Comparative pharmacoeconomic study of vancomycin and teicoplanin in intensive care patients.

Randomized clinical trials and meta-analyses have not demonstrated any statistically significant differences between teicoplanin and vancomycin with regard to efficacy. A cost-minimization analysis was conducted to compare the economical impact of the treatment with vancomycin and teicoplanin in intensive care patients. Information on resource utilization was retrospectively collected from 100 consecutive clinical histories of patients hospitalized in a Spanish Intensive Care Unit, who had been given a glycopeptide antibiotic (50 teicoplanin and 50 vancomycin) for the treatment of a suspected or proven infection. Although personnel, material, and monitoring costs were higher in the vancomycin group, the acquisition costs and the total costs were much lower in this group, so the resulting total costs per day were 5508 ptas (33 euros) for vancomycin-treated patients and 9893 ptas (59.5 euros) for teicoplanin-treated patients. The savings with vancomycin for a 10-day course of treatment would be approximately 40697 ptas (244.5 euros) per patient. Results were consistent for a variety of conditions that were included in the sensitivity analysis.

[Obstetrical anesthesia in 15 women with myasthenia gravis]. / Anestesia en 15 gestantes afectadas de miastenia grave.

OBJECTIVES: To report our experience in managing anesthesia during obstetric delivery of women with myasthenia gravis (MG) and to review the anesthetic technique of choice for vaginal or cesarean delivery in such cases. PATIENTS AND METHODS: Fifteen pregnancies in 12 patients were recorded between 1980 and 1996; 14 cases were documented. Disease course during pregnancy, delivery and postpartum, the course of pregnancy, the presence of severe neonatal myasthenia and anesthetic treatment during vaginal or cesarean delivery were analyzed. RESULTS: Improvement in MG was observed in 6 cases. No change was seen in 4 patients and 3 worsened. In one woman generalized MG debuted 15 days after delivery. Two neonates were premature and a third suffered severe neonatal myasthenia. Six vaginal deliveries were aided by forceps; 8 deliveries were by cesarean and 1 fetus was aborted. Lumbar epidural anesthesia was employed in 73.33% (5 vaginal deliveries and 6 cesareans) and general anesthesia in 26.66% (1 abortion, 1 vaginal delivery and 2 cesareans). CONCLUSIONS: Continuous lumbar epidural anesthesia is the technique of choice for vaginal as well as cesarean deliveries. The combination of opioids and local anesthetics is considered particularly beneficial for patients, as it allows the motor blockade to be decreased. General anesthesia is only indicated when there is bulbar involvement. Short-acting non depolarizing agents, among them atracurium Besilate, are the muscle relaxants of choice. Succinylcholine is contraindicated. Thanks to current optimization of anesthetic and recovery techniques and administration of non depolarizing muscle relaxants with neuromuscular monitoring, the prognosis for pregnant MG patients has improved considerably.

[Anesthesia in Kearns-Sayre syndrome (mitochondrial myopathy)]. / Anestesia en el síndrome de Kearns-Sayre (miopatía mitocondrial).

We report the case of a 27-year-old woman with a history of Kearns-Sayre syndrome and a double mitral lesion who underwent surgery without complications. Anesthetic induction was achieved with propofol and fentanyl, and maintenance was with nitrous oxide and oxygen through a face mask. There were no instances of O2 desaturation or hemodynamic alterations. The postoperative period transpired without adverse events and the patient was released 24 h after surgery. The management of anesthesia in this rare mitochondrial disease is described, and anesthetic alternatives are discussed as depending on clinical findings that can occur in the context of these syndromes.

[Obstetric analgesia using continuous epidural perfusion of bupivacaine, adrenaline, and fentanyl]. / Analgesia obstétrica mediante perfusión epidural continua de bupivacaína, adrenalina y fentanilo.

OBJECTIVES: To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth. PATIENTS AND METHODS: Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out. RESULTS: Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable. CONCLUSIONS: Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.

[Anesthesia in a case of hyperkalemic familial periodic paralysis]. / Anestesia en un caso de parálisis periódica familiar hiperpotasémica.

Periodic familial hyperpotassemic paralysis is a dominant autosomic disease of brief periods of acute flaccid paralysis with complete posterior recovery. During surgical-anesthesia a number of factors concur which may trigger a paralytic episode. To this effect anesthetic drugs such as barbiturates and muscle relaxants have been involved. The case of a 12 year old patient with familial hyperpotassemic paralysis who received general anesthesia with propofol and atracurium besylate for emergency appendectomy is presented. During surgery the plasma levels of potassium were monitored and prophylaxis of the factors which potentially trigger a paralytic picture was performed. Both, the perioperative and the postoperative period, were without complications.