RESUMEN
STUDY OBJECTIVE: To evaluate the effect of carbon dioxide (CO(2)) pneumoperitoneum and retropneumoperitoneum insufflation on CO(2) excretion. DESIGN: Prospective study. SETTING: Operating room and recovery room in a teaching hospital. PATIENTS: 29 patients scheduled for orthopedic spine fusion surgery. INTERVENTIONS: Patients received either transperitoneal insufflation (n = 12) or retroperitoneal insufflation (n = 17). MEASUREMENTS AND MAIN RESULTS: Increases in the partial pressure of end-tidal CO(2) (PetCO(2)) and arterial CO(2) tension (PaCO(2)) during retropneumoperitoneum exceeded those obtained during pneumoperitoneum. Furthermore, PetCO(2) increased faster during retroperitoneum and did not reach a plateau. Finally, 76% of the patients in this group required ventilatory adjustment due to high PetCO(2) levels. CONCLUSIONS: This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.
Asunto(s)
Dióxido de Carbono/administración & dosificación , Endoscopía , Hipercapnia/etiología , Neumoperitoneo Artificial/efectos adversos , Fusión Vertebral , Acidosis Respiratoria/etiología , Dióxido de Carbono/sangre , Dióxido de Carbono/fisiología , Humanos , Complicaciones Intraoperatorias/etiología , Vértebras Lumbares/cirugía , Estudios Prospectivos , Respiración , Espacio Retroperitoneal , Sacro/cirugíaRESUMEN
The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. The use of local anaesthetics may be considered the best choice for avoiding tourniquet pain. Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.
Asunto(s)
Ortopedia , Dimensión del Dolor , Torniquetes/efectos adversos , Vasos Sanguíneos/fisiopatología , Constricción Patológica , Humanos , Músculo Esquelético/fisiopatología , Fibras Nerviosas/fisiología , Dolor/fisiopatologíaRESUMEN
The accident intracranial insertion of a nasogastric tube is a well known complication. We report the case of 19-year-old girl with a severe craniofacial trauma who had a nasogastric tube inserted at the site of the traffic accident. The aspiration gave issue of haemorrhagic fluid. At admission the X-ray of the skull showed the intracerebral penetration of the tube. It was removed but the patient died two days later. The various means of prevention and treatment of this complication are discussed.