Edema pulmonar unilateral porreexpansión tras exéresis de una masamediastínica de gran tamaño / Unilateral pulmonary edema due to reexpansion after exeresis of a large mediastinal

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[Pulse oximetry reduces the unnecessary administration of oxygen in the postanesthesia recovery period]. / La pulsioximetría reduce la administración innecesaria de oxígeno en el período de recuperación postanestésica.

OBJECTIVES: To investigate whether patients admitted to the postanesthesia recovery unit (PRU) need routine oxygen supplementation in the immediate postoperative period, by measuring changes in arterial oxygen saturation (SpO2) with a pulse oximeter. MATERIAL AND METHODS: Two hundred ninety-nine patients were admitted to the PRU after surgery. All breathed room air after their operations. During transfer to and time in the PRU, SpO2 was recorded. We administered oxygen through a face mask to patients whose SpO2 fell below 94% and to patients whose SpO2 levels fell below baseline, when baseline values were less than 94%. We recorded patient data, physical status (ASA), type of anesthesia, duration of surgery, Aldrete score upon admission to the PRU and SpO2 before and after surgery while the patient breathed room air. RESULTS: General anesthesia was used in 82.3% of the patients and local-regional anesthesia with sedation in 17.7%. PRU stay was 75.6 +/- 92.4 min. Twenty-five percent of the patients were treated with oxygen after surgery and 75% did not require supplemental oxygen. Time until the appearance of desaturation was 3.3 +/- 2.8 min. The coefficient of multiple correlation between postoperative SpO2 while breathing room air (dependent variable) and preoperative SpO2, age and duration of surgery was R = 0.522 (p < 0.001). CONCLUSIONS: Our results are sufficient to demonstrate the validity of pulse oximetry for avoiding indiscriminate oxygen supplementation in patients admitted to the PRU.

La pulsioximetría reduce la administración innecesaria de oxígeno en el período de recuperación postanestésica / Pulse oximetry reduces unnecessary oxygen administration during recovery from anesthesia

Objetivos: Investigar si los pacientes ingresados en la Unidad de Recuperación Postanestésica (URPA) necesitan O2 suplementario de rutina en el postoperatorio inmediato, midiendo las variaciones saturación arterial de oxígeno (SpO2) mediante la pulsioximetría. Material y Métodos: Se incluyó a 299 pacientes intervenidos y que asistimos en la URPA una vez finalizada la cirugía. Todos los pacientes respiraban aire ambiente después de haber sido intervenidos. Durante el traslado y permanencia en la URPA se registró SpO2. Administramos O2 mediante mascarilla en los casos de SpO2 < 94 por ciento y en aquellos pacientes con valores de SpO2 inferiores a los basales, cuando éstos eran < 94 por ciento. Durante el estudio se registraron: datos demográficos, estado físico ASA, tipo de anestesia, duración de la intervención, puntuación de la aplicación del test de Aldrete en el momento del ingreso en la URPA y SpO2 pre y postoperatoria respirando aire ambiente. Resultados: La anestesia general se utilizó en el 82,3 por ciento de los pacientes, siendo la técnica lo corregional con sedación en el 17,7 por ciento. El tiempo de estancia en la URPA fue de 75,6 ñ 92,4 min. El 25 por ciento de los pacientes fueron tratados con O2 en el postoperatorio frente al 75 por ciento que no precisaron O2 suplementario. El intervalo de tiempo de la aparición de la desaturación fue de 3,3 ñ 2,8 min. El coeficiente de correlación múltiple entre la SpO2 postoperatoria respirando aire ambiente (variable dependiente) y las variables SpO2 preoperatoria, edad y duración de la intervención fue R = 0,522 (p < 0,001).Conclusiones: Nuestros resultados prueban suficientemente la validez de la pulsioximetría en los pacientes ingresados en la URPA toda vez que evita el uso indiscriminado de O2 en dicha unidad. (AU)

[Postoperative analgesia with epidural methadone in patients operated for hernia of the lumbar disc]. / Analgesia postoperatoria con metadona epidural en pacientes intervenidos de hernia de disco lumbar.

OBJECTIVES: To determine whether the direct application of a single dose of methadone on the dura mater at the end of surgery to repair a lumbar disk hernia provides effective analgesia over the next 24 hours. PATIENTS AND METHODS: We conducted a randomized double blind study in 40 ASA I patients undergoing elective herniated disk repair under general anesthesia. The sample was divided into two groups (A and B). Group A patients received a solution of methadone in saline solution (5 mg methadone/5 ml saline) applied to the dura before the end of surgery. Group B patients (controls) received only 5 ml of saline. Pain intensity was assessed on a visual analog scale (VAS) during the postoperative period. Also recorded were the observer's impression and the amount of analgesia (ketorolac) consumed through a system providing patient controlled analgesia. RESULTS: Each group contained 20 patients. Group A patients needed significantly less postoperative analgesia (64.2 +/- 14.3 mg) than group B patients (109.6 +/- 16.5 mg). The VAS scores were significantly lower in group A during the first two hours after surgery and were correlated with the observer's impression. No patients suffered serious complications during the study. CONCLUSIONS: Topical administration of 5 mg of methadone on the dura mater at the end of herniated lumbar disk repair is an easy, safe and effective technique for providing postoperative analgesia.