Neumomediastino en inmigrantes: presentación de 3 casos de una misma patera / Pneumomediastinum in immigrants: presentation of three cases in the same boat

Tres inmigrantes de raza negra, de una misma patera, procedentes de Malí, fueron rescatados en alta mar, en grave situación clínica, consistente básicamente en deshidratación hipernatrémica y rabdomiólisis, ingresando por ello en el hospital Doctor Negrín de Las Palmas. En las radiografías de tórax se objetivó neumomediastino en los tres casos. Dos de ellos evolucionaron favorablemente tras corregir la situación de deshidratación. Uno de ellos presentó en la evolución neumonía con empiema y precisó drenaje pleural. Se comenta la rareza del neumomediastino en el adulto y los posibles factores desencadenantes, considerando como factor básico en estos casos el gran esfuerzo realizado en alta mar por dichos pacientes hasta ser rescatados

Three black Mali immigrants, sealing in the same boat, were rescued in open sea, in serious clinical situation. They were admitted at Doctor Negrin hospital (Las Palmas). Hypernatremic dehydration and rhabdomyolysis was watched and the x-rays of thorax showed pneumomediastinum in the three cases. Two of them improved quickly after dehydration correction. One of them showed pneumonia with empyema, in the evolution. He needed pleural drainage. We comment the peculiarity of the pneumomediastinum in the adulthood and the possible trigger factors. We consider essential the great effort made in open sea by these patients until they were rescued

Continuous infusion is superior to bolus doses with thoracic paravertebral blocks after thoracotomies.

OBJECTIVES: This study was designed to determine whether a continuous thoracic paravertebral infusion of bupivacaine (continuous TPVI) offers a higher quality of analgesia than a bolus regimen after thoracotomy. DESIGN: A prospective and randomized study. SETTING: It was conducted by an anesthesiology and pain clinic department in a university hospital. PARTICIPANTS: Thirty patients were included in this study. INTERVENTIONS: As postoperative analgesia, the patients received either 20 mL of 0.375% bupivacaine every 6 hours (n = 15; bolus group), or a loading dose of 15 mL of 0.375% bupivacaine, plus an infusion of 5 mL of 0.25% bupivacaine every hour (n = 15; infusion group). MEASUREMENTS AND MAIN RESULTS: Pain intensity was assessed at rest and on movement (coughing) at 0, 1, 4, 10, 20, and 48 hours by means of the visual analog scale. The need for additional rescue analgesia, bupivacaine plasma concentration in the infusion group, blockade level (pinprick), and vital signs were also recorded. There were no significant differences regarding the additional rescue analgesia, vital signs, and pinprick level. However, the pain scores were significantly higher in the bolus group at rest and on movement (p < 0.01). The bupivacaine plasma concentration was low with a Cmax of 1.841 +/- 0.20 micrograms/mL at 15 hours. No systemic toxicity or other side effects were seen. CONCLUSION: Results suggest that continuous TPVI provides better pain control than the bolus regimen after this kind of surgery.