[Anesthesia for electroconvulsive therapy: clinical experience]. / Anestesia en terapia electroconvulsiva. Experiencia clínica.

OBJECTIVE: To assess the utility of propofol and succinylcholine in obtaining optimal convulsions and assuring patient safety during electroconvulsive therapy. PATIENTS AND METHODS: This was a prospective observational study of patients undergoing electroconvulsive therapy under general anesthesia with propofol and succinylcholine. We recorded patient characteristics, doses of propofol and succinylcholine, electroencephalographically-recorded duration of convulsions, and complications. Descriptive statistics were compiled and the data were subjected to analysis of correlations, comparison with the Student t test for independent samples, the Mann-Whitney U test, and analysis of variance. RESULTS: We studied 108 patients, 62% women and 38% men, 80% classified as ASA 1 and 20% as ASA 2. The patients underwent 844 sessions of electroconvulsive therapy; their mean (SD) age was 39.95 (18.09) years. The doses of propofol and succinylcholine were 1.34 (0.32) mgxkg(-1) and 1.35 (0.26) mgxkg(-1), respectively. The mean recorded duration of the first convulsion (29.87 [22.42] seconds) was negatively correlated with age (r = -0.12) and unrelated to propofol dose (r = 0.06) or body weight (r = 0.02). Male and schizophrenic patients had longer-lasting convulsions (P < .01). Cardiovascular complications occurred in 2.4% and psychomotor agitation in 1.4%; there were no respiratory complications, musculoskeletal injuries, nausea, or vomiting. CONCLUSIONS: Electroconvulsive therapy can be safely applied in an operating room or similar space undergeneral anesthesia and with a neuromuscular blockade in order to prevent psychological or musculoskeletal trauma. Propofol did not affect the convulsions at the dosages administered.

[Therapeutic efficacy of different antimalarial regimens in the Costa Rica-Nicaragua border region]. / Eficacia terapéutica de diferentes regímenes antimaláricos en la región fronteriza de Costa Rica y Nicaragua.

The search for short treatments for malaria is still a goal for many developing countries. The World Health Organization has recommended a three-day treatment with primaquine and quinine, but this treatment is difficult to apply in many rural areas because it requires a malaria technician to stay at least three days in a community. This is very hard when these communities are dispersed and increases the cost of treatment and supplies. This study tested treatments of 1, 5, and 9 days against a treatment of 14 days. Using the Kaplan-Meier method, no statistical difference was found among these four treatment approaches. We strongly recommend using the one-day treatment, in and endemic rural areas where the population is dispersed and has difficulty accessing health care.

Ondansetron and droperidol in the prevention of postoperative nausea and vomiting.

We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. Shortly before induction of anaesthesia, patients received: saline i.v. (group I, n = 62); droperidol 2.5 mg i.v. (group 2, n = 60); ondansetron 4 mg i.v. (group 3, n = 57); or droperidol 2.5 mg with ondansetron 4 mg i.v. (group 4, n = 63). Nausea occurred in 45%, 37%, 32% and 29% (P = 0.234) and vomiting in 23%, 17%, 9% and 5% (P = 0.016) of patients in groups 1, 2, 3 and 4, respectively, during the first 24 h. Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P < 0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.

[Nocturnal hypoxemia after abdominal surgery: associated factors and usefulness of oxygen therapy]. / Hipoxemia nocturna después de cirugía abdominal: factores asociados y rol de la oxigenoterapia.

BACKGROUND: Postoperative nocturnal hypoxemia (PONH) is a main factor in the genesis of respiratory, cardiac and neurologic complications after surgery. AIM: To describe the phenomenon of PONH after elective laparoscopy and laparotomy, and to evaluate the usefulness of oxygen therapy in its prevention. PATIENTS AND METHODS: Fifteen elective patients (6 M, 9 F, 51 +/- 8 years old) scheduled for laparotomy (n = 8) or laparoscopy (n = 7) were studied. Ventilatory parameters and pulse oximetry were measured pre and postoperatively. Patients were randomly assigned to receive oxygen by nasal cannula either during the first or the second postoperative night. RESULTS: PONH (SatO2 < 85) developed in seven patients (47%), of which four had undergone laparoscopic surgery. PONH was more frequent in mildly obese patients and those presenting preoperative hypoxemia (p = 0.03). Peak Flow was lower in patients presenting PONH (p = 0.04). In five patients, PONH was associated with significant tachycardia. Oxygen administration was associated with a higher SatO2 and prevented PONH in 6/7 patients. CONCLUSIONS: PONH is a common event in patients older than 40 years scheduled for open or laparoscopic abdominal surgery, and develops more frequently in those with preoperative nocturnal hypoxemia and greater ventilatory impairment. PONH can be prevented, most of the time, with oxygen administration.

Actinobacillus pleuropneumoniae: virulence and gene cloning.

Actinobacillus pleuropneumoniae is the causal agent of porcine contagious pleuropneumonia (PCP). The infection produces important economic losses in porciculture due to its high morbidity and mortality. Survivors are asymptomatic carriers infectious to other pigs and have low alimentary conversion. The causative agent possesses several virulence factors: adhesion fimbriae, lipopolysaccharide of the outer membrane, capsule, and cytolysins. In addition, our group has reported secretion proteases of a wide pH range of activity. These proteases degrade different substrates such as porcine gelatin, hemoglobin and IgA, and bovine or human hemoglobin. To control PCP dissemination, farmers require serodiagnostic tests which detect carriers and discriminate between vaccinated and infected animals. Bacterines used as immunogens are serotype specific and do not prevent the infection. Genes have been cloned that codify a cohemolysin, cytolysins, and an iron-binding protein. We have cloned A. pleuropneumoniae genes using the expression plasmids pUC19 and Bluescript, in Escherichia coli Q358 and DH5 alpha; the screening for antigen production was made in four groups of pigs (vaccinated, experimentally infected, naturally infected, and from slaughterhouses); two E. coli clones expressed polypeptides recognized by sera from all the groups.