A randomised controlled trial in patients undergoing arthroscopic shoulder surgery comparing interscalene block with either 10 ml or 20 ml levobupivacaine 0.25.

The interscalene brachial plexus block is recommended for analgesia after shoulder surgery but it may cause hemidiaphragmatic dysfunction. We tested whether ipsilateral hemidiaphragmatic contraction was better after a smaller dose of local anaesthetic without impairing analgesic effect. We randomly allocated 48 adults to 10 ml or 20 ml levobupivacaine 0.25% before arthroscopic shoulder surgery. The primary outcome was hemidiaphragmatic paralysis, defined as inspiratory thickness < 1.2 times expiratory thickness, measured by ultrasound 4 h after block. Hemidiaphragmatic paralysis was recorded for 6/24 vs. 23/24 supine participants after 10 ml vs. 20 ml levobupivacaine 0.25%, respectively, and for 4/24 vs. 23/24 sitting participants, respectively, p < 0.001 for both. Pain scores after 10 ml injectate were not worse than after 20 ml injectate. Median (IQR [range]) morphine doses in the first 24 postoperative hours after 10 ml and 20 ml levobupivacaine 0.25% were 2 (0-6 [0-23]) mg vs. 1 (0-2 [0-11]) mg, respectively, p = 0.12. No participant had a complication after 10 ml interscalene levobupivacaine, whereas seven had complications after 20 ml levobupivacaine, p = 0.009. Hemidiaphragmatic function was better after 10 ml vs. 20 ml interscalene levobupivacaine 0.25% without impairing analgesia for 24 postoperative hours.

Diaphragmatic paralysis, respiratory function, and postoperative pain after interscalene brachial plexus block with a reduced dose of 10 ml levobupivacaine 0.25% versus a 20 ml dose in patients undergoing arthroscopic shoulder surgery: study protocol for the randomized controlled double-blind REDOLEV study.

BACKGROUND: Arthroscopic shoulder surgery causes severe postoperative pain. An interscalene brachial plexus block provides adequate analgesia, but unintended spread of the local anesthetic administered may result in a phrenic nerve block, usually associated with a nonnegligible incidence of acute hemidiaphragmatic paralysis. The main purpose of this trial will be to analyze the incidence of hemidiaphragmatic paralysis ensuing after interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery administered a standard volume (20 ml) vs. a low volume (10 ml) of levobupivacaine 0.25%. METHODS: This will be a prospective double-blind randomized controlled single-center two-arm comparative trial. Forty-eight patients will be included. The primary goal will be to ultrasonographically determine the incidence of hemidiaphragmatic paralysis by calculating the diaphragmatic thickness ratio in each group. The secondary goals will be to compare the two arms in terms of (1) decrease in forced vital capacity and (2) in forced expiratory volume at 1 s by spirometry; (3) decrease in diaphragmatic excursion by ultrasound; (4) 24-h total intravenous morphine consumption; (5) time to first opioid request of a patient-controlled analgesia pump; and (6) postoperative complications. DISCUSSION: This trial will demonstrate that a low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis following arthroscopic shoulder surgery according to spirometry and ultrasound measurements and does not provide inferior postoperative analgesia to the standard volume, as measured by opioid requirements. TRIAL REGISTRATION: EudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (registered on 7 January 2020). ClinicalTrials.gov identification number: NCT04385966 (retrospectively registered on 8 May 2020). Ethics Committee approval: EC19/093 (18 December 2019).

A comparative study of five horizontal subsurface flow constructed wetlands using different plant species for domestic wastewater treatment.

This project studied domestic wastewater treatment by horizontal subsurface flow (HSSF) constructed wetlands (CW) and compared the effect of four different plant species on the operating conditions, dissolved oxygen (DO), and redox potential (ORP), and their efficiency on pollutants removal. Five HSSF CWs were fed for 10 months with low loaded synthetic domestic wastewater, using theoretical hydraulic residence time of 7.6 days. The plant species under study were the following: Phragmites australis (CW1), Lythrum salicaria (CW3), Cladium mariscus (CW4) and Iris pseudacorus (CW5). CW2 was not planted and this was used as control. Qualitative measurements determined a greater growth of Lythrum salicaria and Iris pseudacorus than the others. Dissolved oxygen concentrations were very low in the entire bulk liquid of all the CWs. Also ORP values were very similar in all wetlands, dealing with facultative anaerobic environments. All planted wetlands improved pollutants removal compared with the unplanted control wetland. The performances in terms of COD, TN, TP and SO4(2-) removal obtained by the different CWs were in the ranges 80-90%, 35-55%, 15-40% and 45-60% respectively. Lythrum salicaria and Iris pseudacorus, which exhibited greater growth, were always the most efficient species that improved not only nutrients plant uptake but also other microbial removal processes probably due to a higher aeration potential, such as nitrification or aerobic respiration. Sulphate reduction was the most important mechanism for COD removal. Cladium mariscus, an autochthonous plant that grows in the south-central Iberian Peninsula, was less efficient than Lythrum salicaria and Iris pseudacorus, but improved the unplanted wetland wastewater efficiency.

[Two cases of acute pulmonary edema secondary to laryngospasm]. / Dos casos de edema agudo de pulmón secundario a laringospasmo.

We report two cases of acute pulmonary edema attributable to episodes of postextubation laryngospasm appearing when two young patients awoke after appendectomies under general anesthesia. Both patients improved in less than 48 hours with diuretics, oxygen therapy and liquid restriction, making tracheal intubation unnecessary. The pathophysiology and clinical and radiological signs of pulmonary edema are reviewed.

[Orodental hygiene habits in preadolescents and adolescents from 2 urban and 2 rural secondary schools]. / Estudio de hábitos de higiene bucodental en preadolescentes y adolescentes de dos colegios urbanos y dos rurales.

OBJECTIVE: Buccodental health is a problem of high prevalence, including mainly caries, malocclusion and malposition. Dental caries is the principal oral problem of childhood and adolescence. The objective of our study was to know the information, customs and attitudes in relationship to buccodental hygiene of preadolescent and adolescent students. MATERIAL AND METHODS: The design is a cross-sectional epidemiological study of two urban (n = 330 students) and two rural (n = 270 students) schools. We performed an individual interview with the students that included 27 items concerning knowledge, customs and attitudes about buccodental hygiene. RESULTS: The prevalence of caries is 24.5% in our population. We found the best buccodental hygiene in rural students and girls. The adolescents are more problematic than preadolescents. CONCLUSION: It is important to make health examinations and to have health education in school, especially concerning some pathologies with a higher prevalence such as dental caries and other buccodental diseases. The first step towards good health education is to know the reality of the problem. A higher level of sanitary education in rural schools is most likely the cause for better results in this population. The girls have more conscience of this disease. It is necessary to increase the health education about buccodental hygiene, mainly in adolescence.

Anestesia en un paciente con déficit congénito de antitrombina III / anesthesia in a patient with congenital antithromin III deficit

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Anestesia en un caso de malformación Arnold-Chiari tipo I / Anesthesia in a case of Arnold-Chiari type I malformation

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Fibrobroncoscopia a través de mascarilla laríngea en un paciente con síndrome de goldenhar / Fiberoptic bronchoscopy by laryngeal mask in a patient with Goldehar's syndrome

No disponible

Anestesia general en una gestante con ataxia de friedreich / General anesthesia in a pregnant patient with Friedreich ataxia

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Anestesia subaracnoidea en un caso de miopatía mitocondrial / Anesthesia in a case of mitochondrial myopathy

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