Enhanced removal of the endocrine disruptor compound Bisphenol A by adsorption onto green-carbon materials. Effect of real effluents on the adsorption process.

The high exposure to the endocrine disrupting compounds (EDC) in water represents a relevant issue for the health of living beings. The xenoestrogen Bisphenol A (BPA), a suspected EDC, is an industrial additive broadly used for manufacturing polycarbonate and epoxy resins. Due to its harmful effect in humans and the aquatic environment, an efficient method to remove BPA from wastewater is urgently required. The present work aims to study the adsorption of BPA from aqueous solutions onto carbonaceous materials, e.g., a synthesized carbon xerogel (RFX), a chemical-activated carbon from Kraft lignin (KLP) and a commercial activated carbon (F400) for comparative purposes. Batch kinetic and adsorption tests of BPA in ultrapure water were accomplished, finding higher adsorption capacities of BPA onto both F400 activated carbon (qsat = 407 mg g-1) and the biochar KLP (qsat = 220 mg g-1), versus to that obtained for the xerogel (qsat = 78 mg g-1). Furthermore, kinetic experiments revealed faster kinetic adsorption for RFX and KLP materials, achieving the equilibrium time within 24 h, attributed to their more-opened porous structure. Pseudo-first order, pseudo-second order, Elovich, intra-particle diffusion and film diffusion models were used to fit the experimental data. Thus, the BPA adsorption isotherms were analysed by Langmuir, Freundlich, Sips, Redlich-Peterson and Dual-site Langmuir (DLS) isotherm models.In addition, the influence of different aqueous matrices, such as a hospital wastewater, a wastewater treatment plant (WWTP) effluent and a river water, on BPA removal efficiency has been explored. These adsorption tests revealed a clear competitive effect between the target compound (BPA) and the natural organic matter content (NOM) present in the matrices for the active sites, resulting in a high decreasing of BPA adsorption removal.

New insights from modelling and estimation of mass transfer parameters in fixed-bed adsorption of Bisphenol A onto carbon materials.

The removal of Bisphenol A, 2,2-bis (4-hydroxyphenyl) propane (BPA) in fixed-bed columns was investigated by breakthrough adsorption tests at different operation conditions and further prediction by a mathematical model to describe the adsorption-diffusion process onto two synthesized carbon porous materials. In this study, a xerogel (RFX) prepared by an optimized conventional sol-gel method and a lignin-based activated carbon (KLP) obtained via chemical activation were used in batch and fixed-bed adsorption experiments. The materials were fully characterized and their adsorptive properties were compared to those obtained with a commercial activated carbon (F400). RFX and KLP materials reached the equilibrium adsorption in only 24 h, whereas F400 activated carbon required 48 h. In addition, F400 and KLP adsorbents showed higher equilibrium adsorption capacity values (qe = 0.40 and 0.22 kg/kg, for F400 and KLP, respectively) than that obtained for the xerogel (qe = 0.08 kg/kg). Both synthesized carbon-adsorbents were studied in fixed-bed adsorption tests, exploring the effect of the operation conditions, e.g., initial BPA concentration (0.005-0.04 kg/m3), weight of adsorbent (0.01-0.05 g) and volumetric flow rate (0.2 to 1.0 mL/min), on the adsorption performance of the column. All the tested adsorption columns reached the equilibrium in a very short time, due to the efficient dimensionless of the bed. Additionally, the regeneration of the exhausted adsorbent was studied, achieving the total reuse of the solids after three consecutive cycles using methanol as regeneration agent. Finally, a mathematical model based on mass conservation equations was proposed, allowing to efficiently fit the experimental BPA breakthrough curves and estimate the external and adsorbed-phase mass transfer coefficients with a high accuracy.

Safety of laparoscopic subtotal cholecystectomy in acute cholecystitis. Experience in Southeast Mexico. / Seguridad de la colecistectomía subtotal laparoscópica en colecistitis aguda. Experiencia en el sureste de México.

INTRODUCTION: Subtotal cholecystectomy has been employed in cases of tecnically difficult cholecystectomy to prevent common bile duct injury. Given that there are few reports in Mexico on the theme, we consider it important to present the 18-year experience of a surgical group in the South-Southeast of Mexico. AIM: To determine the safety of laparoscopic subtotal cholecystectomy in patients with acute cholecystitis. MATERIALS AND METHODS: A retrospective, observational, and comparative study was conducted on patients with gallstones that underwent laparoscopic cholecystectomy. The variables analyzed were: anthropometric characteristics, comorbidities, conversion rate, surgery duration, hospital stay, and morbidity and mortality. STATISTICAL ANALYSIS: Descriptive statistics were applied through measures of central tendency and dispersion and standard deviation, utilizing the SPSS v22 program. RESULTS: A total of 1,101 medical records of patients with gallstones were reviewed. Of those patients, 223 presented with acute cholecystitis (20.25%) and they were divided into 2 groups: A) total cholecystectomy (82.95%) and B) subtotal cholecystectomy (17.05%). The anthropometric characteristics, risk factors, conversion rate, and hospital stay were similar in both groups. Only surgery duration was longer in the subtotal cholecystectomy group. Complications were more frequent, there was 1 death, and there was no bile duct injury in the subtotal cholecystectomy group. Those results were not statistically significant between the two groups. CONCLUSIONS: Subtotal cholecystectomy is a valuable resource in patients with acute cholecystitis. In our case series, it was a safe and reliable procedure for preventing bile duct injury. A larger number of cases are needed to corroborate those results.

The aroma of La Mancha Chelva wines: Chemical and sensory characterization.

The aim of this study is the chemical and sensory description of the aroma of wines white Chelva through five successive vintages. Solid Phase Extraction (SPE) was used for the isolation of volatile compounds and Gas Chromatography Mass Spectrometry (GC-MS) was employed by their analysis. Aroma Sensory Profile of wines was defined using the Quantitative Descriptive Sensory Analysis (QDA). A total of 77 volatile compounds were identified in Chelva wines. Chelva wines present a great quantity of aromatic compounds of very different chemical nature and with different aromatic descriptors, which will increase its aromatic complexity of these wines. Aroma sensory profile of Chelva wines was defined by higher intensity of fresh and peach aromas with notes citric, green apple, tropical fruit and sweet. This study showed that the Chelva grapes variety cultivated in La Mancha region present a great aroma potential and a complex sensory profile and can be considered a viable alternative to traditional grape varieties cultivated in this region for increasing the offer to the consumer.

Soil Carbon Pools in Dryland Agroecosystems as Affected by Several Years of Drought.

No-till and increased cropping intensity (CI) can increase yield and soil organic C (SOC) in the US Great Plains compared with traditional wheat ( L.)-fallow management. However, gains in SOC and other C pools may not be permanent. Increasing frequency of drought may reduce C inputs and potentially reverse gains accrued during wetter periods. This study examined the effect of drought on the persistence of SOC with two objectives: (i) to determine soil C pools (0-20 cm) after 24 yr in no-till as influenced by potential evapotranspiration (PET), landscape position (slope), and CI; and (ii) to compare the size of the C pools after the first 12 yr (wet) versus the subsequent 12 yr, notable for frequent droughts. Rotations were wheat-corn ( L.)-fallow (WCF), continuous cropping (CC), and a grass Conservation Reserve Program mixture planted across slopes at three sites in Colorado with similar precipitation but increasing PET. After 24 yr, water-soluble organic C increased with CI from WCF to CC to grass with 250, 340, and 440 kg C ha, respectively. Soil microbial biomass C also increased with CI-1500, 1660, and 2135 kg C ha for WCF, CC, and grass, respectively. The particulate organic matter C pool had a three-way interaction with PET, slope, and CI. Overall, between Years 12 and 24, SOC increased in grass by 16.9%, with a rate of 425 kg C ha yr sequestration compared with 10.5 and 1.4% for the WCF and CC systems, respectively.

Presence of plastic particles in waterbirds faeces collected in Spanish lakes.

Plastic intake by marine vertebrates has been widely reported, but information about its presence in continental waterfowl is scarce. Here we analyzed faeces of waterbirds species (European coot, Fulica atra, mallard, Anas platyrhynchos and shelduck, Tadorna tadorna) for plastic debris in five wetlands in Central Spain. We collected 89 faeces of shelduck distributed in four lakes, 43.8% of them presented plastic remnants. Sixty percent of 10 faeces of European coot and 45% of 40 faeces of mallard contained plastic debris. Plastic debris found was of two types, threads and fragments, and were identified as remnants of plastic objects used in agricultural fields surrounding the lakes. Differences in prevalence of plastic in faeces, number of plastic pieces per excrement and size of the plastic pieces were not statistically significant between waterfowl species. Thus, our results suggest that plastic may also be frequently ingested by waterfowl in continental waters, at least in our study area. Future studies should address this potential problem for waterbird conservation in other wetlands to evaluate the real impact of this pollutant on waterbirds living in inland water.

Differentiation stage of myeloma plasma cells: biological and clinical significance.

The notion that plasma cells (PCs) are terminally differentiated has prevented intensive research in multiple myeloma (MM) about their phenotypic plasticity and differentiation. Here, we demonstrated in healthy individuals (n=20) that the CD19-CD81 expression axis identifies three bone marrow (BM)PC subsets with distinct age-prevalence, proliferation, replication-history, immunoglobulin-production, and phenotype, consistent with progressively increased differentiation from CD19+CD81+ into CD19-CD81+ and CD19-CD81- BMPCs. Afterwards, we demonstrated in 225 newly diagnosed MM patients that, comparing to normal BMPC counterparts, 59% had fully differentiated (CD19-CD81-) clones, 38% intermediate-differentiated (CD19-CD81+) and 3% less-differentiated (CD19+CD81+) clones. The latter patients had dismal outcome, and PC differentiation emerged as an independent prognostic marker for progression-free (HR: 1.7; P=0.005) and overall survival (HR: 2.1; P=0.006). Longitudinal comparison of diagnostic vs minimal-residual-disease samples (n=40) unraveled that in 20% of patients, less-differentiated PCs subclones become enriched after therapy-induced pressure. We also revealed that CD81 expression is epigenetically regulated, that less-differentiated clonal PCs retain high expression of genes related to preceding B-cell stages (for example: PAX5), and show distinct mutation profile vs fully differentiated PC clones within individual patients. Together, we shed new light into PC plasticity and demonstrated that MM patients harbouring less-differentiated PCs have dismal survival, which might be related to higher chemoresistant potential plus different molecular and genomic profiles.

[Validation in Spain of the quality of life questionnaire PROSQOLI in patients with advanced prostate cancer]. / Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado.

OBJECTIVES: Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. MATERIAL AND METHODS: A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. RESULTS: Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. CONCLUSIONS: The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.

First Report of Ascochyta Blight Caused by QoI-Resistant Isolates of Ascochyta rabiei in Chickpea Fields of Nebraska and South Dakota.

Ascochyta blight, caused by Ascochyta rabiei, is a serious disease of chickpea (Cicer arietinum) and fungicide applications are used to manage the disease in the North Central plains (4). During the 2010 growing season, a commercial field near Stanley, SD was treated with pyraclostrobin (Headline, BASF, NC) and called a management failure by the grower. Similarly, limited efficacy of pyraclostrobin was observed in an ascochyta research trial near Scott's Bluff, NE. In both locations, symptoms and signs consistent with A. rabiei infection existed on leaves, stems, and pods; namely, circular brown lesions with concentric rings of dark brown pycnidia. Symptomatic samples were collected, disinfected with 95% ethanol for 1 min, rinsed with sterile water, placed in 0.5% NaOCl for 1 min, and rinsed again with sterile water for 1 min (4). Samples were air dried, placed on potato dextrose agar (PDA) plates for 3 to 7 days, and colonies with morphological characteristics typical of A. rabiei were single-spored and transferred to new PDA plates and incubated for 7 to 14 days. Three and six putative A. rabiei isolates were obtained from South Dakota and Nebraska samples, respectively. Morphological characteristics were consistent with A. rabiei; cultures were brown with concentric rings of dark, pear-shaped pycnidia with an ostiole, and conidia were hyaline, single-celled, and oval-shaped (2). Comparison of the internal transcribed spacer (ITS) region amplified from the genomic DNA of 3-day-old liquid cultures using ITS4/ITS5 primers by BLASTN searches using the nr database in GenBank (Accession Number FJ032643) also confirmed isolates to be A. rabiei. Mismatch amplification mutation assay (MAMA) PCR was used for detection of sensitive and resistant isolates to QoI fungicides (1). Confirmation of the presence of the G143A mutation was carried out by cloning an mRNA fragment of the cytochrome b gene using cDNA synthesized from total RNA of A. rabiei and CBF1/CBR2 (1,3). Total RNA was extracted from 3-day-old liquid cultures and it was used instead of genomic DNA for this PCR to avoid large intronic regions commonly present in mitochondrial genes. The G143A mutation has previously been correlated with resistance to QoI fungicides in other fungal plant pathogens (3). Also, these isolates were determined to be QoI-resistant in vitro by PDA amended with a discriminatory dose of 1 µg/ml of azoxystrobin (4). To our knowledge, this is the first report of QoIresistant A. rabiei isolates causing infections on chickpeas in South Dakota and Nebraska. QoI-resistant isolates were reported in North Dakota and Montana in 2005 and 2007, respectively (4). Of nearly 300 isolates collected from these states from 2005 and 2007, approximately 65% were determined to be QoI resistant (4). The widespread occurrence of QoIresistant isolates and reduction of fungicide performance in fields led the North Dakota State University Cooperative Extension Service to actively discourage the use of QoI fungicides on chickpeas in North Dakota and Montana (4). It is likely that similar recommendations will need to be adopted in South Dakota and Nebraska for profitable chickpea production. References: (1) J. A. Delgado, 2012 Ph.D. Diss. Department of Plant Pathology, North Dakota State University. (2) R. M. Harveson et al. 2011. Online. Plant Health Progress doi:10.1094/PHP-2011-0103-01-DG. (3) Z. Ma et al. Pestic. Biochem. Physiol. 77:66, 2003. (4) K. A. Wise et al. Plant Dis. 93:528, 2009.

Variations in the mitochondrial cytochrome c oxidase subunit I gene indicate northward expanding populations of Culicoides imicola in Spain.

Culicoides imicola is the main vector for bluetongue (BT) and African horse sickness (AHS) viruses in the Mediterranean basin and in southern Europe. In this study, we analysed partial mitochondrial cytochrome c oxidase subunit I (COI) gene to characterize and confirm population expansion of Culicoides imicola across Spain. The data were analysed at two hierarchical levels to test the relationship between C. imicola haplotypes in Spain (n = 215 from 58 different locations) and worldwide (n = 277). We found nineteen different haplotypes within the Spanish population, including 11 new haplotypes. No matrilineal subdivision was found within the Spanish population, while western and eastern Mediterranean C. imicola populations were very structured. These findings were further supported by median networks and mismatch haplotype distributions. Median networks demonstrated that the haplotypes we observed in the western Mediterranean region were closely related with one another, creating a clear star-like phylogeny separated only by a single mutation from eastern haplotypes. The two, genetically distinct, sources of C. imicola in the Mediterranean basin, thus, were confirmed. This type of star-like population structure centred around the most frequent haplotype is best explained by rapid expansion. Furthermore, the proposed northern expansion was also supported by the statistically negative Tajima's D and Fu's Fs values, as well as predicted mismatch distributions of sudden and spatially expanding populations. Our results thus indicated that C. imicola population expansion was a rapid and recent phenomenon.

Samara size versus dispersal and seedling establishment in Ailanthus altissima (Miller) Swingle.

We have specifically carried out a greenhouse experiment to assess relationship between samara weight and seed success. Relationship assessed as dispersal potential, germination level, germination rate and early seedling mass for the invasive species Ailanthus altissima. For this purpose, we considered two close stands as seeds source. We found no correlation between samara size and neither germination level, germination rate, nor seedling mass, but a positive correlation with samara projected area. These results suggest that samara weight is not directly related to germination, dispersal and invasion potential neither. Nevertheless, stands differed in the invasion potential of their samaras; one stand presented samaras with higher projected area per weight unit whereas the other one presented samaras that produced heavier seedlings. Whatever the origin, (genetic or environmental) of this differences it should be advantageous for a colonizing invader species such as A. altissima since it could imply a wider range of habitats susceptible to invasion.

Proyecto Balmis / Balmis Project

El Proyecto Balmis es una iniciativa conjunta de la Inspección General de Sanidad y la Inspección General CIS, para la renovación tecnológica y funcional del Sistema de Información Sanitaria de Defensa, sustituyendo al actual Sistema Malta, tras veinte años de servicio. Balmis está integrado dentro de la plataforma tecnológica corporativa del Plan Director CIS de Defensa, y extiende su alcance, además de a los hospitales, a las unidades sanitarias operativas y desplegables en operaciones (role 2 y 3). Basado en el concepto de reingeniería de procesos, y centrado en la Historia Clínica electrónica, va a suponer un salto tecnológico que situará el sistema de Información Sanitario de Defensa en vanguardia de los actualmente en desarrollo, tanto en el SNS como en la OTAN. Balmis ha entrado en servicio en el hospital Central de la Defensa el pasado mes de junio de 2008 (AU)

Proyect Balmis is a joint initiative of the General Inspection of the Medical Service and the General Inspection (CIS (Communication and Information System). The goal of this Project is the functional and technological updating of the Defense Medical Information System, replacing the current Malta System after twenty years of service. Project Balmis is integrated in the corporate technological platform of the Defense Director Plan for CIS and includes not only the hospitals, but also the deployable medical units (roles 2 and 3). It is based on the concept of process reengineering and focused on the electronic medical record. It implies a technological leap that will place the Defense Medical Information System on the leading edge, in the Spanish National Health Service as well as in NATO. Project Balmis was started in the Defense Central Military Hospital last June 2008 (AU)

Tendinitis aquílea bilateral por ciprofloxacino en ausencia de factores de riesgo / Ciprofloxacin-associated bilateral Achilles tendinitis in absence of risk factors

El ciprofloxacino es la quinolona más usada; debido a esto, el mayor número de casos de tendinopatías comunicados se deben a su uso. El cuadro clínico de la tendinitis producida por quinolonas se caracteriza por su instauración rápida y por afectar como localización preferente al tendón de Aquiles. La aparición de la tendinitis puede suceder desde el segundo o tercer día hasta la quinta o sexta semana de iniciado el tratamiento, siendo con frecuencia la afectación bilateral y soliendo desaparecer la sintomatología al retirar el antibiótico. Como factores de riesgo asociados podemos citar la edad avanzada, el tratamiento prolongado con corticoides, la insuficiencia renal, la tuberculosis multirresistente, la hemodiálisis, la vasculopatía periférica y la enfermedad reumática asociada. Para el diagnóstico no existe ningún método complementario efectivo, siendo en todos los casos el diagnóstico clínico. La retirada del fármaco es esencial para el restablecimiento a la normalidad de la patología tendinosa, aunque el manejo adecuado y temprano no previene de un tiempo de recuperación prolongado, existiendo siempre el riesgo de una secuela funcional. Cada vez están apareciendo nuevas quinolonas y está aumentando su utilización, siendo esta reacción común de grupo, por lo que sería recomendable el seguimiento de los pacientes a los que se les administran quinolonas (AU)

Ciprofloxacin is the quinolone used most, which is why there are more cases of tendon disease reported for this drug. The quinolone-induced clinical picture of tendinitis is characterized by its rapid initiation and its preferentially affected site is the Achilles tendon. The appearance of tendinitis may occur from the second-third day until the fifth or sixth week of treatment initiation, the involvement frequently being bilateral. The symptoms generally disappear after withdrawing the antibiotic. As associated risk factors, we can mention elderly age, prolonged treatment with corticosteroids, renal failure, multiresistant tuberculosis, hemodialysis, peripheral vascular disease and associated rheumatic disease. There is no effective complementary method for its diagnosis, the diagnosis always being clinical. Withdrawal of the drug is essential for the reestablishment of normality of the tendinous condition, although adequate and early management does not prevent a long recovery time and there is always risk of functional sequel. New quinolones are continuing appearing and their use is increasing. This reaction is common to the group so that follow-up of the patients who are going to be administered quinolones would be recommendable (AU)

Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0, 25% con adrenalina vs. analgesia intravenosa con tramadol / Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia). Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1) y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12): se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13): se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1) como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.). Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anotó la aparición de cualquier complicación o efecto adverso. Los datos se analizaron mediante t Student y test χ2. Resultados: No existieron diferencias en cuanto a las características demográficas. La duración de la analgesia fue mayor en el grupo A (7,3 ± 5,1 h) que en el grupo B (2,8 ± 2,2 h) (p < 0,01). La valoración subjetiva de la intensidad dolorosa fue mayor en el grupo B (2,23 ± 0,83) que en el grupo A (0,66 ± 0,6) (p < 0,01). El grado de confort, según escala objetiva, fue significativamente mayor en el grupo que recibió el bloqueo con anestésico local. Discusión: La anestesia para neonatos sometidos a reparación de labio leporino, empleando bloqueo bilateral intraoral del nervio infraorbitario es una técnica segura, simple y rápida, que permite una analgesia duradera en el postoperatorio a la vez que minimiza los riesgos de depresión respiratoria, ya que posibilita una reducción en la utilización de analgésicos opioides, permitiendo un inmediato y confortable despertar (AU)

Objective: To compare the effectiveness and length of bilateral intraoral blockade of the infraorbitary nerve versus standard intravenous analgesia with tramadol for the management of postoperative pain in breast-fed infants undergoing chieloplasty due to harelip. Material and methods: After conducting an adequate pre-anesthetic assessment and obtaining the informed consent from their parents, we performed a double-blind, randomized, controlled and randomized study in 25 ASA I infants with ages ranging from 3 to 10 months that were candidates to corrective harelip surgery (chieloplasty). All of them were pretreated half an hour before the surgical procedure with oral midazolan (0.5 mg.kg-1) and the same anesthesiologist performed the anesthetic technique and the nerve blockade in all the cases, this being inhaled induction with sevoflurane prior to venoclysis. General anesthesia was achieved with intravenous administration of atropine, fentanyl and rocuronium at the standard doses prior to endotracheal intubation and mechanical ventilation. Patients were randomized to one of the following groups: Group A (n = 12): 1-2 ml of bupivacaine 0.25% plus adrenaline was administered for bilateral blockade of the intraorbitary nerve and intravenous saline solution instead of intravenous analgesia with tramadol. Group B (n = 13): saline solution was administered for nerve blockade, instead of bupivacaine, and intravenous tramadol (1.5 mg.kg-1) was provided as postoperative analgesia. All of the patients underwent general anesthesia with sevoflurane and fentanyl "on-demand" according to standard parameters (blood pressure, heart rate, pupil size, etc.). During the first six hours at Reanimation, length of analgesia, degree of discomfort and pain severity were assessed. The presence of complications or side effects was also recorded. Data were analyzed using the t Student and the χ2 test. Results: No differences were found regarding demographic features. Analgesia lasted more in group A (7.3 ± 5.1 h) compared to group B (2.8 ± 2.2 h) (p < 0.01). Subjective assessment of pain severity was higher in group B (2.23 ± 0.83) compared to group A (0.66 ± 0.6) (p < 0.01). Degree of comfort, as assessed through an objective scale, was significantly greater in the group undergoing blockade with local anesthetic. Discussion: Anesthesia for neonates undergoing surgical reparation of harelip with intraoral bilateral blockade of the infraorbitary nerve is a safe, simple and quick technique that provides a lasting postoperative analgesia and also reduces the risks of respiratory depression, since it allows a lower use of opiate analgesics and, hence, an immediate and comfortable awakening (AU)