[Analgesia preventiva con pregabalina en pacientes postoperados de colecistectomía laparoscópica].

BACKGROUND: Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures. OBJECTIVE: To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients. METHODS: A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the emergency nurses association scale at 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale. RESULTS: Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005). CONCLUSION: The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

ANTECEDENTES: La analgesia preventiva es la administración de un fármaco analgésico con el objetivo de atenuar el dolor postoperatorio, la hiperalgesia y alodinia. Está justificado su uso con la finalidad de ofrecer analgesia y disminuir la ansiedad a los pacientes sometidos a procedimientos laparoscópicos. OBJETIVO: Evaluar si la pregabalina en dosis de 1 mg/kg de peso es eficaz para analgesia preventiva en pacientes postoperados de colecistectomía laparoscópica. MÉTODOS: Se realizó un ensayo clínico controlado ciego simple que incluyó 60 pacientes programados para colecistectomía laparoscópica divididos en 2 grupos de manera aleatoria, donde al grupo 1 se administró placebo y al grupo 2 se le administró pregabalina una dosis diaria 72 horas previas a la intervención quirúrgica. La intensidad del dolor se evaluó mediante la Escala Numérica Analógica a la hora, 2, 6,12 y 24 horas postoperatorias, así como el nivel de ansiedad prequirúrgico con la Escala de Hamilton. RESULTADOS: Se demostró disminución del dolor en los pacientes del grupo de pregabalina desde la primera hora (p = 0.002), posteriormente fue más notorio el descenso del dolor en comparación con los pacientes a los que se les dio placebo, con valor estadísticamente significativo (p < 0.001), lo mismo sucedió con el nivel de ansiedad evaluada con la Escala de Hamilton (p < 0.005). CONCLUSIÓN: El uso de pregabalina para analgesia preventiva resulta ser eficaz en la ansiedad preoperatoria y el periodo posquirúrgico, y con mínimos efectos adversos, en los pacientes operados de colecistectomía laparoscópica.

Preventive analgesia with pregabalin in laparoscopic cholecystectomy post-operated patients.

BACKGROUND: Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures. OBJECTIVE: To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients. METHODS: A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the numeric analog scale at 1, 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale. RESULTS: Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005). CONCLUSION: The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

Evaluation of a Model (RUMINANT) for Prediction of DMI and CH4 from Tropical Beef Cattle.

Simulation models represent a low-cost approach to evaluating agricultural systems. In the current study, the precision and accuracy of the RUMINANT model to predict dry matter intake (DMI) and methane emissions from beef cattle fed tropical diets (characteristic of Colombia) was assessed. Feed intake (DMI) and methane emissions were measured in Brahman steers housed in polytunnels and fed six forage diets. In addition, DMI and methane emissions were predicted by the RUMINANT model. The model's predictive capability was measured on the basis of precision: coefficients of variation (CV%) and determination (R2, percentage of variance accounted for by the model), and model efficiency (ME) and accuracy: the simulated/observed ratio (S/O ratio) and slope and mean bias (MB%). In addition, combined measurements of accuracy and precision were carried out by means of mean square prediction error (MSPE) and correlation correspondence coefficient (CCC) and their components. The predictive capability of the RUMINANT model to simulate DMI resulted as valuable for mean S/O ratio (1.07), MB% (2.23%), CV% (17%), R2 (0.886), ME (0.809), CCC (0.869). However, for methane emission simulations, the model substantially underestimated methane emissions (mean S/O ratio = 0.697, MB% = -30.5%), and ME and CCC were -0.431 and 0.485, respectively. In addition, a subset of data corresponding to diets with Leucaena was not observed to have a linear relationship between the observed and simulated values. It is suggested that this may be related to anti-methanogenic factors characteristic of Leucaena, which were not accounted for by the model. This study contributes to improving national inventories of greenhouse gases from the livestock of tropical countries.

Active core rewarming avoids bioelectrical impedance changes in postanesthetic patients.

BACKGROUND: Postoperative hypothermia is a common cause of complications in patients who underwent laparoscopic cholecystectomy. Hypothermia is known to elicit electrophysiological, biochemical, and cellular alterations thus leading to changes in the active and passive membrane properties. These changes might influence the bioelectrical impedance (BI). Our aim was to determine whether the BI depends on the core temperature. METHODS: We studied 60 patients (52 female and 8 male) age 40 to 80 years with an ASA I-II classification that had undergone laparoscopic cholecystectomy under balanced inhalation anesthesia. The experimental group (n = 30) received active core rewarming during the transanesthetic and postanesthesic periods. The control group (n = 30) received passive external rewarming. The BI was recorded by using a 4-contact electrode system to collect dual sets of measurements in the deltoid muscle. The body temperature, hemodynamic variables, respiratory rate, blood-gas levels, biochemical parameters, and shivering were also measured. The Mann-Whitney unpaired t-test was used to determine the differences in shivering between each group at each measurement period. Measurements of body temperature, hemodynamics variables, respiratory rate, and BI were analyzed using the two-way repeated-measures ANOVA. RESULTS: The gradual decrease in the body temperature was followed by the BI increase over time. The highest BI values (95 ± 11 Ω) appeared when the lowest values of the temperature (35.5 ± 0.5°C) were reached. The active core rewarming kept the body temperature within the physiological range (over 36.5°C). This effect was accompanied by low stable values (68 ± 3 Ω) of BI. A significant decrease over time in the hemodynamic values, respiratory rate, and shivering was seen in the active core-rewarming group when compared with the controls. The temporal course of shivering was different from those of body temperatue and BI. The control patients showed a significant increase in the serum-potassium levels, which were not seen in the active-core rewarming group. CONCLUSIONS: The BI analysis changed as a function of the changes of core temperature and independently of the shivering. In addition, our results support the beneficial use of active core rewarming to prevent accidental hypothermia.

Recommendations for airway management in a suspected or confirmed case with COVID-19. A protocol of the Department of Cardiovascular Anesthesia of the National Institute of Cardiology Ignacio Chávez / Recomendaciones para el manejo de la vía aérea en caso sospechoso y/o confirmado con COVID-19. Protocolo del Departamento de Anestesiología Cardiovascular del Instituto Nacional de Cardiología Ignacio Chávez

The new coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), detected in Wuhan, China, causes coronavirus disease 2019 (COVID-19), which was declared pandemic, and has caused more than 19 million confirmed cases and more than 700 thousand deaths worldwide. When our institution was converted to COVID's hospital since early April 2020, specific care protocols were developed, with the aim of improving the quality of care and safety of patients and the staff involved in their management. Airway management represents one of the highest risks of direct contact infection with aerosol generation (orotracheal intubation, secretion aspiration, extubation, cardiopulmonary resuscitation, high flow oxygen therapy, noninvasive ventilation, and invasive ventilation). We present the current recommendations for airway management as well as a step-by-step airway management protocol to carry out a more secure procedure based on the literature reported so far.

El nuevo coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), detectado en Wuhan (China), causante de la enfermedad por coronavirus 2019 (COVID-19), que se declaró como pandemia, ha causado más de 19 millones de casos confirmados y más de 700 mil muertes en el mundo. Nuestra institución se reconvirtió a hospital COVID desde principios de abril del 2020, con lo que se desarrollaron protocolos de atención específicos, con el objetivo de mejorar la calidad de atención y seguridad de los pacientes y el personal involucrado en su manejo. El manejo de la vía aérea representa uno de los riesgos más altos de contagio por contacto directo en la generación de aerosoles (intubación orotraqueal, aspiración de secreciones, extubación, resucitación cardiopulmonar, terapia de oxígeno de alto flujo, ventilación no invasiva y ventilación invasiva). Presentamos las recomendaciones actuales para el manejo de la vía aérea, así como un protocolo de manejo paso a paso para llevar a cabo un procedimiento con mayor seguridad basados en la literatura reportada hasta el momento.

[Hyperglycemia controlled with GIK solution in non-diabetic patients subjected to heart surgery]. / Control de la hiperglucemia con la solución de glucosa-insulina-potasio en pacientes no diabéticos en cirugía cardíaca.

UNLABELLED: We prospectively compared, the glucose-insulin-potassium (GIK) solution 1,000 mL 10% glucose, 20 units of fast acting insulin and 60 mEq of potassium chloride, against a GIK solution with 1,000 mL of glucose, 40 units of fast acting insulin an 120 mEq of chloride, in the hyperglycemic control of non-diabetic patient subjected to cardiac surgery. We divided 40 patients in four groups ten patients each. Group A was the control they received 1,000 mL of 10% glucose in water, 20 units of fast acting insulin and 60 mEq of potassium chloride in a drops/ hour dose without an infusion pump. Group B received the same solution in a 50 mL/hour dose. Group C received 1,000 mL of 10% glucose in water, 40 units of fast acting insulin plus, 120 mEq of potassium chloride at the same infusion rate as Group A. Group D 2 1,000 mL of 10% of glucose in water, 40 units of fast acting insulin in the same rate as Group B. The GIK solution was started after anesthesia induction and maintained all along the extracorporeal circulation, the study continued until the patient was transferred to the intensive care unit. We measured blood glucose, circulating insulin and seric levels of potassium three times; basal before the anesthetic induction, during the extracorporeal circulation and at the intensive care unit arrival. The data were analyzed with measure of central tendency, dispersion and multivariate analysis. RESULTS: Among the four groups no statistically significant differences existed in demographic data. In Group A, glucose and potassium levels were higher as compared with the rest of the groups (p <0.05) in all measurements; Group D was less hyperglycaemic as compared with Groups A, B, and C. CONCLUSION: The solution with low insulin dose does useful plasmatic insulin levels in the hyperglycemia in non diabetic patients subjected to cardiac surgery.

[Update of the pulmonary artery catheter in cardiac surgery]. / Actualidades del catéter de flotación pulmonar en cirugía cardíaca.

The pulmonary Artery Catheter was introduced 30 years ago in the clinical practice, one of the main uses is cardiac surgery. There are attempts to substitute hemodynamic values obtained by the catheter with the use of noninvasive devices but none has successfully used, there are several controversy areas based in the utility of the catheter, finding contradictory literature reports, most studies reefers generally to the surgical patient, there are no studies in cardiac surgery, several groups have published statements, they recommended a indication tailored to the hemodynamic status and three interrelated variables to be assessed; patient factors, procedure factors and practice setting factors. The conclusion is the pulmonary artery catheter is only a monitoring device, the value of the hemodiynamic parameters obtained lies in the medical team.

[Glucose-insulin-potassium (GIK) solution: cardioprotective effects of insulin]. / Solución de glucosa-insulina-potasio (GIK): efectos cardioprotectores de la insulina.

In the Anesthesiology Department of the Instituto Nacional de Cardiología The medical staff uses the glucose insulin potassium i.v. for myocardial protection. The energy is dereived from lipidic beta oxidation, glucose breakdown and amino acid catabolism in mitochondria. In myocardial ischemia, from de aortic cross clamping, the metabolic myocardial substrates diminished as well as the energy produced by adenosine (ATP). During myocardial ischemia, an increase in long chain lipids emhances mitochondrial permeability, promotes depletion of citochrome C and lost of the capability of transmembrane regulation. In the hipoperfused myocardium, by coronary vasoconstriction, short chain fatty acids oxidation predominates, if fatty metabolism during reperfusion is elevated. More of them will enter [IBM1] the Krebs cycle and, as a consequence, less energy will be produced. The glucose-insulin-potassium solution provides the glucose needed by the myocardium in reperfusion conditions and protects the cellular membrane's integrity as well as pumps and ionic channels, it allows maintaining the action potential probably because ATP-depended channels block and prevent potassium loss, it reduces the cytosol calcium overload and prevent cardiac arrhythmias, preserves the sodium ATPasa pump avoiding the rise in cytosolic sodium; glucose prevents the production of free oxygen radicals. Fatty acids, during ischemia, are responsible for the metabolism and elevation of enzymes, such as acilcarnitine and acylcoenzime-A, which promote intracellular calcium overload and arrhythmias. The insulin has anti-inflammatory effects and anti-apoptoic effects. When blood glucose is controlled during the perioperative period the mortality is reduced.

Analgesia preventiva con pregabalina en pacientes postoperados de colecistectomía laparoscópica / Preventive analgesia with pregabalin in patients after laparoscopic cholecystectomy

Resumen Antecedentes: La analgesia preventiva es la administración de un fármaco analgésico con el objetivo de atenuar el dolor postoperatorio, la hiperalgesia y alodinia. Está justificado su uso con la finalidad de ofrecer analgesia y disminuir la ansiedad a los pacientes sometidos a procedimientos laparoscópicos. Objetivo: Evaluar si la pregabalina en dosis de 1 mg/kg de peso es eficaz para analgesia preventiva en pacientes postoperados de colecistectomía laparoscópica. Métodos: Se realizó un ensayo clínico controlado ciego simple que incluyó 60 pacientes programados para colecistectomía laparoscópica divididos en 2 grupos de manera aleatoria, donde al grupo 1 se administró placebo y al grupo 2 se le administró pregabalina una dosis diaria 72 horas previas a la intervención quirúrgica. La intensidad del dolor se evaluó mediante la Escala Numérica Analógica a la hora, 2, 6,12 y 24 horas postoperatorias, así como el nivel de ansiedad prequirúrgico con la Escala de Hamilton. Resultados: Se demostró disminución del dolor en los pacientes del grupo de pregabalina desde la primera hora (p = 0.002), posteriormente fue más notorio el descenso del dolor en comparación con los pacientes a los que se les dio placebo, con valor estadísticamente significativo (p < 0.001), lo mismo sucedió con el nivel de ansiedad evaluada con la Escala de Hamilton (p < 0.005). Conclusión: El uso de pregabalina para analgesia preventiva resulta ser eficaz en la ansiedad preoperatoria y el periodo posquirúrgico, y con mínimos efectos adversos, en los pacientes operados de colecistectomía laparoscópica.

Abstract Background: Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures. Objective: To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients. Methods: A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the emergency nurses association scale at 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale. Results: Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005). Conclusion: The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

Control de la hiperglucemia con la solución de glucosa-insulina-potasio en pacientes no diabéticos en cirugía cardíaca / Hyperglycemia controlled with GIK solution in non-diabetic patients subjected to heart surgery

We prospectively compared, the glucose-insulin-potassium (GIK) solution 1,000 mL 10% glucose, 20 units of fast acting insulin and 60 mEq of potassium chloride, against a GIK solution with 1,000 mL of glucose, 40 units of fast acting insulin an 120 mEq of chloride, in the hyperglycemic control of non-diabetic patient subjected to cardiac surgery. We divided 40 patients in four groups ten patients each. Group A was the control they received 1,000 mL of 10% glucose in water, 20 units of fast acting insulin and 60 mEq of potassium chloride in a drops/ hour dose without an infusion pump. Group B received the same solution in a 50 mL/hour dose. Group C received 1,000 mL of 10% glucose in water, 40 units of fast acting insulin plus, 120 mEq of potassium chloride at the same infusion rate as Group A. Group D 2 1,000 mL of 10% of glucose in water, 40 units of fast acting insulin in the same rate as Group B. The GIK solution was started after anesthesia induction and maintained all along the extracorporeal circulation, the study continued until the patient was transferred to the intensive care unit. We measured blood glucose, circulating insulin and seric levels of potassium three times; basal before the anesthetic induction, during the extracorporeal circulation and at the intensive care unit arrival. The data were analyzed with measure of central tendency, dispersion and multivariate analysis. RESULTS: Among the four groups no statistically significant differences existed in demographic data. In Group A, glucose and potassium levels were higher as compared with the rest of the groups (p <0.05) in all measurements; Group D was less hyperglycaemic as compared with Groups A, B, and C. CONCLUSION: The solution with low insulin dose does useful plasmatic insulin levels in the hyperglycemia in non diabetic patients subjected to cardiac surgery.

Actualidades del catéter de flotación pulmonar en cirugía cardíaca / Update of the pulmonary artery catheter in cardiac surgery

The pulmonary Artery Catheter was introduced 30 years ago in the clinical practice, one of the main uses is cardiac surgery. There are attempts to substitute hemodynamic values obtained by the catheter with the use of noninvasive devices but none has successfully used, there are several controversy areas based in the utility of the catheter, finding contradictory literature reports, most studies reefers generally to the surgical patient, there are no studies in cardiac surgery, several groups have published statements, they recommended a indication tailored to the hemodynamic status and three interrelated variables to be assessed; patient factors, procedure factors and practice setting factors. The conclusion is the pulmonary artery catheter is only a monitoring device, the value of the hemodiynamic parameters obtained lies in the medical team.

Solución de glucosa-insulina-potasio (GIK): efectos cardioprotectores de la insulina / Glucose-insulin-potassium (GIK) solution: cardioprotective effects of insulin

In the Anesthesiology Department of the Instituto Nacional de Cardiología The medical staff uses the glucose insulin potassium i.v. for myocardial protection. The energy is dereived from lipidic beta oxidation, glucose breakdown and amino acid catabolism in mitochondria. In myocardial ischemia, from de aortic cross clamping, the metabolic myocardial substrates diminished as well as the energy produced by adenosine (ATP). During myocardial ischemia, an increase in long chain lipids emhances mitochondrial permeability, promotes depletion of citochrome C and lost of the capability of transmembrane regulation. In the hipoperfused myocardium, by coronary vasoconstriction, short chain fatty acids oxidation predominates, if fatty metabolism during reperfusion is elevated. More of them will enter [IBM1] the Krebs cycle and, as a consequence, less energy will be produced. The glucose-insulin-potassium solution provides the glucose needed by the myocardium in reperfusion conditions and protects the cellular membrane's integrity as well as pumps and ionic channels, it allows maintaining the action potential probably because ATP-depended channels block and prevent potassium loss, it reduces the cytosol calcium overload and prevent cardiac arrhythmias, preserves the sodium ATPasa pump avoiding the rise in cytosolic sodium; glucose prevents the production of free oxygen radicals. Fatty acids, during ischemia, are responsible for the metabolism and elevation of enzymes, such as acilcarnitine and acylcoenzime-A, which promote intracellular calcium overload and arrhythmias. The insulin has anti-inflammatory effects and anti-apoptoic effects. When blood glucose is controlled during the perioperative period the mortality is reduced.

Contaminación por halotano en el quirófano, con el uso de dos circuitos anestésicos: Circuito semicerrado y circuito semiabierto / Halothane pollution in operating room. a comparison using semiclosed and semiopen anesthetic circuits

Por cromatografía de gases, fue identificada y cuantificada la existencia de halotano en el área respiratoria del anestesiólogo y en la sangre del anestesiólogo, cirujano e instrumentista, durante el transcurso de un acto quirúrgico bajo anestesia general inhalatoria con halotano y el comportamiento de estos niveles durante una jornada de trabajo de 6 hrs, con el empleo de dos circuitos anestésicos: circuito semicerrado y circuito semiabierto. Los resultados muestran que los niveles de contaminación por halotano en el área respiratoria del anestesiólogo al final de una cirugía bajo anestesia general inhalatoria son similares con el uso de circuito semicerrado y semiabierto, siendo estos cuando menos 10 veces más altos que los valores permisibles por la NIOSH. Las concentraciones sanguíneas de halotano en el personal que integra el equipo quirúrgico son más altos cuando se utiliza el circuito semiabierto, y superan los niveles permisibles incluso para medio ambiente

Buprenorfina epidural para el manejo del dolor postoperatorio / Epidural buprenorphine in the management of postoperative pain

Se estudiaron 15 pacientes de ambos sexos, sometidos a cirugía electiva y de urgencia, a los cuales se les administró Buprenorfina 0.3 mg diluidos en 9 ml de solución fisiológica por vía epidural a nivel de L2-L3, para manejo de analgesia postoperatoria. Se utilizó la escala visual análoga de 10 cm (EVA) para medir la intesidad del dolor antes y después de la administración de Buprenorfina por vía epidural. Se realizó registro de signos vitales, previos a la administración de Buprenorfina y una hora después. Se analizó la incidencia de náuseas, vómito y sedación, así como la duración del efecto analgésico con una dosis única de 0.3 mg. El alivio del dolor fue del 88.5 por ciento (p<0.001) la analgesia se mantuvo en promedio 8.7 h; se encontró diferencia significativa en los valores de presión arterial, sistólica y diastólica, y en la frecuencia cardiaca (p<0.05). Los efectos secundarios fueron náuseas 20 por ciento, vómito 13 por ciento y sedación leve 26.6 por ciento, concluimos que el uso de Buprenorfina epidural resulta un tratamiento eficaz y seguro para el alivio del dolor postoperatorio

Flumazenil como antagonista del midazolam en pacientes sometidas a legrado uterino por aborto incompleto / Flumazenil as antagonist of midazolam in D&C incomplete abortion

Se investigó el efecto antagónico del flumazenil en relación al uso de midazolam como inductor. Se estudiaron 20 pacientes a las cuales se les practicó LUI mediante anestesia general endovenosa. Clasificadas ASA I-II, edad promedio 27.1 ñ 3.4. La inducción fue con midazolam 300 µg/kg IV; al término del procedimiento se administró flumazenil 200 µg IV y dosis subsecuentes de 100 µg según el grado de sedación, la dosis promedio fue 330 µg. La dosis promedio de midamizolam fue 22.7 ñ 4.2 mg. El 15 por ciento de las pacientes respondió con 200 µg, 50 por ciento con 300 µg, 25 por ciento mejoró con 400 µg y sólo 10 por ciento requirió 500 µg. No encontramos diferencia significativa en los parámetros respiratorios y hemodinámicos básales y los registrados a los 15, 30 y 60 minutos de seguimiento. La acción clínica del flumazenil se observó a los 5 minutos posteriores a su administración. Concluimos que el flumazenil resulta efectivo para antagonizar el efecto sedante del midazolam cuando se ha utilizado como inductor en procedimientos de corta duración

Uso de pentalmidón 10 por ciento en cirugía cardiaca como solución de cebado del circuito de circulación extracorpórea / The use of then percent pentastarch as a cardiopulmonary bypass priming solution in cardiac surgery

El uso en la administración de sangre y sus derivados, se ha visto disminuida por el riesgo de transmisión de enfermedades infecciosas y de sensibilización a los diferentes componentes de ésta. Los coloides se han convertido en una alternativa muy prometedora en la reposición del volumen intravascular en el paciente crítico. Durante cirugía cardiaca con colocación extracorpórea (CEC), el cebado de la bomba se realiza en forma habitual con solución cristaloide, disminuyéndose en forma importante la Presión Coloidosmótica del Plasma (PCO) y favoreciéndose el paso de líquido al intersticio. En el presente estudio se analizaron 20 pacientes de ambos sexos, con edades comprendidas entre los 20 y 70 años, con estado físico ASA II-III, sometidos a cirugía cardíaca de revascularización coronaria, con circulación extracorpórea se efectuó con pentalmidon 10 por ciento y en el Grupo 2 con Albúmina 10 por ciento; se midieron la PCO, osmolaridad sérica, proteínas totales, tiempos de coagulación, plaquetas, cantidad de sangrado y transfusión de productos sanguíneos entre otros, en el período preoperatorio, antes de iniciar la CEC previo a la administración de la hepatina, 10 minutos después de administrada la protamina, 1 hora después de la llegada a la UCI y 24 hrs. después de llegar a la UCI. El uso clínico del pentalmidón 10 por ciento como solución de cebamiento del circuito de circulación extracorpórea tiene mayor poder oncótico que la albúmina, sin alterar significativamente la función respiratoria y el sistema de la coagulación, siendo, por tanto, seguro y eficaz para este propósito

Oxido nítrico inhalado en cirugía de válvula mitral en pacientes con hipertensión arterial pulmonar: (estudio preliminar) / Nitric oxide in mitral valve replacement in patients with pulmonary arterial hypertension: (preliminary report)

El óxido nítrico, es considerado actualmente como una de las terapéuticas alternativas para la hipertensión arterial pulmonar ya sea primaria o secundaria tanto en pacientes adultos como en pacientes pediátricos. Se llevó a cabo un estudio prospectivo en el cual se incluyeron pacientes portadores de valvulopatía mitral e hipertensión arterial pulmonar. Se administró óxido nítrico inhalado a la dosis de 40 ppm y FiO2 mayor a 75 por ciento a través de la máquina de anestesia. Estos pacientes fueron sujetos a cambio valvular mitral (ya sea mecánica o biológica) y se valoraron parámetros hemodinámicos (presiones pulmonares, sistémicas, gasto cardiaco y otras derivadas de la colocación de catéter de flotación pulmonar), valorando la disminución de la presión arterial pulmonar. Una vez terminada la cirugía se suspendió la administración de dicho gas y se tomaron muestras sanguíneas de metahemoglobina. Los resultados revelaron que el óxido nítrico a la dosis de 40 ppm fue capaz de reducir las resistencias vasculares pulmonares en 17 por ciento, se encuentra libre de efectos deletéreos cardiovasculares y no presenta niveles tóxicos de metahemoglobina

Oxido nítrico y anestesia / Nitric oxide and anesthesia

La presente revisión, describe las implicaciones fisiológicas, anestésicas y los efectos de óxido nítrico (NO) sobre la ciruclación pulmonar y el síndrome de insuficiencia respiratoria progresiva del adulto. La importancia para el anestesiólogo del óxido nítrico (NO) y/o el efecto de relajación derivado del endotelio, (FRDE)va más alla del entendimiento del papel de este último, en los estados fisiológicos y fisiopatológicos cardiovasculares. ¿Como son medidas estas interacciones? ¿Existen diferencias significativas entre los anestésicos con relación a sus efectos sobre el FRDE? ¿Es clínicamente importante el efecto de los anestésicos en la actividad basal de FRDE o solo en respuesta a una estimulación exógena?. Son preguntas que se plantean durante esta revisión

Esmolol en fibrilación auricular rápida secundaria a estenosis mitral / Utility of esmolol in rapid auricular flutter secondary to mitral stenoses

Se estudiaron 40 pacientes portadores de estenosis mitral, confirmada por cateterismo cardiaco y/o ecocardiografía transtorácica, programados para remplazo valvular mitral, los cuales semonitorizaron con electrocardiograma (DII), línea arterial, así comocatéter de flotación en arteria pulmonar. Registrándose las siguientes constantes hemodinámicas: Frecuencia Cardiaca (FC), presión arterial media (PAM), presión arterial pulmonar (PAP), presión capilar pulmonar (PCP), presión venosa central (PVC) y Gasto Cardiaco (GC), calculándoce Volumen Latido (VL), Indice sistólico (IS), Resistencias Vasculares Sistémicas (VS), Indice Trabajo Ventricular Izquierdo (ITVI), Resistencias Vasculares Pulmonares (RVP) y Producto presión-frecuencia (PPF). Se estímulo de ninguna índole se administró clorhidrato de esmolol en infusión a dosis de 450 µg/kg/min durante 15 min, tiempo en el cual se realizaron las mediciones antes mencionadas; básales (sin esmolol) y a los 3, 5, 10 y 15 minutos de iniciada la infusión, obteniéndose resultados significativos en el gasto cardiaco, índice cardiaco, frecuencia cardiaca, volumen latido,índice sistólico e índice de trabajo de ventricular izquierdo así como en las resistencias vasculares sistémicas y producto presión-frecuencia

Alfentanyl en pacientes con cardiopatías congénitas / Alfentanyl in patients with congenital cardiopathies

Se estudiaron 39 pacientes con diferentes cardiopatías congénitas programados para corrección total de la misma bajo circulación extracorporea, administrándose anestesia balanceada con halogenado e infusión de clorhidrato alfentanyl en diferentes tiempos durante el acto anestésico quirúrgico, monitorizandose electrocardiograma de superficie, presión arterial invasiva, presión venosa central, tomándose muestras sanguíneas arteriales para verificar concentraciones plasmáticas de alfentanyl así mismo las variables hemodinámicas para correlacionar dichas muestras; dichos tiempos de medición fueron control, 3 min, incisión de piel, esternotomía, circulación extracorporea, cierre de esternón y fin de la cirugía; concluyéndose que las dosis administradas provee adecuada anestesia, así mismo se conserva estabilidad hemodinámica. Obteniéndose concentraciones plasmáticas adecuadas de anestesia cuando dichos niveles fueron de 192-303 ng/ml