[Continuous femoral nerve block to control postoperative pain in outpatient orthopedic surgery]. / Bloqueo femoral continuo para control del dolor postoperatorio en cirugía ortopédica ambulatoria.

OBJECTIVE: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction. MATERIAL AND METHODS: We carried out a single-blind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed. RESULTS: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects. CONCLUSION: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction.

Bloqueo femoral continuo para control del dolor postoperatorio en cirugía ortopédica ambulatoria / Continuous femoral nerve block to control postoperative pain in outpatient orthopedic surgery

OBJETIVOS: Investigar la eficacia, viabilidad y seguridad del bloqueo femoral continuo como técnica analgésica para cirugía ambulatoria de reconstrucción de ligamento cruzado anterior, ya que el dolor postoperatorio es una de las complicaciones más frecuentes en cirugía ortopédica ambulatoria. MATERIAL Y MÉTODOS: Estudio prospectivo simple. Pacientes estado físico ASA I-II, a los que se realizó tratamiento del dolor postoperatorio mediante bloqueo continuo del nervio femoral con bupivacaína 0,125%, a través de un dispositivo elastomérico dentro de un abordaje multimodal. El dolor postoperatorio fue evaluado mediante escala numérica y verbal desde el periodo postoperatorio inmediato hasta las primeras 48 horas. Se valoran los efectos secundarios y el grado de satisfacción de los pacientes. RESULTADOS: Se incluyeron 63 pacientes. El bloqueo continuo del nervio femoral fue eficaz (en las primeras 24 horas postoperatorias un porcentaje superior al 90% no presentó dolor o éste fue leve, sin necesidad de rescate en el 92% de los casos) y seguro como analgesia postoperatoria, con ausencia de efectos secundarios significativos. CONCLUSIÓN: El bloqueo continuo del nervio femoral con bupivacaína 0,125% administrada a través de sistemas elastoméricos es una opción de manejo del dolor postoperatorio eficaz y segura en cirugía ambulatoria de reconstrucción de ligamento cruzado anterior (AU)

OBJECTIVE: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction. MATERIAL AND METHODS: We carried out a singleblind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed. RESULTS: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects. CONCLUSION: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction (AU)

[Systemic toxicity caused by local anesthetics after peripheral nerve blocks]. / Toxicidad sistémica por anestésicos locales tras bloqueos de nervios periféricos.

Peripheral nerve blocks have aroused increasing interest in recent years, leading to a rise in the rate of complications. At the same time noteworthy technical advances have been made in areas such as nerve stimulation and ultrasound imaging, and local anesthetics have become safer. Nevertheless, the risk of anesthetic-related systemic toxicity, which manifests with neurological symptoms that tend to be forerunners of cardiovascular ones, can not be ignored. We report 2 cases of systemic toxicity due to the use of a mixture of local anesthetics during nerve blocks for outpatient surgery.

Toxicidad sistémica por anestésicos locales tras bloqueos de nervios periféricos / Systemic toxicity caused by local anesthetics after peripheral nerve blocks

Existe en los últimos años un interés creciente de los anestesiólogos por los bloqueos nerviosos periféricos, lo cual puede conllevar un incremento en la frecuencia de aparición de complicaciones. Al mismo tiempo hubo grandes avances tecnológicos (neuroestimulación, ultrasonografía…) y se incorporaron anestésicos locales cada vez más seguros, sin embargo, no podemos obviar el riesgo de toxicidad sistémica asociado, que habitualmente se manifiesta con síntomas neurológicos que suelen preceder a los cardiovasculares. Presentamos dos casos de toxicidad sistémica utilizando mezclas de anestésicos locales durante la realización de bloqueos nerviosos periféricos en cirugía ambulatoria

Peripheral nerve blocks have aroused increasing interest in recent years, leading to a rise in the rate of complications. At the same time noteworthy technical advances have been made in areas such as nerve stimulation and ultrasound imaging, and local anesthetics have become safer. Nevertheless, the risk of anesthetic-related systemic toxicity, which manifests with neurological symptoms that tend to be forerunners of cardiovascular ones, can not be ignored. We report 2 cases of systemic toxicity due to the use of a mixture of local anesthetics during nerve blocks for outpatient surgery

[Brachial plexus block with levobupivacaine at the humeral canal: comparison of a small volume at high concentration with a large volume at low concentration]. / Bloqueo del plexo braquial a nivel humeral con levobupivacaína: estudio comparativo alta concentración/pequeiio volumen frente a baja concentraci6n/alto volumen.

OBJECTIVE: To assess differences in the brachial plexus block in 2 groups who received the same dose of levobupivacaine: 1 group received a small volume of solution at high concentration and the other group received a large volume in solution at low concentration. MATERIAL AND METHODS: A prospective, randomized clinical trial enrolling 69 patients scheduled for wrist and/or hand surgery with a brachial plexus block with levobupivacaine in the humeral canal. Nerve stimulation was used to locate a response from the 4 terminal nerves in the brachial plexus. In the group receiving a larger volume, 10 mL of a solution of levobupivacaine at a concentration of 0.375% was used for each nerve. In the high concentration group receiving a smaller volume, levobupivacaine was used at a concentration of 0.75% in 5 mL for each nerve. Sensory latency was assessed by the pin prick technique. Motor block, the success rate (percentage), and duration of sensory and motor blockades were also evaluated. RESULTS: The full sensory block was significantly more efficacious in the large volume group than in the high concentration group (85.3% vs 51.6%, P = 0.003). A full motor block was reached in a small percentage of patients in both groups. There were no significant differences in latency or duration of block. CONCLUSIONS: The success rate was lower in the group receiving the smaller volume at a higher concentration. It is advisable to administer local anesthetics in larger volumes at lower concentrations to improve block quality. Latency and duration were similar in both groups.

[Popliteal fossa sciatic nerve block for ambulatory hallux valgus surgery: comparison of lateral and posterior approaches]. / Bloqueo del nervio ciático en el hueco poplíteo para cirugía de hallux valgus en régimen ambulatorio: comparación de los abordajes lateral y posterior.

OBJECTIVE: The aim of this study was to assess the efficacy, effectiveness, technical difficulty, and clinical usefulness of the popliteal sciatic peripheral nerve block for unilateral hallus valgux surgery and to compare the posterior and lateral approaches. We also aimed to investigate patient comfort during the procedure. MATERIALS AND METHODS: This prospective, randomized trial enrolled 60 patients scheduled for unilateral hallux valgus surgery. The patients were randomly assigned to groups of 30 patients to receive a nerve block by either a posterior or lateral approach. A nerve stimulator was used to locate the response of the two branches forming the sciatic nerve--the posterior tibial nerve and the common peroneal nerve. Then, 20 mL of 0.5% ropivacaine was injected for each nerve. Variables analyzed were efficacy, complications, quality and duration of postoperative analgesia, degree of comfort while the technique was being performed, and level of satisfaction. RESULTS: The level of comfort was good for 19 patients (70%) in the posterior approach group and for 29 (97%) in the lateral approach group (P<0.05). Level of satisfaction was good or very good for 93% and 96% of the patients in the posterior and lateral approach groups, respectively. Block efficacy was excellent for 48 patients (80%), good for 9 (15%), and poor for 3 (5%), with no significant differences between the groups. CONCLUSION: Both the posterior and lateral approaches provide easy access to the sciatic nerve for performing a block. The rate of success is high and postoperative analgesia is good, with no noteworthy complications. However, the lateral approach is more comfortable for the patient.

Naúseas y vómitos postoperatorios en cirugía ambulatoria / Post-operative nause and vomiting in Ambulatory Surgery

Las náuseas y vómitos postoperatorios se incluyen entre las experiencias más desagradables que puede presentar un paciente, y constituyen uno de los motivos con mayor impacto negativo en la satisfacción global dentro del conjunto de la experiencia (..) (AU)

Post-operative nausea and vomiting are amongst the most disagreeable symptoms patients can experience and are one of the main negative reasons for patient's discontent with the surgical procedure. Despite the advances (..) (AU)

Bloqueo del nervio ciático en el hueco poplíteo para cirugía de hallux valgus en régimen ambulatorio: comparación de los abordajes lateral y posterior / Popliteal sciatic nerve block for ambulatory hallux valgus surgery

OBJETIVO: El objetivo de este estudio es valorar la eficacia, efectividad, comodidad, dificultades técnicas y utilidad clínica del bloqueo periférico del nervio ciático poplíteo para cirugía de hallux valgus unilateral, comparando el abordaje posterior y el abordaje lateral. MATERIAL Y MÉTODOS: Estudio prospectivo, aleatorio, de 60 pacientes programados para cirugía de hallux valgus unilateral. Se hacen dos grupos de 30 pacientes, se realizó bloqueo del nervio ciático por vía posterior (P) en uno, y por vía lateral (L), en el otro. Mediante neuroestimulación se localizó la respuesta de las dos ramas que forman el nervio ciático, el nervio tibial posterior y el nervio peroneo común, inyectando 20 ml ropivacaína 0.5% en cada una. Se analizó eficacia, complicaciones, calidad y duración de la analgesia postoperatoria, grado de comodidad durante la realización de la técnica y grado de satisfacción. RESULTADOS: Encontramos que el grado de comodidad es bueno en 19 pacientes grupo P (70%) y en 29 (97%) del grupo L (p<0,05), mientras que el grado de satisfacción fue bueno/muy bueno en el 93% y 96% de los pacientes en los grupos P y L respectivamente. La eficacia del bloqueo fue excelente en 48 pacientes (80%), buena en 9 (15%) y fracasó en 3 casos (5%), no existiendo diferencias entre ambos grupos. CONCLUSIÓN: El abordaje del nervio ciático, tanto vía posterior como lateral es fácil de realizar, con elevado índice de éxito, buena analgesia postoperatoria y sin complicaciones destacables, sin embargo, el abordaje lateral ofrece mayor comodidad al paciente

OBJECTIVE: The aim of this study was to assess the efficacy, effectiveness, technical difficulty, and clinical usefulness of the popliteal sciatic peripheral nerve block for unilateral hallus valgux surgery and to compare the posterior and lateral approaches. We also aimed to investigate patient comfort during the procedure. MATERIALS AND METHODS: This prospective, randomized trial enrolled 60 patients scheduled for unilateral hallux valgus surgery. The patients were randomly assigned to groups of 30 patients to receive a nerve block by either a posterior or lateral approach. A nerve stimulator was used to locate the response of the two branches forming the sciatic nerve—the posterior tibial nerve and the common peroneal nerve. Then, 20 mL of 0.5% ropivacaine was injected for each nerve. Variables analyzed were efficacy, complications, quality and duration of postoperative analgesia, degree of comfort while the technique was being performed, and level of satisfaction. RESULTS: The level of comfort was good for 19 patients (70%) in the posterior approach group and for 29 (97%) in the lateral approach group (P<0.05). Level of satisfaction was good or very good for 93% and 96% of the patients in the posterior and lateral approach groups, respectively. Block efficacy was excellent for 48 patients (80%), good for 9 (15%), and poor for 3 (5%), with no significant differences between the groups. CONCLUSION: Both the posterior and lateral approaches provide easy access to the sciatic nerve for performing a block. The rate of success is high and postoperative analgesia is good, with no noteworthy complications. However, the lateral approach is more comfortable for the patient

Cancer de mama en programas de CMA / Breast cancer in a programme for ambulatory surgery

OBJETIVO: Evaluar el tratamiento quirúrgico en un programa de cirugía sin ingreso de enfermas diagnosticadas de cáncer de mama. PACIENTES Y MÉTODO: Estudio prospectivo de mujeres diagnósticas de cáncer de mama durante el año 2002 y subsidiarias de cirugía conservadora. Las técnicas quirúrgicas realizadas fueron tumorectomía mas biopsia del ganglio centinela, tumorectomía y/o cuadrantectomía, tumorectomía más linfadenectomía axilar o linfadenectomía. Todas las pacientes previo a la cirugía son educadas en el manejo de drenajes aspirativos por una enfermera especializada y los procedimientos quirúrgicos se realizan con una técnica anestesica-analgésica multimodal. RESULTADOS: El estudio incluye 66 pacientes, de edad 57+-16, en las que se realiza un total de 78intervenciones (66 principales y 12 de rescate),con un tiempo quirúrgico de 62,3+- 26 y un tiempo anestésico de 81,4 +- 24 minutos. Fueron ambulatorias 58 pacientes (87,8 %), 7 (10,6%)tuvieron una estancia entre 12-24 horas y 1 (1,3 %)tuvo una estancia superior a 24 horas. La cirugía de rescate fue ambulatoria en 5 pacientes (41,6%).Las náuseas y/o vómitos postoperatorios fueron las principales complicaciones anestésicas(15,4%) y el sangrado agudo postoperatorio la quirúrgica mas grave (0,25% de los casos), siendo necesario antes de transcurridas 6 horas, la revisión quirúrgica en dos pacientes. CONCLUSIÓN: La cirugía conservadora del cáncer de mama (resección tumoral con biopsia de ganglio centinela), es factible y segura en programas de Cirugía Mayor Ambulatoria, cuando se lleva a cabo una selección estricta, existe una organización asistencial adecuada y un equipo multidisciplinar con experiencia en cirugía ambulatoria (AU)

OBJECTIVE: To assess the surgical treatment of patients diagnosed with breast cancer in a programme for ambulatory surgery. PATIENTS AND METHODS: A prospective study was undertaken on women diagnosed with breast cancer during 2002 and the benefits of conservative surgery. The surgical techniques used were: lumpectomy with sentinel lymph nodebiopsy, lumpectomy and/or quadrantectomy and lumpectomy with axillary lymphadenectomy or lymphadenectomy. Before surgery all the patients were trained by a specialized nurse on the correct handling of suction drains. The surgical procedures were carried out by means of a multimodalanaesthetic and analgesic therapy. RESULTS: The study included 66 patients aged57+/-16 years old. Of the 78 operations performed,66 were primary operations and the remaining 12were rescue operations. Surgery lasted 62+/- 26minutes and the anaesthetic time was 81+/- 24minutes. Fifty eight of the patients (87,8%) had ambulatory surgery, while 7 patients (10,6%) had a hospital stay of between 12-24 hours and 1 patient(1,3%) stayed more than 24 hours. Rescue surgery was ambulatory in 5 patients (41,6%).The main post-operative (..) (AU)

Efecto del opioide intradural en bloqueos selectivos espinales en cirugía artroscópica de rodilla ambulatoria / Effect of intrathecal opioid in selective spinal anesthesia for outpatients undergoing knee arthroscopic surgery

INTRODUCCIÓN: Recientemente numerosos estudios demostraron que la realización de bloqueos espinales selectivos genera mayor estabilidad hemodinámica y mayor selectividad en el control de la agresión quirúrgica. OBJETIVO: Evaluar la influencia de la asociación de fentanilo a anestésicos locales administrados por vía intradural en bloqueos espinales selectivos en CMA.MATERIAL Y MÉTODOS: Estudio prospectivo, randomizado de 60 pacientes ASA I - III, programados para cirugía artroscópica de rodilla. Los pacientes se dividen en dos grupos; Grupo A: 5 mg (1ml) de bupivacaína 0,5% hiperbara. Grupo B: 5 mg (1ml) de bupivacaína 0,5% hiperbara asociado a 10 mg de fentanilo. La anestesiaintradural se realizó en decúbito lateral con aguja25 G en el espacio L2-L3, inyectando la solución anestésica en un 1 minuto y manteniéndose en esa posición durante 20 minutos. Se considera fracaso de la técnica si L1-L3 no se bloquean tras20 minutos y no se incluyen en el estudio pacientes con peso superior a 70 Kg. El bloqueo sensitivo se evaluó mediante la técnica de pinchazo y frío-calor y el bloqueo motor mediante la escala de Bromage modificada. RESULTADOS: No existen diferencias en las características demográficas, ASA, ni duración de la cirugía. Las complicaciones fueron mayores en el grupo B, sin existir diferencias en los tiempos de recuperación. CONCLUSIÓN: La asociación de fentanilo a anestésicos locales no modificó cualitativamente el bloqueo espinal selectivo, sin embargo la incidencia de efectos secundarios fue significativamente superior (AU)

INTRODUCTION: Many studies have recently demostrated that selective spinal blocks provide better control of surgical aggression with increased hemodynamic stability. OBJECTIVES: To assess the influence of intrathecalfentanyl added to a local anesthetic in selectivespinal anesthesia in the outpatient setting. METHODS: A prospective study, in which 60patients ASA I-III undergoing ambulatory surgical arthroscopy were randomly divided into two groups: Group A: 5 mg hyperbaric 0.5 % bupivacaine(1ml) and Group B: 5 mg hyperbaric 0.5 % bupivacaine (1ml) with the addition of 10 mg fentanyl. The subarachnoid anesthesia was performed in the lateral decubitus position with a 25 gauge pencil-point needle at the L2-L3 ( ..) (AU)

Tratamiento del dolor en cirugía mayor ambulatoria / No disponible

El objetivo de esta revisión es evaluar el estado actual y las perspectivas futuras del tratamiento del dolor agudo postoperatorio en Cirugía Mayor Ambulatoria(CMA). Basándonos en los estudios y revisiones publicadas podemos concluir: 1. El dolor postoperatorio es la causa médica más frecuente de demoras en el alta en una unidad de CMA, y uno de los principales motivo de ingreso hospitalario. 2. Un porcentaje importante de pacientes dados de alta, pueden tener dolor de moderado a severo durante las primeras 24-48 horas del periodo postoperatorio, aunque durante los últimos años disminuyo gracias a los esfuerzos realizados por el personal médico y de enfermería. 3. Es importante informar al paciente del grado de dolor esperado y de las alternativas de que disponemos para tratarlo. 4. No existen pautas de tratamiento universales debido a la gran variabilidad de procedimientos realizados en CMA, por lo que los protocolos anestésico- analgésicos deben individualizarse según la intensidad del trauma quirúrgico. 5. Una buena analgesia postoperatoria es una de las claves del éxito de los programas de CMA y se ha demostrado que el grado de satisfación del paciente guarda una relación directa con el control del dolor postoperatorio. 6. El paracetamoly los AINES son los fármacos mas empleados para el tratamiento del dolor postoperatorio, aunque durante los últimos años debido a la incorporación de procedimientos más complejos y dolorosos existen múltiples evidencias de que estos fármacos solos producen analgesia inadecuada. 7. La realización de técnicas anestésicas-analgésicas multimodales son las que proporcionan mayor eficacia analgésica en el postoperatorio.8. En la actualidad disponemos de técnicas y métodos eficientes y seguros para garantizar la consecución de analgesia postoperatoria (analgesia continua mediante sistemas de infusión elastoméricos) tras procedimientos que producen dolor intenso (AU)

The object of this review was to evaluate the present state and future perspectives of the treatment of postoperative pain in Ambulatory Surgery. Based on published revisions and studies we concluded that: 1. Postoperative pain is the most common medical cause which delays discharge from the Ambulatory Unit and is one of the main reasons for hospital admission. 2. An important percentage of discharged patients will experiment moderate to severe pain during the first 24-48hours following surgery, although this percentage has decreased in the last few years thanks to the efforts of medical and nursing personnel. 3. It is important to inform the patients of the amount of pain they can expect and of the possible means of treating it. 4. There are no universal methods for pain management due to the large number of different procedures undertaken in Ambulatory Surgery, therefore anaesthetic-analgesic protocols should be individualized depending on surgical trauma. 5. Good postoperative analgesia is essential in Ambulatory Surgical Programmes. The degree of patient satisfaction has been shown to be directly related to the control of postoperative pain. 6. Paracetamol and NSAID are the drugs most frequently used to control postoperative pain, although, over the last few years, and due to the increase of more complex and painful procedures, it is evident that these drugs only produce inadequate analgesia. 7. Multiple (..) (AU)

[The effect of propofol vs desflurane on recovery from anesthesia with remifentanil in outpatient surgery]. / Repercusión en la recuperación postanestésica de propofol frente a desflurano asociados a remifentanilo en cirugía ambulatoria.

OBJECTIVES: To compare the effect on parameters of postanesthetic recovery of propofol and desflurane administered with high doses of remifentanil for major outpatient surgery. PATIENTS AND METHODS: Seventy patients were randomly assigned to receive propofol (target concentration 1.5-2 microg/ml) or desflurane in perfusion (end expiratory concentration 0.5 MAC) during maintenance of anesthesia with remifentanil (0.25-1 microg/kg/min). The anesthetic agents were withdrawn after surgery. We recorded the times until eye opening, respiration, tracheal extubation, ability to cough, response to verbal orders and orientation. We also recorded the time until a score of 10 on the Aldrete recovery scale was attained, pain on a visual analog scale, sedation on the Ramsay scale, and instances of nausea or vomiting during the first 24 h after surgery. RESULTS: No statistically significant differences in patient characteristics, type of surgery or anesthesia were found. Times until early signs of postanesthetic recovery (eye opening, spontaneous breathing, tracheal extubation) were significantly less (p < 0.05) in the desflurane group. The groups were similar for all other parameters compared (times until ability to cough, respond to verbal orders, orientation and a score of 10 on the Aldrete scale). Duration of stay in the postanesthetic recovery unit, time in the day surgery ward and intensity of postoperative pain were also similar. The rate of postoperative nausea or vomiting was significantly lower in the propofol group. CONCLUSION: During anesthesia with remifentanil, the administration of desflurane is associated with better psychomotor recovery parameters than is propofol, but the rate of nausea and vomiting is higher with desflurane.

Repercusión en la recuperación postanestésica de propofol frente a desflurano asociados a remifentanilo en cirugía ambulatoria / The effect of propofol or desflurane on recovery from anesthesia with remifentanil for outpatient surgery

OBJETIVOS. Comparar la repercusión en parámetros de recuperación postanestésica de dos agentes anestésicos, propofol y desflurano, cuando se administran asociados a dosis elevadas de remifentanilo en cirugía mayor ambulatoria (CMA). PACIENTES Y MÉTODOS. Se incluyó a 70 pacientes para recibir de forma aleatoria propofol en perfusión (concentración TCI diana de 1,5-2 µg/ml) o desflurano (concentración teleinspiratoria de 0,5 CAM) durante el mantenimiento anestésico con remifentanilo (0,25-1 µg/kg/min). Al final de la intervención se suprimieron los agentes anestésicos y se registró el tiempo hasta la apertura de ojos, la ventilación espontánea, la extubación traqueal, la capacidad de toser, la respuesta a órdenes verbales y la orientación temporoespacial, así como el tiempo que tardaban en alcanzar una puntuación de 10 en la escala de recuperación de Aldrete, la intensidad del dolor postoperatorio mediante escala visual analógica, el grado de sedación según escala Ramsay y la incidencia de náuseas y vómitos postoperatorios durante las primeras 24 h. RESULTADOS. No existieron diferencias estadísticamente significativas entre ambos grupos respecto a las características demográficas y anestesicoquirúrgicas. Los parámetros de recuperación postanestésica tempranos (apertura de ojos, ventilación espontánea, extubación traqueal) fueron significativamente menores (p < 0,05) en el grupo desflurano, sin existir significación estadística en el resto de los parámetros comparados (capacidad de toser, respuesta a órdenes verbales, orientación temporoespacial y puntuación de 10 en la escala de Aldrete). Tampoco existieron diferencias con respecto a los tiempos de estancia en la unidad de recuperación postanestésica (URPA) y la sala de deambulación, ni en lo referente al dolor postoperatorio. En el grupo propofol la incidencia de náuseas y vómitos postoperatorios fue significativamente menor. CONCLUSIÓN. La anestesia basada en remifentanilo y desflurano proporciona unos parámetros de recuperación psicomotriz superiores al propofol, pero con una mayor incidencia de náuseas y vómitos (AU)

No disponible

[Preloading with 500 ml of Hartmann's solution lessens the incidence and severity of hypotension and reduces the need for ephedrine after epidural anesthesia in ambulatory patients]. / La prehidratación con 500 ml de solución de Hartmann disminuye la incidencia e intensidad de la hipotensión y reduce las necesidades de efedrina tras anestesia epidural en pacientes ambulatorios.

INTRODUCTION: Fluid preloading to prevent hypotension after epidural anesthesia has been widely questioned, although few studies have been performed in outpatients. OBJECTIVE: To evaluate the incidence and severity of hypotension, and the need for vasoactive agents after epidural anesthesia in outpatients who did or did not receive fluid preloading. PATIENTS AND METHODS: Forty patients under 55 years of age (ASA I and II) undergoing general surgery on an outpatient basis were assigned randomly to two groups of 20 according to whether they were to receive loading with Hartmann's solution or not before epidural anesthesia. All received a similar epidural dose of 2% mepivacaine. Hypotension was defined as a decrease of 20% in systolic or mean blood pressure in comparison with baseline, or absolute pressures of < 90 and 60 mmHg, respectively. Hypotension was treated with 5 mg boluses of ephedrine. RESULTS: Fourteen patients in the non-preloading group and 5 in the preloading group developed hypotension (p < 0.05). Hypotensive episodes were fewer in patients receiving preloading fluids (0.5 +/- 1.2 versus 2.0 +/- 2.4; p < 0.05). The ephedrine dose required was higher in non-preloaded patients than in preloaded ones (10.0 +/- 12.2 versus 2.6 +/- 6.3 mg; p < 0.05). Time until presentation of hypotension was longer for non-preloaded patients. CONCLUSIONS: For patients undergoing outpatient surgery, fluid preloading with 500 ml of Hartman's solution decreases both the incidence and severity of hypotension, as well as the need for vasoactive drugs after epidural anesthesia.