Crisis epilépticas en urgencias: aspectos clínicos y diagnósticos de una serie de 153 pacientes / Seizures in the Emergency Department: Clinical and diagnostic data from a series of 153 patients

Introducción: Las crisis epilépticas son un motivo de ingreso frecuente en urgencias y requieren una actuación diagnóstico-terapéutica precoz y precisa. Nuestro objetivo fue describir las características clínico-evolutivas de una serie de pacientes con crisis epilépticas atendidos en urgencias.MétodosEstudio observacional retrospectivo de todos los pacientes con crisis epilépticas que ingresaron en urgencias y fueron atendidos por neurología de guardia, de febrero a agosto de 2017.ResultadosSe incluyeron 153 pacientes, correspondientes al 9,9% del total de urgencias neurológicas. La mediana de edad fue de 58 años, el 52,3% fueron mujeres y el 51% tenía antecedente de epilepsia. El 82,4% de las crisis tuvo un inicio focal y la etiología más frecuente fue la enfermedad cerebrovascular (24,2%). Doce pacientes se complicaron con estatus epiléptico (7,8%), lo que se relacionó con mayor puntuación en la escala ADAN (p < 0,001) y con antecedente de epilepsia refractaria (p = 0,002). La mortalidad hospitalaria fue del 3,7%; se asoció a mayor edad (p = 0,049) y a estatus epiléptico (p = 0,018). El 80% de los pacientes sin epilepsia conocida recibió el diagnóstico de epilepsia en urgencias, todos iniciaron tratamiento. El índice Kappa de concordancia para el diagnóstico de epilepsia en urgencias, comparado con el diagnóstico tras un año de seguimiento en la unidad de epilepsia fue 0,45 (se modificó el diagnóstico en el 20% de los pacientes).ConclusionesLas crisis epilépticas constituyen una urgencia neurológica frecuente, con potenciales complicaciones y una morbimortalidad relevante. En pacientes sin epilepsia conocida es apropiado realizar el diagnóstico de epilepsia en urgencias, pero es recomendable un seguimiento posterior en consultas especializadas. (AU)

Introduction: Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department.MethodsWe performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017.ResultsWe included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was .45 (diagnosis was modified in 20% of patients).ConclusionsSeizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended. (AU)

Seizures in the Emergency Department: clinical and diagnostic data from a series of 153 patients.

INTRODUCTION: Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS: We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS: We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was 0.45 (diagnosis was modified in 20% of patients). CONCLUSIONS: Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.

The importance of timing in epilepsia partialis continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyse the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n = 6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4 hours. The median time to treatment onset (TT) for all patients was 12.3 hours. The median time from treatment onset to EPC control (TC) was 30 hours; TC showed a strong positive correlation with TT (Spearman's rho = 0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with TC (rho = 0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Screening of substance use and mental health problems among Spanish medical students: A multicenter study.

BACKGROUND: This study aimed to determine the prevalence of substance consumption and mental health problems among Spanish medical students, and their association with sociodemographic factors. METHODS: A multicentre cross-sectional study was conducted. Self-reported data on sociodemographic and clinical characteristics were collected, including BDI-II, PHQ-9, brief STAI, and single-item academic burnout (IUBA). RESULTS: Overall, 1265 students (74.2% female) completed the survey. Of them, 37.4% scored positive for depressive symptoms, as measured by the BDI-II, and more than half (53%) by the PHQ-9. Suicidal ideation was reported by about 12% whilst high levels of state and trait anxiety were informed by 28.8% and 29.4% of the students. The prevalence of burnout was 40.2%. Female and pre-clinical students reported significantly (p < 0.01) higher rates of depressive, anxiety, and burnout symptoms. Alcohol, energy drinks, and tobacco were the most frequently used substances. Total scores of self-reported mental health problems negatively correlated (p < 0.001) with objective academic results and positively correlated (p < 0.02) with the number of substances consumed in the last 30 days. LIMITATIONS: Research-based on self-reported data could favour information bias due to the social desirability effect and memory error. CONCLUSIONS: A high prevalence of substance consumption and several mental health problems was found among medical students, especially females. The relevant influence of academic-related factors on students' well-being may be a call for medical schools to implement initiatives aimed to improve students' ability to detect, address, and seek help for their mental health issues.

Status epilepticus without impairment of consciousness: Long-term outcomes according to duration.

OBJECTIVE: The point after which non-convulsive status epilepticus (NCSE) can cause permanent damage remains to be elucidated. The aim of this study was to analyze the association between time to resolution and long-term outcomes in NCSE. METHODS: We performed a retrospective study of all patients with focal NCSE without consciousness impairment at two tertiary care hospitals in Spain. All the data were registered prospectively and the study period was December 2014-May 2018. We collected information on demographics, SE etiology, time to administration of different lines of treatment, time to NCSE resolution, and outcomes at discharge, 1 year, and 4 years. Clinical outcome was prospectively categorized as good (return to baseline function) or poor (new disability and death). RESULTS: Seventy-four patients with a mean (±SD) age of 63.4 ±â€¯17.5 years and a mean follow-up time of 2.4 ±â€¯2.2 years were studied. A poor outcome at discharge was associated with a potentially fatal etiology (p < 0.001), EMSE score (Epidemiology-based Mortality Score in Status Epilepticus) (p = 0.012), lateral periodic discharges on EEG (p = 0.034), and occurrence of major complications during hospitalization (p = 0.007). An SE duration of >100 h was clearly associated with a worse outcome (p < 0.001). In the multiple regression analysis, the only independent predictors of a poor outcome at discharge were an SE duration of >+100 hours (p = 0.001), a potentially fatal etiology (p = 0.001), and complications during hospitalization (p = 0.010). An SE duration of >100 hours retained its value as the optimal cutoff point for predicting poor outcomes at both 1 year (p = 0.037) and 4 years (p = 0.05). Other predictors of poor long-term outcomes were a potentially fatal etiology (p < 0.001) and EMSE score (p = 0.034) at 1 year, and progressive symptomatic etiology at 4 years (p = 0.025). SIGNIFICANCE: In patients with focal NCSE without consciousness impairment, a potentially fatal etiology and an SE duration of >100 h were associated with poor short-term and long-term outcomes.

Seizures in the Emergency Department: Clinical and diagnostic data from a series of 153 patients. / Crisis epilépticas en urgencias: aspectos clínicos y diagnósticos de una serie de 153 pacientes.

INTRODUCTION: Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS: We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS: We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P<.001) and with history of refractory epilepsy (P=.002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P=.049) and status epilepticus (P=.018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was .45 (diagnosis was modified in 20% of patients). CONCLUSIONS: Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.

The importance of timing in epilepsia partialis continua. / La relevancia del tiempo en la epilepsia parcial continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyze the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n=6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4hours. The median time to treatment onset for all patients was 12.3hours. The median time from treatment onset to EPC control was 30hours; time from treatment onset to EPC control showed a strong positive correlation with TT (Spearman's rho=0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with time from treatment onset to EPC control (rho=0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Evaluación de impacto de la intervención Módulo Ambientes Seguros para la prevención de accidentes domésticos durante la primera infancia / Impact assessment of the Safe Environment Intervention Module for prevention of domestic accidents during early childhood

Resumen El impacto de la intervención Módulo Ambientes Seguros contra los accidentes domésticos que sufren niños durante la primera infancia fue evaluado a través de visitas domiciliarias en las cuales se valoró el nivel de riesgo de accidentes domésticos y la calidad del contexto inmediato de desarrollo temprano de los niños, antes y después de la intervención, en dos grupos. Se conformó un grupo intervención de 29 cuidadoras y un grupo control de 18 participantes que fueron seleccionadas según su disponibilidad para ser visitadas en sus hogares y para participar en la intervención. Los resultados mostraron que la intervención mejoró la calidad del contexto inmediato del desarrollo temprano de los niños en su dimensión interacción, y disminuyó la conducta de dejar solos a los niños en casa. Al finalizar, las participantes manifestaron un alto grado de satisfacción con la intervención Módulo Ambientes Seguros.

The Safe Environment Intervention Module for the prevention of domestic accidents in early childhood was assessed using home visits to test its effects on the level of risk of domestic accidents, as well as the quality of the immediate context of early child development. The intervention was developed in four sessions in which 29 caregivers participated. They self-reported their satisfaction at the end of the intervention. A control group with 18 caregivers was formed according to their availability. The results showed that the intervention improves the quality of the immediate context of early child development in their interactive dimensions, and reduces the behaviour of leaving children alone at home. Participants were highly satisfied with the Safe Environment Intervention Module.

Prevalencia del dolor agudo postoperatorio en un servicio de cirugía gastro-intestinal y satisfacción del paciente / Prevalence of acute postoperative pain in gastrointestinal surgery service and patient satisfaction

Introducción: El tratamiento adecuado del dolor, la disminución del estrés preoperatorio, la rehabilitación y la nutrición precoz, disminuyen la morbimortalidad postoperatoria y son la base actual del manejo del paciente quirúrgico. A pesar de haber mejorado los conocimientos sobre fisiopatología del dolor postoperatorio y de disponer de fármacos para su tratamiento, la mitad de los pacientes refieren dolor moderado o intenso. Objetivos: 1. Conocer la incidencia e intensidad del dolor agudo postoperatorio en una la unidad de cirugía gastrointestinal. 2. Evaluar el valor predictivo de la escala visual analógica a las dos horas de la intervención, en relación al grado de dolor postoperatorio durante las primeras 24 horas. 3. Evaluar el grado de satisfacción de los pacientes respecto al control del dolor postoperatorio. Material y métodos: Estudio observacional descriptivo y prospectivo, realizado en el Servicio de Cirugía Gastrointestinal del Hospital Clínico de Barcelona. Se realizó la valoración del dolor en los siguientes momentos: a) al final de la intervención, inmediatamente tras ser extubado el paciente; b) a las dos horas post-intervención; c) a las 24 horas en reposo y en movimiento; d) se recoge el máximo valor de dolor, así como el mínimo dolor referido por el paciente en las últimas 24 horas desde el final de la intervención; e) se valoró la satisfacción del paciente en relación al tratamiento del dolor recibido por parte de los profesionales, y en comparación con las expectativas que él tenía antes de la intervención. Si ha tenido más o menos dolor del que él esperaba tener; f) se registra si el paciente ha podido dormir la primer noche después de la intervención. El estudio fue aprobado por el Comité Ético de Investigación Clínica del Hospital (CEIC). Se solicitó el consentimiento informado de todos los participantes. Resultados: Se incluyeron 51 pacientes (54,9 % hombres y 45,1 % mujeres). La edad media fue de 55,9 ( DE: ± 16,32), 45 pacientes (88,2 %) refirieron haber experimentado dolor en algún momento durante las primeras 24 horas; el 11,8 % no tuvo dolor. En el momento de la entrevista a las 24 horas postintervención, 41 pacientes (80,4 %) refirieron dolor leve (EVA de 0 a 3); el resto de pacientes 15 (19,6 %) refirieron tener dolor moderado (EVA de 4 a 6). El 88,2 % de los pacientes pudo dormir durante la primera noche después de la intervención. Se encontró correlación entre el valor del EVA a las dos horas post-intervención ,y la intensidad del dolor valorada a las 24 horas, tanto en reposo como en movimiento (p = 0,049 y p = 0,03). Presentaron mucho más dolor de lo que ellos esperaban un 2 %, algo más de lo que esperaba un 21,6 %, mucho menos de lo esperado un 29,4 %, lo que esperaban un 33,3 %. Conclusiones: La incidencia de dolor agudo postoperatorio (DAP) es de un 88,2 % a las 24 horas, siendo la intensidad leve en el 80,4 % de los pacientes y moderada en el 19,6 %. La EVA a las dos horas post intervención tiene un alto poder predictivo de los pacientes que presentarán dolor durante las primeras 24 horas. El grado de satisfacción de los pacientes en relación al tratamiento del dolor fue elevado (AU)

Introduction: Adequate pain treatment, together with items that reduce preoperative stress, introducing rehabilitation and nutrition at an early stage, decrease postoperative morbidity and mortality are the current basis of surgical patient management despite greatly improved knowledge of pathophysiology of postoperative pain and provide drug for treatment, half of the patients reported moderate to severe pain in the postoperative period. Objectives: 1. Know the incidence and intensity of acute postoperative pain in gastrointestinal surgery unit. 2. Assessing the predictive value of visual analogue scale at two hours after surgery. 3. To measure the degree of satisfaction of the patients operated on CGI respect to postoperative pain control. Material and methods: A prospective, descriptive, observational study, was conducted in the Department of Gastrointestinal Surgery Clinical Hospital of Barcelona. We performed a measurement of the degree of pain at different times: a) at the end of the intervention; b) at two hours post intervention; c) after 24 hours at rest and in motion immediately after extubation the patient; d) collect the maximum amount of pain and minimal pain reported by the expected patient in the last 24 hours from the end of the intervention is collected; e) patient satisfaction was assessed in relation to the treatment of pain received from professionals and compared to the expectations he had before surgery. If you have had more or less pain than he would have expected; f) the Clinical Research Ethics Committee of the Hospital (CEIC) approved in October 2011, and g) respondents were informed consent request. Results: The study included 51 patients one (54.9 %) males and (45.1 %) women the mean age was 55.90 (SD ± 16.32). A total of 45 patients (88.2 %) reported having experienced pain Sometime in the last 24 hours versus 11.8 % 6 patients who had no pain at the time of the interview 41 patients (80.4 %) mild pain VAS 0-3. The remaining 15 patients (19.6 %) reported having moderate pain VAS 4-6. However, 88.2 % of patients could not sleep during the first night after surgery. A correlation between the value of EVA at two hours post intervention and assessed pain intensity at 24 hours, both at rest and in motion p 0.049 and p 0.03 Despite suffering pain satisfaction was very good, presented much more pain than they expected 2 %, something more than expected by 21.6 %, much less than what they expected 29.4 % what they expected 33.3 %. Conclusions: 1. DAP incidence is 88.2 % at 24 hours after the IQ. With a mild pain intensity in 80.4 % of patients and moderate pain intensity in 19.6 %. 2. The Eva at two hours post-intervention, indicating that patients will require special attention and has a high predictive as it almost certainly will suffer pain 24 hours. 3. Although there is acute postoperative pain degree of patient satisfaction with physicians and nurses regarding their treatment was very satisfactory (AU)

Efecto de los cuentos en la competencia acuática real y percibida en infantes / Tales effect in real and perceived aquatic competence in preschoolers

Pese a existir un interés creciente en los estudios por la renovación de los contenidos lúdicos tradicionales, así como en la utilización del medio acuático como recurso educativo, en la actualidad existen muy pocas investigaciones que relacionen ambos aspectos. Por ello, el objetivo de este estudio cuasi-experimental fue comprobar el efecto de los cuentos motores acuáticos sobre la competencia motriz percibida y la capacidad motriz real. Los participantes fueron 16 infantes de 3 a 5 años a los que se le midió la competencia motriz real y percibida acuática. Tras una prueba no paramétrica los resultados mostraron que la administración del programa de cuentos motores contribuyó de manera positiva y significativa sobre la competencia motriz percibida del grupo experimental. Se discuten los resultados en pro de incluir en los programas educativos acuáticos los cuentos motores de cara a fomentar el autoconcepto infantil (AU)

Even though a growing interest exists in the study of the renewal of the traditional ‘play’ curriculum, as well as the utilization of the aquatic medium as an educational resource, at present, very few studies link both areas. For this reason, the objective of this quasi-experimental study was to confirm the effect of aquatic motor tales over perceived motor competency and real motor capacity. We studied 16 preschoolers among 3 to 5 years of age for their real and perceived aquatic motor competency. After a non-parametric test was administered, the results show that administration of aquatic mobility stories contributed positively and significantly on the perceived motor competence of the experimental group. The results are discussed in favor of inclusion of aquatic educational programs in order to promote the self-esteem of this age-group (AU)

Neurobehçet disease: clinical and demographic characteristics.

BACKGROUND: Neurobehçet disease (NBD) is a rare complication of Behçet disease (BD) but with important burdens of morbidity and mortality. Little is known about this complication because there are no validated diagnostic criteria, and all the studies have small number of patients. The prevalence reported normally ranges between 5% and 15% and it is more frequent amongst men between 20 and 40 years old. The typical presentations include focal parenchymal lesions, vascular thrombosis, arterial vasculitis, and aseptic meningo-encephalitis. METHODS: We retrospectively studied medical histories of all patients admitted to the hospital and discharged from it with diagnosis of BD from January 1996 to September 2009. NBD was defined as having neurological and/or psychiatric symptoms with compatible abnormalities in MRI and/or cerebrospinal fluid and without another possible explanation for their symptoms. RESULTS: Behcet disease was diagnosed in 25 patients and seven from these patients fulfilled our criteria of Neurobehcet disease (28%). Patients with NBD were significantly younger at the onset of their symptoms and had a significantly longer evolution until diagnosis and treatment compared to patients with non-Neuobehçet disease. Six presented a relapsing-remitting pattern, with a good outcome with corticosteroids. CONCLUSIONS: As reported in previous studies, progressive course was less frequent, with only one case, and had a more aggressive disease. Brainstem involvement bears a poorer prognosis because it is linked with a progressive evolution. In our series, NBD complication was not that infrequent. It is very important to be highly suspicious of this possibility to start early a correct treatment.

Human and rabbit inter-species comparison of ionic mechanisms of arrhythmic risk: A simulation study.

Experimental studies of pro-arrhythmic mechanisms are scarcely performed in humans due to the limited availability of human cardiomyocytes. Subsequently, extrapolation of animal experimental research to humans is widely extended. Our aim is to systematically compare the ionic mechanisms of the main cellular biomarkers of arrhythmic risk between human and rabbit using computer simulations. For this purpose four stimulation protocols were applied to the Mahajan et al. rabbit ventricular action potential (AP) model for control conditions and for ± 15 and ± 30% variations in the ionic current conductances of the main repolarization currents to quantify cellular biomarkers. Sensitivity of every simulated biomarker to every parameter modification was compared to that obtained for human in our previous work. Our results show that the ionic mechanisms involved in AP triangulation, systolic intracellular calcium concentration and AP duration (APD) accommodation to abrupt changes of pacing rate are very similar in both species. Unfortunately, significant differences were found in the ionic mechanisms related to APD, restitution properties and rate dependence of intracellular calcium and sodium concentrations. In conclusion, extrapolation of experimental research in rabbit to humans is limited by the existence of species dependent ionic mechanisms. In addition, this analysis is very useful for understanding and improvement of mathematical models.

Gabapentina en el tratamiento de la neuromiotonía ocular / Gabapentin in the treatment of ocular neuromyotonia

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Fentanyl intratecal reduce los requerimientos de propofol TCI sitio-efecto en la sedación monitorizada por índice biespectral (bis) durante anestesia espinal para cirugía artroscópica / Intrathecal fentanyl reduces the dose of TCI propofol effect required for sedation monitored by bispectral index during spinal anesthesia for arthroscopic surgery

Introducción: La adición de opioides a los anestésicos locales en anestesia espinal (AE) modula algunos aspectos de la anestesia y la analgesia. Nuestro objetivo fue evaluar dos dosis de fentanilo (F) intradural sobre los requerimientos de propofol (P) en la sedación durante AE. Pacientes y Método: Estudio clínico, prospectivo, controlado de 75 pacientes, ASA I, distribuidos en 3 grupos: Grupo 1 (n=25): Bupivacaína 0,75 por ciento HB (BHB), 12,5 mg; Grupo 2 (n=25): BHB 12,5 mg + 15 µgr F; Grupo 3 (n=25): BHB 12,5 mg + 25 µgr F. Realizada AE, se instaló monitor BIS XP, registrándose valor basal. Luego, se inició sedación con propofol TCI sitio-efecto con dosis de 2,5 µgr/ml, para mantener BIS entre 60 y 75. Se registró BIS, signos vitales, dosis total utilizada (DTP), dosis promedio de infusión (DPI), el costo final del consumo de P y el tiempo de latencia del despertar. Resultados: El DPI fue de 0,084 mg*kg-1*min-1 (G 1), 0,059 mg*kg-1*min-1 (G 2) y 0,061 mg*kg-1*min-1 (G 3) (p < 0,05 G2 y G3 v/s G1). La DTP fue 344 mg*hr-1 (G 1), 227 mg*hr-1 (G 2) y de 241 mg*hr-1 (G 3). Los costos de P fueron menores en 32,8 por ciento en el Grupo 2 y 29,1 por ciento en el G 3, comparados con G 1. Conclusiones: La adición de 15 ó 25 µgr de F a la BHB reduce las dosis promedio de infusión, dosis total utilizada y los costos de P en pacientes bajo AE.

The addition of opioids to local anesthetics used in spinal anesthesia (SA) modulates some aspects of the anesthesia and analgesia. Our purpose was to evaluate two intrathecal fentanyl (F) doses over TCI Propofol requirements for sedation during SA. Methods: Prospective clinical study of 75 patients, ASA I, randomly assigned in 3 groups: Group 1 (n=25): Bupivacaine 0.75% HB (HBB), 12.5 mg; Group 2 (n=25): BHB 12.5 mg + 15 µgr F; Group 3 (n=25): BHB 12.5 mg + 25 µgr F. After SA a BIS XP monitor was installed and basal value registered. Then, sedation with Propofol TCI site-effect was started with a dose of 2.5 µgr/ml, to obtain BIS between 60 and 75. We registered total infusion dose (TID), mean infusion dose (MID), propofol costs and vital signs variations. Results: TID was 0.084 mg*kg-1min-1 (G 1), 0.059 mg*kg-1min-1 in (G 2) and 0.061 mg*kg-1*min-1 (G 3) (p < 0.05 G2 and G3 v/s G1). The MID was 344 mg*hr-1 in Group 1, 227 mg*hr-1 in Group 2 and 241 mg* hr-1 in Group 3 (p < 0.05). Propofol costs were lower in a 32.8% in Group 2 and in 29.1% in Group 3 v/s Group 1 (p < 0.05). Conclusions: The addition of 15 or 25 µgr of F to HBB reduces the total infusion doses and the mean infusion doses as well as propofol costs in patients under spinal anesthesia. Key words: Intrathecal fentanyl, sedation, spinal anesthesia, intrathecal opioids, propofol requirements.