[Ultrasound-guided infraclavicular axillary vein cannulation]. / Canalización de la vena axilar infraclavicular guiada por ecografía.

BACKGROUND AND OBJECTIVE: Percutaneous central venous cannulation is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. We wanted to evaluate an ultrasound-guided technique for the axillary vein cannulation, looking specifically at the ease of use, success rate and decreased complications. METHODS: Sixty consecutive surgical patients scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding an in plane puncture of axillary vein was used. After locating the vessels, an echo-guided sterile procedure was performed to cannulate the vein. RESULTS: Cannulation was successful in all patients, and there were no complications during insertion of the catheters. Both axillary veins were cannulated, and the vein was punctured successfully at first attempt in 95% of the patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 (7- 135) seconds. CONCLUSION: This ultrasound-guided technique for inserting central venous catheters in axillary vein was easy to apply. This procedure could increase precision and safety in patients undergoing axillary vein cannulation.

Canalización de la vena axilar infraclavicular guiada por ecografía / Ultrasound-guided infraclavicular axillary vein cannulation

Introducción y objetivos. La canalización venosa central percutánea es un procedimiento que puede ser difícil. Tradicionalmente se han utilizado técnicas basadas en referencias anatómicas externas para identificar los sitios de punción. Hemos evaluado una técnica guiada por ultrasonidos para la canalización de la vena axilar infraclavicular. Método. Se incluyeron pacientes quirúrgicos programados para la colocación de un catéter venoso central. Utilizamos una sonda lineal de ultrasonidos, 12MHz, para guiar la punción en plano de la vena axilar infraclavicular. El miembro superior ipsilateral fue colocado en abducción a 90° del eje cráneo-caudal. Se analizó el número de intentos, el tiempo empleado en la técnica (desde punción de la piel hasta aspiración de sangre) y la incidencia de complicaciones. Resultados. Fueron incluidos 60 pacientes. Fueron escaneadas ambas venas axilares infraclaviculares y el catéter se pudo colocar en un primer intento en el 95% de los pacientes. No hubo fallos de canalización. La mediana de tiempo de la técnica fue de 15 (rango 7-135) segundos. No hubo complicaciones mayores durante el procedimiento de inserción del catéter. Conclusión. La visualización por ultrasonidos de la vena axilar infraclavicular permitió su canalización con un mínimo cambio de posición del paciente, incluso durante la cirugía, en un tiempo clínicamente adecuado y sin complicaciones inmediatas(AU)

Background and objective. Percutaneous central venous cannulation is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. We wanted to evaluate an ultrasound-guided technique for the axillary vein cannulation, looking specifically at the ease of use, success rate and decreased complications. Methods. Sixty consecutive surgical patients scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding an in plane puncture of axillary vein was used. After locating the vessels, an echo-guided sterile procedure was performed to cannulate the vein. Results. Cannulation was successful in all patients, and there were no complications during insertion of the catheters. Both axillary veins were cannulated, and the vein was punctured successfully at first attempt in 95% of the patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 (7 - 135) seconds. Conclusion. This ultrasound-guided technique for inserting central venous catheters in axillary vein was easy to apply. This procedure could increase precision and safety in patients undergoing axillary vein cannulation(AU)

Implicaciones anestésicas en el manejo de un paciente con síndrome de ehlerdanlos vascular o tipo IV / No disponible

No disponible

Alteración de los niveles plasmáticos de melatonina tras la administración de propofol en perfusión continua / Altered plasma melatonin concentrations after administration of propofol in continuous infusion

OBJETIVOS: Determinar posibles variaciones en losniveles plasmáticos de melatonina en pacientes sometidosa sedación con propofol en perfusión continua.PACIENTES Y MÉTODO: Estudio prospectivo aleatorio enpacientes sanos sometidos a anestesia espinal para cirugíatraumatológica de miembros inferiores y separadosen dos grupos: (A) sedación con propofol (3-4 mg Kg-1 h-1, i.v.) y (B) sometidos a cirugía sin sedación. Se realizó lacomparación de estos grupos con otros dos: (C) no sometidoni a cirugía ni a sedación (sólo una muestra basal envoluntarios sanos), para control de valores basales, y (D)curva teórica con los valores de melatonina plasmáticarecogidos en la literatura, tanto basales como en rangohipnótico. La determinación de los valores de la hormonase realizó mediante ELISA, tanto los basales, como alos 10 y 60 minutos tras iniciarse la sedación y 90 minutostras ser retirada la misma.RESULTADOS: Incluimos 20 pacientes. No apreciamosdiferencias en los valores basales (p>0,269), tras 60minutos después de iniciar la sedación, ni 90 minutostras retirar la misma (p>0,347 y p>0,057 respectivamente).Apreciamos diferencias significativas entre los gruposA y D respecto al B (p<0,001) en el minuto 10 trasiniciar la sedación con propofol.CONCLUSIONES: Observamos un aumento de melatoninaplasmática durante la administración de propofol enperfusión continua (AU)

OBJECTIVE: To determine possible variations in plasma ;;levels of melatonin in patients sedated with propofol ;;administered in continuous infusion. ;;PATIENTS AND METHODS: Healthy patients receiving ;;spinal anesthesia for lower limb orthopedic surgery were ;;randomized to 2 groups in this prospective study: group A ;;patients were sedated with intravenous propofol infused at ;;a rate of 3 to 4 mg·kg-1h-1 and group B underwent surgery ;;without sedation. Data from these groups were compared ;;with data from 2 other groups. Group C data, from healthy ;;volunteers who did not undergo surgery or sedation, were ;;compared with baseline values. Group D data were ;;theoretical reference values for plasma melatonin levels ;;taken from the literature, for comparisons at baseline and ;;in the range of hypnosis. Hormone levels were determined ;;by enzyme-linked immunosorbent assay at baseline, at 10 ;;and 60 minutes after the start of sedation, and 90 minutes ;;after withdrawal of sedation. ;;RESULTS: Twenty patients were enrolled. No significant ;;between-group differences were detected at baseline (P>.269), ;;60 minutes after starting sedation or 90 minutes after ;;withdrawing it (P>.347 and P>.057 respectively). Values were ;;significantly different between group B and groups A and D ;;10 minutes after starting sedation with propofol (P<.001). ;;CONCLUSIONS: Plasma levels of melatonin increased; during administration of propofol in continuous perfusion (AU)

Intervenciones del psicólogo en las Clínicas del Dolor: una propuesta desde la experiencia de la Unidad del Dolor del Hospital Universitario Príncipe de Asturias en Alcalá de Henares, Madrid / Psychological interventions in Pain Clinics: a experiencial proposal from the Pain Clinic of the Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid

Se muestran algunos recursos que la psicología aporta al tratamiento del dolor crónico, tratando de integrarlos de un modo efectivo para que los aplique un solo profesional dentro de la Unidad del Dolor. Como herramientas de evaluación se recurre a la entrevista no estructurada, pero orientada con un guión que aborde aspectos psicológicos del propio dolor y de la vida con dolor. También se criban las posibles psicopatologías mediante un cuestionario basado en los criterios del DSM-IV. El proceso de evaluación es siempre individual y pretende ampliar la información ya recogida por los médicos. La intervención propuesta se basa en diversas técnicas de aplicación grupal, combinando en cada paciente aquellas que se muestren útiles para aumentar su funcionalidad y autonomía. Dichas técnicas son: relajación muscular progresiva, técnicas de respiración, técnicas cognitivas (transformación imaginativa del dolor y del contexto, desviación por medio del pensamiento y de estímulos externos y somatización). El programa resultante aborda los aspectos psicológicos del dolor más estudiados, y aplica intervenciones de efectividad contrastada al máximo de pacientes abarcables por un sólo profesional (AU)

Some psychological resources on the treatment of chronic pain ares shown, trying to integrate them to be applied by a single professional with the maximun effectivity. Structured interview is choosen as the main tool for evaluation, the use of a survey is also recomended as a guide to cover the psychological aspects of the pain and the life with pain. In order to detect psychopatology, a test based on DSM-IV criteria is used. The evaluation process is always individual and it tries to expand the information already collected by the anaesthetists. The suggested intervention is based on several grupal techniques. They are combined for each patient attending to wich ones have shown effectiveness on the increasement of autonomy. Proposed techniques are: progressive muscular relaxation, respiration exercises and some cognitive techniques. The resulting program covers the most studied psychological aspects of the chronic pain, and uses resources with well tested results on the treatment of chronic pain (AU)

Manejo del dolor en el cáncer urológico / Management of pain in urologic cancer

Cada día la atención integral del paciente oncológico ocupa un mayor tiempo en nuestra actividad asistencial. El dolor de los pacientes afectos de cáncer urológico precisa nuestra atención y constante puesta al día en disciplinas afines como la farmacología y la terapéutica del dolor. Un mejor conocimiento de los aspectos fisiológicos y de las características del dolor que sufren estos pacientes permitirá el manejo eficiente de los mismos, tanto en la vertiente de dolor postoperatorio, como en el paciente que sufre progresión tumoral. Desde un punto de vista práctico se revisan los aspectos etiopatogénicos del dolor y se presentan unas pautas terapéuticas elementales que deben ser conocidas por todo urólogo. Dichas pautas incluyen tanto las diversas modalidades terapéuticas como las complicaciones que se puedan generar del tratamiento analgésico. Su correcta aplicación evitará la prolongación de ingresos hospitalarios innecesarios y permitirá una consiguiente disminución de costes.Para ello el paciente oncológico debe recibir cuidados integrales de forma individualizada, lo que le permitirá afrontar su situación con dignidad. Esta asistencia debe encuadrarse deseablemente en el entorno familiar. (AU)

[Subcutaneous, pneumomediastinal, pneumopericardial emphysema and pneumothorax following retrosigmoid resection]. / Enfisema subcutáneo, neumomediastino, neumopericardio y neumotórax tras resección anterior de rectosigma.

Pulmonary alveolar rupture can occur spontaneously or as a result of mechanical ventilation or other causes, and may give rise to bullae or emphysema without producing extrapulmonary air. Most but not all cases occur in patients with underlying lung disease. We describe a patient with no history of lung disease who underwent anterior sigmoid resection under combined (general/epidural) anesthesia. Soon after the patient awoke from anesthesia, subcutaneous, pneumomediastinal and pneumopericardiac emphysema developed, along with bilateral pneumothorax. We discuss the possible causes of extra-alveolar air was well as ways to detect and treat it.

[Anaphylactic shock caused by the rupture of an unknown hepatic hydatid cyst]. / Shock anafiláctico por rotura traumática de quiste hidatídico hepático desconocido.

We report the case of a 66-year-old woman with moderate-to-severe mitral stenosis who survived anaphylactic shock due to traumatic rupture of a hydatid liver cyst. Hydatid liver disease was diagnosed by ultrasound, and necessary life-support measures were taken, with hydration to restore electrolytic balance and vasoactive amines. The suspected diagnosis of hydatid liver cyst rupture was confirmed surgically. We discuss the immunologic mechanisms of anaphylactic shock and its treatment, and emphasize that Echinococcus liver cysts should be suspected in cases of anaphylaxis of uncertain etiology. Acute vascular collapse, generalized cutaneous erythema, urticaria and edema are suggestive of anaphylaxis arising from hydatidosis, particularly when patients reside in endemic areas.

[Anesthesia for cesarean section in patients with mitral valve prolapse]. / Anestesia para cesárea en pacientes con prolapso de la válvula mitral.

Mitral valve prolapse is the most frequent cardiac valvulopathy. Given its greater incidence in young women it is a factor which must be taken into account when performing cesarean section. Two patients with mitral valve prolapse in whom a cesarean section was carried out are presented: case 1, a 22-year-old woman, ASA II, 72 kg, with mitral valve prolapse associated with the Wolf-Parkinson-White syndrome and an episode of paroxysmal supraventricular tachycardia. The cesarean section which was indicated because of the absence of fetal progression was performed under epidural anesthesia. Forty-five minutes after regional blockade a hypotensive episode was observed which remitted following the i.v. administration of 6 mg of methoxamine. No other complication was reported. The Apgar score of the neonate at one minute was 7; case 2, a 31 year-old woman, ASA II, 51 kg, diagnosed with mitral valve prolapse with no associated symptomatology. A cesarean section was performed in this patient because of pedal presentation under general anesthesia without complications. The Apgar score of the neonate at one minute was 8. The physiopathology of mitral valve prolapse as well as anesthesia management during cesarean section in this type of valvulopathy is reviewed.

[Botulinum toxin: clinical uses and anesthetic implications]. / Toxina botulínica: usos clínicos e implicaciones anestésicas.

Botulinum toxin, a neurotoxin responsible for botulism, is at present used to treat anomalous muscle contractions. Administration to children and relatively uncooperative patients requires general anesthesia, which should be selected taking into consideration the special characteristics of the surgical procedure and the possible interactions of anesthetic drugs and the toxin.