Estudio comparativo de diferentes sets de infusión epidural a velocidades máximas para analgesia del parto / Comparative study of different epidural infusion sets at maximum speeds for labor analgesia

INTRODUCCIÓN: Una de las ventajas de utilizar bolos epidurales es que se ejerce mayor presión de inyección y por tanto más difusión produciendo un mayor bloqueo sensitivo. Por tanto si a mayor velocidad de administración del bolo más presión se ejerce cabe esperar que el nivel sensitivo alcanzado sea mayor. OBJETIVO: Nuestro objetivo fue comparar el nivel sensitivo alcanzado con el set de alto flujo y el de flujo estándar a velocidades máximas. MATERIAL Y MÉTODOS: Se incluyeron setenta y tres gestantes primíparas que solicitaron analgesia epidural utilizando bolos epidurales intermitentes programados a 10ml cada 60 min de ropivacaína al 0,1% con fentanilo 2ug/ml más analgesia epidural controlada por la paciente. Dichos bolos se administraron con set de infusión estándar a 250ml/h o de alto flujo a 500ml/h según la práctica clínica habitual de cada anestesiólogo. El objetivo primario fue evaluar el nivel sensitivo alcanzado. Los objetivos secundarios fueron la escala visual analógica, la escala modificada de Bromage y el consumo anestésico en términos de analgesia de rescate (analgesia epidural controlada por la paciente y bolos administrados por el anestesiólogo). RESULTADOS: La mediana del nivel sensitivo máximo fue T9 en el grupo de alto flujo y T7 en el de flujo estándar, siendo dicha diferencia significativa estadísticamente (P=0,0002). No hubo diferencias significativas en la escala visual analógica, Bromage o analgesia de rescate. CONCLUSIÓN: El set de alto flujo no ofrece beneficios en cuanto a los resultados analizados por lo que hay que valorar su uso ya que conlleva un coste adicional

INTRODUCTION: The higher injection pressure obtained with epidural boluses give greater anaesthetic spread, and therefore better sensory block. Therefore, it stands to reason that anaesthetic administered at greater injection pressure and a higher flow rate would spread to a higher sensory level. OBJECTIVE: Our aim was to compare the sensory level reached with the high flow. and standard flow set at maximum rates. MATERIAL AND METHODS: We included 73 primiparous women who requested epidural analgesia for labour using programmed intermittent epidural boluses of 0.1% ropivacaine at a flow rate of 10ml/h and 2 ug/ml fentanyl plus patient-controlled epidural analgesia. The boluses were administered with a standard (250ml/h) or high-flow (500ml/h) infusion set, according to the usual clinical practice of each anaesthesiologist. The primary objective was to evaluate the sensory level reached. Secondary objectives were pain on a visual analogue scale, motor block measured on the modified Bromage scale, and anaesthesia consumption in terms of rescue analgesia (patient-controlled epidural analgesia) and anaesthesiologist-administered boluses. RESULTS: The median maximum sensory level reached was T9 in the high flow group and T7 in the standard flow group; this difference was statistically significant (p=.0002). There were no significant differences in visual analogue scale, Bromage or rescue analgesia between groups. CONCLUSION: Our results show that the high flow set does not offer benefits. The use of such sets need to be evaluated due to their higher cost

Comparative study of different epidural infusion sets at maximum speeds for labor analgesia. / Estudio comparativo de diferentes sets de infusión epidural a velocidades máximas para analgesia del parto.

INTRODUCTION: The higher injection pressure obtained with epidural boluses give greater anaesthetic spread, and therefore better sensory block. Therefore, it stands to reason that anaesthetic administered at greater injection pressure and a higher flow rate would spread to a higher sensory level. OBJECTIVE: Our aim was to compare the sensory level reached with the high flow. and standard flow set at maximum rates. MATERIAL AND METHODS: We included 73 primiparous women who requested epidural analgesia for labour using programmed intermittent epidural boluses of 0.1% ropivacaine at a flow rate of 10ml/h and 2 ug/ml fentanyl plus patient-controlled epidural analgesia. The boluses were administered with a standard (250ml/h) or high-flow (500ml/h) infusion set, according to the usual clinical practice of each anaesthesiologist. The primary objective was to evaluate the sensory level reached. Secondary objectives were pain on a visual analogue scale, motor block measured on the modified Bromage scale, and anaesthesia consumption in terms of rescue analgesia (patient-controlled epidural analgesia) and anaesthesiologist-administered boluses. RESULTS: The median maximum sensory level reached was T9 in the high flow group and T7 in the standard flow group; this difference was statistically significant (p=.0002). There were no significant differences in visual analogue scale, Bromage or rescue analgesia between groups. CONCLUSION: Our results show that the high flow set does not offer benefits. The use of such sets need to be evaluated due to their higher cost.

Oral health and quality of life in the municipal senior citizen's social clubs for people over 65 of Valencia, Spain.

BACKGROUND: The world population is aging considerably. The state of elderly's dentition is poor. Many authors agree that the oral health status influence the elderly's quality of life.The objective of our study was to analyze the relation between the oral health status and the general health status through the quality of life of elderly people aged 65 years or more in Valencia, Spain. MATERIAL AND METHODS: A cross-sectional oral health survey and an oral examination have been designed to study an elderly population. There were 202 adults (103 men and 99 women). Age: 65 years of age and over. Randomly selected senior citizen's social clubs. The Oral Health Impact Profile (OHIP-14) has been used to obtain the health survey. Moreover, the EuroQol-5d and a Visual Analogue Scale (VAS) have been the tools to obtain the general health status. Finally, sociodemographic and oral health questions have been needed. RESULTS: Descriptive and inferential results have been done and the main results are the following, the mean additive score of the OHIP-14 was 8.88, the mean value of the EuroQol-5d was 0.58 and of the VAS, 72.90. The OHIP-14 was consistently and significantly correlated with the index EuroQol-5d and with variables such as number of teeth, missing teeth, DMFT, dental status (being or not edentulous) and occupation. The EuroQol-5d was related to dental habits, sex, income, systemic pathologies and filled teeth. CONCLUSIONS: The oral health has a high impact on quality of life. The oral health and the general health are closely related. The oral hygiene and getting toothless influence negatively on the quality of life of elderly people.

[Prognostic factors of mortality during the episode of pneumonia due to Pneumocystis carinii in patients with HIV infection]. / Factores pronósticos de mortalidad durante el episodio de neumonía por Pneumocystis carinii en pacientes con infección por VIH.

BACKGROUND: Despite a steady decrease in its incidence, pneumonia caused by Pneumocystis carinii (PCP) are still diagnosed, and they occur frequently in patients unaware of being infected with the human immunodeficiency virus (HIV). Since it is a disease with a high mortality risk, its early diagnosis and therapy would allow these patients to benefit from the advantages afforded Pneumocystis carinii, neumonía, infecciones oportunistas relacionadas con el sida, pronóstico.by anti-retroviral therapy. PATIENTS AND METHODS: Retrospective study, in which all adult HIV infected patients with microbiologically demonstrated PCP diagnosed at two tertiary-level hospitals in our country between 1985 and 1996 were included. The clinical records of patients were used as information source. The relative risks (RR) of death were estimated by the multivariant logistic regression. RESULTS: PCP was the first AIDS indicating disease in approximately 70 % of cases. Thirteen percent of patients died during the episode. Patients aged over 45 years had a death RR during the episode of 3.15 (95 % CI from 0.8 to 12.2); patients previously diagnosed of AIDS had a death RR of 3.4 (95 % CI from 1.3 to 9), and those with an alveolar-arterial oxygen gradient (pA-aO2) > 50 mmHg, a death RR of 3 (95% CI from 1.1 to 8). CONCLUSIONS: Factors independently related to survival to the PCP episode are age below 45 years, not to have had another AIDS indicating disease, and to have a pA-aO2 below 50 mmHg at diagnosis.

Factores pronósticos de mortalidad durante el episodio de neumonía por Pneumocystis carinii en pacientes con infección por VIH / Prognostic factors of mortality during the episode of pneumonia due to Pneumocystis carinii in patients with HIV infection

Fundamento. A pesar de un claro descenso en su incidencia, se siguen diagnosticando neumonías por Pneumocystis carinii (NPC), presentándose con frecuencia en pacientes que ignoran su situación de infectados por el VIH. Puesto que se trata de una enfermedad con un riesgo elevado de mortalidad, su rápido reconocimiento y tratamiento les permitirá beneficiarse a posteriori de las ventajas aportadas por el tratamiento antirretrovírico. Pacientes y métodos. Estudio retrospectivo en el que se incluyeron todos los pacientes adultos con infección por VIH y NPC confirmada microbiológicamente, diagnosticados en dos hospitales terciarios de nuestro país entre 1985 y 1996. Las historias clínicas de los pacientes se utilizaron como fuente de información. Los riesgos relativos (RR) de muerte se estimaron mediante regresión logística multivariable. Resultados. La NPC fue la primera enfermedad indicadora de sida en aproximadamente el 70 por ciento de los casos. Un 13 por ciento de los pacientes fallecieron durante el episodio. Los pacientes mayores de 45 años tienen un RR de muerte durante el episodio de 3,15 (índice de confianza [IC] 95 por ciento: 0,8, 12,2); aquellos que habían sido previamente diagnosticados de sida tienen un RR de muerte de 3,4 (índice de confianza [IC] 95 por ciento: 1,3, 9) y los que presentan un gradiente alveolo-arterial de oxígeno (pA-a O2) > 50 mmHg, un RR de muerte de 3 (IC 95 por ciento: 1,1,8).Conclusiones. Los factores relacionados de forma independiente con la supervivencia al episodio de NPC son la edad menor de 45 años, el no haber tenido con anterioridad otra enfermedad indicadora de sida y presentar en el momento del diagnóstico un pA-a O2 inferior a 50 mmHg. (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)

[Presence of Pneumocystis carinii in cerebrospinal fluid]. / Pneumocistis carinii en líquido cefalorraquídeo.

Pneumocistis carinii is a ubiquitous protozoan present in mammals which frequently causes pulmonary problems in immunodeficient patients, especially those infected with the Human Immunodeficiency Virus. Given its particular affinity with the lung area, it is rarely present in other tissues. It has on occasions been detected in the liver, spleen and lymphatic ganglia, external auditory canal, skin and to a lesser extent, other organs. It is extremely rare that the pathogen in question produces extra-pulmonary clinical conditions. The case presented is that of an ex-intravenous drug user diagnosed as a carrier of the HIV/C-3 virus, who presented indications of meningeal pathology and in whose cephalorachidian fluid samples were detected Pneumocistis carinii cysts.

[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.

[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.