Vasoespasmo coronario en la inducción de la anestesia general / Coronary vasospasm in general anaesthesia induction

El vasoespasmo de la arteria coronaria en la inducción de la anestesia general es una complicación poco documentada en nuestro entorno, por su baja incidencia o por pasar desapercibida. Presentamos el caso de una mujer previamente sana, programada para artroscopia de hombro, que en la inducción anestésica presentó taquicardia ventricular, que revirtió espontáneamente a ritmo sinusal con elevación de ST en cara lateral, y que se diagnosticó y trató con una angiografía inmediata. La importancia del caso se basa en la escasa bibliografía encontrada y en ser de los pocos comunicados en pacientes sanos durante la inducción de la anestesia general y, con diagnóstico y resolución angiográfico inmediato(AU)

Coronary artery vasospasm in the induction of general anaesthesia is a rarely reported complication in our environment, owing to its low incidence or due to having disappeared. We present a case of a previously healthy woman, scheduled for shoulder arthroscopy, who in the anaesthetic induction had a ventricular tachycardia, which spontaneously reverted to sinus rhythm with ST elevation on the left side, and which was diagnosed and treated immediately by using angiography. The importance of the case is based on the lack of references found, and on being rarely reported in health patients during the induction of general anaesthesia, and with an immediate diagnosis and resolving using angiography(AU)

[Coronary vasospasm in general anaesthesia induction]. / Vasoespasmo coronario en la inducción de la anestesia general.

Coronary artery vasospasm in the induction of general anaesthesia is a rarely reported complication in our environment, owing to its low incidence or due to having disappeared. We present a case of a previously healthy woman, scheduled for shoulder arthroscopy, who in the anaesthetic induction had a ventricular tachycardia, which spontaneously reverted to sinus rhythm with ST elevation on the left side, and which was diagnosed and treated immediately by using angiography. The importance of the case is based on the lack of references found, and on being rarely reported in health patients during the induction of general anaesthesia, and with an immediate diagnosis and resolving using angiography.

Parálisis facial tras anestesia epidural / Facial paralysis after epidural anesthesia

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[Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial]. / Analgesia postoperatoria en la intervención abierta de hallux valgus en Cma. comparación entre analgesia oral y bloqueo perineural contínuo del nervio tibial posterior.

INTRODUCTION: This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery. MATERIAL AND METHODS: Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend. RESULTS: The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique. CONCLUSION: Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.

Analgesia postoperatoria en la intervención abierta de hallux valgus en CMA. Comparación entre analgesia oral y bloqueo perineural continuo del nervio tibial posterior / Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial

INTRODUCCIÓN: El presente trabajo valora la seguridady eficacia del bloqueo continuo del nervio tibial posterioren el tobillo, mediante la infusión domiciliaria porelastómero de ropivacaína al 0,375%, en pacientes intervenidosde hallux valgus en cirugía ambulatoria (CMA).MATERIAL Y MÉTODO: Se compara la analgesia oralconvencional de la unidad de CMA, metamizol 575 mgVO c/6h (AC) con la analgesia perineural (AP), infusióncontinua a 5 mL h-1 de ropivacaína 0,375% en nerviotibial posterior, en dos grupos de 20 pacientes, distribuidosaleatoriamente. Intervenciones realizadas bajo anestesiaintradural con mepivacaína hiperbara e infiltraciónintra-articular con bupivacaína al 0,25%. Ambos gruposutilizaron tramadol 50 mg VO c/8h como analgésico derescate. El servicio de atención domiciliaria realizó loscontroles: valoración del dolor según la escala analógicavisual (EVA 0-10), calidad sueño, necesidad de analgesiade rescate, aceptación de la técnica, incidencias y efectossecundarios, a las 12, 24 y 48 h de la intervención. Trabajodescriptivo, comparaciones mediante prueba U deMann Whitney; para el análisis de calidad del sueño ynecesidad de analgesia se utilizó el test de tendencia linealChi cuadrado.RESULTADOS: El grupo AP presentó valores de EVAsignificativamente menores a las 4 h, 12 h y 24 h y menornecesidad de analgesia de rescate. No diferencias en calidaddel sueño (p=0,07). No incidencias ni efectos secundarios.No hubo casos de reingreso. Los pacientes manifestaronun alto grado de aceptación de la técnica.CONCLUSIÓN: La analgesia perineural continua domiciliariase muestra efectiva y segura en nuestro ámbito

INTRODUCTION: This trial assessed the safety and efficacyof a continuous posterior tibial nerve block in theankle provided in the patient’s home by elastomericpump infusion of 0.375% ropivacaine after ambulatoryhallux valgus surgery.MATERIAL AND METHODS: Patients were randomizedto 2 groups of 20 each to receive either the conventionaloral analgesia prescribed by our team after outpatientsurgery (metamizole 575 mg/6 h p.o.) or perineuralanalgesia with a continuous infusion of 5 mL.h-1 of0.375% ropivacaine in the posterior tibial nerve. Surgerywas performed under hyperbaric spinal anesthesiawith mepivacaine and an injection of 0.25% bupivacaineinto the joint. Both groups also received 50 mg/8 hp.o. of tramadol as rescue analgesia. Assessment duringvisits by the home care team 12, 24, and 48 hours aftersurgery included the following variables: pain on avisual analog scale (VAS, 0-10), sleep quality, need forrescue analgesia, acceptance of the technique, sideeffects and adverse events. Descriptive statistics werecalculated and comparisons were performed with theMann-Whitney U test; sleep quality and need for rescueanalgesia were compared by applying the ÷2 statisticwith a test of linear trend.RESULTS: The perineural analgesia group had significantlylower VAS scores at 4, 12, and 24 hours and lessneed for rescue analgesia. No differences in sleep qualitywere found (P0.07). The incidence of side effectsdid not differ, and there were no readmissions. Thepatients expressed a high level of acceptance of thetechnique.CONCLUSION: Continuous perineural analgesia in thehome setting was found to be effective and safe in ourpatients

Catéter epidural anudado espontáneamente / Spontaneous kinking of an epidural catheter

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[Convulsions induced by ropivacaine after brachial plexus block]. / Convulsiones inducidas por ropivacaína tras la realización de un bloqueo del plexo braquial.

Ropivacaine is a local anesthetic frequently used to provide regional blocks because its toxicity threshold is favorable and it is highly selective for sensory nerve fibers. Few reports of adverse events and complications related to use of ropivacaine have been published. We report 2 cases of central nervous system toxicity. Each occurred after a brachial plexus block with 0.75% ropivacaine, one performed by an axillary approach and one by an infraclavicular approach with nerve stimulation.

¿La monitorización del índice biespectral del EEG podría ser un buen monitor de la evolución neurológica de los pacientes en coma de origen metabólico? / Might EEG bispectral index monitoring provide a good reflection of the neurological evolution of patients in metabolic coma?

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