Manejo multimodal conservador de material de osteosíntesis ante herida quirúrgica con sobreinfección polimicrobiana, incluyendo Staphylococcus aureus resistente a meticilina. Caso clínico / Conservative multimodal management of osteosynthesis material in surgical wounds with polymicrobial superinfection, including methicillin-resistant Staphylococcus aureus. Clinical case

El tratamiento retentivo de material protésico sobreinfectado por gérmenes resistentes es un desafío, especialmente cuando el agente causal es Staphylococcus aureus resistente a meticilina. Presentamos el manejo conservador satisfactorio de material de osteosíntesis implantado por fractura de tobillo a un paciente añoso y que sufrió sobreinfección por el citado microorganismo, en el que el tratamiento antimicrobiano consistió en la combinación de antibioterapia sistémica guiada por antibiograma (tras un primer ciclo empírico ineficaz), junto a irrigaciones tópicas de sevoflurano, aplicación de crema de sulfadiazina de plata y posteriormente cobertura del defecto cutáneo con terapia de presión negativa. Destacamos el novedoso papel del sevoflurano como analgésico y como antimicrobiano tópico (sumado a la crema de sulfadiazina de plata) en la evolución favorable de la herida, especialmente en el período en el que la antibioterapia empírica era ineficaz y todavía no se había comenzado con terapia de presión negativa

Retentive treatment of prosthetic material superinfected by resistant microorganisms is a challenge, especially when the causative agent is a methicillin-resistant Staphylococcus aureus. We present the successful conservative management of osteosynthesis material implanted due to ankle fracture in an elderly patient who suffered superinfection by the aforementioned microorganism, in which the antimicrobial treatment consisted of the combination of antibiotic-guided systemic antibiotics (after a first ineffective empirical cycle), together with topical irrigations of sevoflurane, applications of silver sulfadiazine cream, and subsequently coverage of the skin defect with negative pressure therapy. We highlight the novel role of sevoflurane as an analgesic and as a topical antimicrobial agent (in addition to silver sulfadiazine) in the favourable evolution of the wound, especially in the period in which the empirical antibiotic therapy was ineffective and negative pressure therapy had not yet been applied

Conservative multimodal management of osteosynthesis material in surgical wounds with polymicrobial superinfection, including methicillin-resistant Staphylococcus aureus. Clinical case. / Manejo multimodal conservador de material de osteosíntesis ante herida quirúrgica con sobreinfección polimicrobiana, incluyendo Staphylococcus aureus resistente a meticilina. Caso clínico.

Retentive treatment of prosthetic material superinfected by resistant microorganisms is a challenge, especially when the causative agent is a methicillin-resistant Staphylococcus aureus. We present the successful conservative management of osteosynthesis material implanted due to ankle fracture in an elderly patient who suffered superinfection by the aforementioned microorganism, in which the antimicrobial treatment consisted of the combination of antibiotic-guided systemic antibiotics (after a first ineffective empirical cycle), together with topical irrigations of sevoflurane, applications of silver sulfadiazine cream, and subsequently coverage of the skin defect with negative pressure therapy. We highlight the novel role of sevoflurane as an analgesic and as a topical antimicrobial agent (in addition to silver sulfadiazine) in the favourable evolution of the wound, especially in the period in which the empirical antibiotic therapy was ineffective and negative pressure therapy had not yet been applied.

[Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously]. / Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea.

OBJECTIVES: To study muscle weakness caused by low doses of rocuronium and rocuronium intolerance in healthy volunteers, with the general aim of producing brief skeletal-muscle relaxation that would have potential applications in clinical situations. PATIENTS AND METHODS: After receiving authorization from the clinical research ethics committee of our hospital, we set out to study the effects on subjective and objective muscle strength of injecting 3 doses of rocuronium (0.1 mg x kg(-1), 0.05 mg x kg(-2), and 0.075 mg x kg(-1)) in healthy volunteers, each dose on a different day. Objective muscle strength was measured using a hand dynamometer. We also recorded the development of expected adverse effects (diplopia, dysarthria, and dysphagia). RESULTS: Five volunteers (all authors) were studied. In the first subject, the dose of 0.1 mg x kg(-1) of rocuronium was unsatisfactory because it was too strong, causing extreme skeletal-muscle weakness and discomfort due to diplopia, dysarthria, and dysphagia. The dose of 0.05 mg x kg(-1) was well tolerated but caused no subjective feeling of weakness or any effect measurable on dynamometry. These doses were not administered to the other subjects. In the 4 remaining volunteers, the dose of 0.075 mg x kg(-1) caused a brief feeling of muscle weakness that was considered to be acceptable, though the findings were compromised by 2 technically defective baseline dynamometry readings. The volunteers also reported brief, mild discomfort, principally due to dysphagia. CONCLUSIONS: Doses of 0.075 mg x kg(-1) of rocuronium in healthy awake subjects breathing spontaneously are acceptably tolerated and cause brief muscle weakness that may be of use in situations that require skeletal muscle relaxation at specific moments.

Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea / Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously

OBJETIVOS: Investigar en voluntarios sanos la debilidadmuscular producida por dosis bajas de rocuronio ysu tolerancia, con la idea general de producir una breverelajación muscular esquelética potencialmente aplicableen situaciones clínicas.PACIENTES Y MÉTODOS: Tras autorización del Comitéde Ética e Investigación Clínica de nuestro hospital, nospropusimos estudiar en voluntarios sanos los efectos detres dosis de rocuronio (0,1, 0,05 ó 0,075mg Kg-1), administradasen diferentes días, sobre la fuerza muscular anivel subjetivo y objetivo (medida con un dinamómetrode puño), y la aparición de efectos adversos previstos(diplopia, disartria, disfagia).RESULTADOS: Se incluyeron cinco voluntarios. En elprimer sujeto la dosis de 0,1 mg Kg-1 de rocuronio resultóinadecuada por exceso de efecto (debilidad extrema dela musculatura esquelética; experiencia desagradablepor diplopia, disartria y disfagia) y la dosis de 0,05 mgKg-1 fue bien tolerada, pero sin sensación de debilidad niefectos apreciables sobre la dinamometría. Estas dosdosis no se administraron al resto de sujetos. En losotros cuatro voluntarios, la dosis de 0,075 mg Kg-1 produjouna breve sensación de debilidad muscular consideradaaceptable (aunque los resultados estuvieroninterferidos por dos dinamometrías basales deficientestécnicamente), con leve y breve sensación desagradable(por disfagia principalmente).CONCLUSIONES: Dosis de rocuronio de 0,075 mg Kg-1en sujetos sanos conscientes y respiración espontáneason aceptablemente toleradas y producen un breve estadode debilidad muscular que podría ser de utilidad ensituaciones que precisen momentos puntuales de relajaciónmuscular esquelética(AU)

OBJETIVES: To study muscle weakness caused by lowdoses of rocuronium and rocuronium intolerance inhealthy volunteers, with the general aim of producingbrief skeletal-muscle relaxation that would havepotential applications in clinical situations.PATIENTS AND METHODS: After receiving authorizationfrom the clinical research ethics committee of ourhospital, we set out to study the effects on subjective andobjective muscle strength of injecting 3 doses ofrocuronium (0.1 mg.kg-1, 0.05 mg.kg-1, and 0.075 mg.kg-1)in healthy volunteers, each dose on a different day.Objective muscle strength was measured using a handdynamometer. We also recorded the development ofexpected adverse effects (diplopia, dysarthria, anddysphagia).RESULTS: Five volunteers (all authors) were studied.In the first subject, the dose of 0.1 mg.kg-1 of rocuroniumwas unsatisfactory because it was too strong, causingextreme skeletal-muscle weakness and discomfort due todiplopia, dysarthria, and dysphagia. The dose of 0.05mg.kg-1 was well tolerated but caused no subjectivefeeling of weakness or any effect measurable ondynamometry. These doses were not administered to theother subjects. In the 4 remaining volunteers, the dose of0.075 mg.kg-1 caused a brief feeling of muscle weaknessthat was considered to be acceptable, though thefindings were compromised by 2 technically defectivebaseline dynamometry readings. The volunteers alsoreported brief, mild discomfort, principally due todysphagia.CONCLUSIONS: Doses of 0.075 mg.kg-1 of rocuronium inhealthy awake subjects breathing spontaneously areacceptably tolerated and cause brief muscle weaknessthat may be of use in situations that require skeletalmuscle relaxation at specific moments(AU)