after subarachnoid anaesthesia using isobaric mepivacaine 20 mg/ml and isobaric lidocaine 20 mg/ml. METHODS: Eighty patients of both sexes, ASA class I-II, scheduled for elective minor orthopaedic surgery under subarachnoid anaesthesia, were prospectively included and randomly allocated to receive 40-60 mg of either isobaric mepivacaine 20 mg/ml (Group M) or isobaric lidocaine 20 mg/ml (Group L). Patients were evaluated on the first postoperative day by one investigator unaware of the grouping, looking for symptoms suggestive of TNS, such as pain or dysaesthesias in the buttocks or lower limbs with or without back pain. RESULTS: TNS symptoms were observed in three patients (7.5%) of Group M and in one patient (2.5%) of Group L, without statistically significant differences between the groups. Symptoms had an abrupt onset and relief, lasted from 45 min to 24 h, and had a complete resolution without sequelae. The only statistically significant difference between groups was longer motor blockade in Group M (P=0.0031). CONCLUSION: In this study TNS was associated with isobaric mepivacaine 20 mg/ml, with an incidence of 7.5%, and with isobaric lidocaine 20 mg/ml, with an incidence of 2.5%, in patients having orthopaedic procedures in the supine position.

Postoperative respiratory function in children after abdominal surgery. A comparison of epidural and intramuscular morphine analgesia.

Thirty children undergoing urological and abdominal surgery were entered into a randomised trial comparing the effects of epidural and intramuscular morphine on postoperative respiratory function. The forced vital capacity and the forced expired volume in 1 s were measured before and 6 h after surgery and on each of the following seven days. Significant decreases (p < 0.01) in forced vital capacity and forced expired volume in 1 s were seen after surgery. After the first postoperative day, a gradual recovery in pulmonary function was observed but the measured parameters had not returned to their pre-operative control values by the end of the study. There were no statistically significant differences between the two groups during the study with respect to forced vital capacity and forced expired volume in 1 s. The quality of analgesia was better in the epidural morphine group than in the intramuscular morphine group. The incomplete recovery of pulmonary function suggests that pain is not the only cause of postoperative respiratory changes in these patients.

Stability of an oral midazolam solution for premedication in paediatric patients.

The objectives of this study were to assess the stability of a 1 mg/ml oral midazolam solution elaborated by our Hospital Pharmacy Service, and to confirm its clinical effect in presurgical paediatric patients. The solution's stability was tested by determining its pH and its UV-visible absorption spectrum at room temperature for up to 60 days. A high performance liquid chromatography method was used to confirm it. There was no significant change in pH value of either the test or a control solution. No loss of midazolam could be detected during the test. The Anaesthesiology Service assessed the sedation quality (very good, good, bad) and the venous puncture response, 20 minutes after the administration of 0.3 mg/kg of an oral midazolam solution. Twenty children were examined (age: 4-7 years). In addition, the haemodynamic and ventilatory functions were evaluated.

[Otological assessment in patients operated on for cleft palate]. / Valoración otológica en pacientes intervenidos de fisura palatina.

Tympanometry and otoscopy has been carried out to determine the presence of middle ear disease on patients with cleft palate and the influence of corrective surgery. This explorations have been evaluated preoperatively and at one and six months postoperative follow-up. There is a high incidence of otitis media with effusion in patients with cleft palate, almost 60 per 100 in our study. The influence of cleft palate surgery repair has not revealed as a mayor factor on its resolution, although a visible benefit has been observed in the long term controls. We recommend a otorhinolaryngological follow-up in these patients.

[Comparison of intramuscular and intranasal premedication with midazolam in children]. / Comparación de la premedicación con midazolam por vía intramuscular o intranasal en niños.

The study involved 40 children ASA I to II type who were randomly divided into two groups of 20 patients with comparable age and sex profile. Premedication consisting of 0.2 mg/kg of midazolam (Dormicum, Roche) and 0.015 mg/kg of atropine was administered 30 to 40 min before surgical intervention by intramuscular way in one group and by intranasal in the other one. In the operating room a peripheral vein was cannulated and general anesthesia was induced with thiopental sodium and succinylcholine. Arterial blood oxygen saturation, heart rate, arterial blood pressure and respiratory rate were measured at baseline, beginning of sedation (closing eyes), and arrival at the operating room. The time at the onset of sedation, the degree of sedation at the operating room, and the reaction to the venopuncture were also measured. In both groups of patients heart rate and systolic arterial blood pressure measured at the arrival to the operating room were significantly higher than those recorded at baseline and at the onset of sedation. Diastolic blood pressure in patients with intranasal premedication increased on arrival to the operating room with respect to the sedation values. Arterial oxygen saturation significantly decreased from the baseline values in both groups at the onset of sedation and on arrival at the operating room. There were no significant changes in respiratory rate. None of the alterations had clinical consequences. There were no significant differences in the onset of sedation (12.42 +/- 4.07 min in the intramuscular group and 15.26 +/- 7.99 min in the intranasal administration), degree of sedation and response to venopunction in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Stevens-Johnson syndrome associated with esophageal stenosis]. / Síndrome de Stevens-Johnson asociado a estenosis esofágica.

Stevens-Johnson syndrome consists of inflammatory bullous lesions of the skin and mucous membranes and seems to be associated to several pharmacologic and/or infectious triggering factors which might share a common immunologic way. Esophageal stenosis secondary to Stevens-Johnson syndrome is very rare. During the last 40 years, only two cases in children have been reported. In the present work, we report clinical features and anesthetic management of a 6-year-old girl requiring seven general anesthesia procedures with ketamine and isoflurane for correction of esophageal stenosis.