ABSTRACT
PURPOSE: Results of efficacy and safety assessments of topical sevoflurane use in patients with long-term treatment-refractory vascular ulcers are reported. METHODS: Patients were randomly assigned to receive sevoflurane instillations (1 mL per cm2 of ulcer area 1-4 times daily) plus standard wound care (ulcer cleaning, debridement, and dressing changes) or standard care only. Topical sevoflurane was initiated during hospitalization, with self- or nurse-administered instillations continued after discharge. Study participants were evaluated at least once weekly for 1 month and then every 2 weeks for up to 90 days. The primary efficacy measures were debridement-related and overall pain (assessed using a 10-point visual analog scale), daily opioid use, and ulcer size; secondary measures were patient and clinician impressions of improvement and ulcer-related admissions during treatment. The primary safety endpoint was intolerable sevoflurane-related adverse effects. RESULTS: Compared with the group receiving standard care alone (n = 5), the sevoflurane group (n = 10) had significant (p = 0.001) reductions in mean ± S.D. scores for debridement-related pain on day 1 of treatment and at subsequent time points; the sevoflurane group also had significant reductions in overall pain, daily opioid use, and ulcer size. Outcomes in terms of patient- and clinician-rated improvement and emergency admissions also favored the sevoflurane group. Mild localized reddening in the area surrounding ulcers occurred in 4 sevoflurane-treated patients. CONCLUSION: Direct application of sevoflurane onto vascular ulcers resulted in an intense and long-lasting analgesia and was associated with a progressive reduction of ulcer size.
Subject(s)
Anesthetics, Inhalation/administration & dosage , Pain Management/methods , Pain/drug therapy , Sevoflurane/administration & dosage , Skin Ulcer/drug therapy , Administration, Cutaneous , Aged , Aged, 80 and over , Chronic Disease/drug therapy , Female , Humans , Male , Middle Aged , Pain/diagnosis , Pain/etiology , Pain Measurement , Prospective Studies , Skin Ulcer/complications , Treatment OutcomeABSTRACT
Objetivo. Valorar los resultados preliminares obtenidos en nuestro servicio en revascularización infragenicular con aloinjerto arterial criopreservado (AAC) en caso de ausencia de injerto autólogo. Pacientes y métodos. Entre junio de 2001 y agosto de 2005, realizamos ocho procedimientos en ocho pacientes (dos mujeres y seis varones) con una edad media de 73 años (rango: 55-82 años). En dos casos los injertos fueron compuestos AAC-segmento venoso residual. En otros dos casos se emplearon dos AAC. Las indicaciones para intervenir fueron isquemia crítica (siete) e infección protésica (uno). En cinco casos había al menos una revascularización previa. Los AAC se obtuvieron de donante cadáver. La anastomosis distal se realizó sobre poplítea (dos), arteria tibial (cinco) o arteria perimaleolar (uno). En todos los casos se descartó la existencia de segmento venoso autólogo suficiente mediante eco-Doppler. El seguimiento fue clínico y ecográfico. Resultados. Durante el primer mes se produjeron una rotura de AAC y una trombosis precoz, ambas con reparación satisfactoria. Durante un seguimiento medio de 14 meses (rango: 1-46 meses), cuatro injertos sufrieron un fallo primario: dos trombosis, una estenosis y una degeneración aneurismática. Ello derivó en una amputación mayor, una trombectomía y una sustitución del injerto. La permeabilidad global fue del 75% (6/8) y la salvación de extremidad del 87,5% (7/8). Una paciente falleció a los cuatro y otro a los 46 meses, ambos con injerto permeable. Conclusión. A pesar de ser una serie pequeña, los AAC pueden ser una opción en las revascularizaciones infrageniculares en caso de ausencia de injerto autólogo suficiente para ésta
Aim. To assess our preliminary results of infrapopliteal bypass grafting performed with cryopreserved arterial allografts (CAA) in case of absence of alternate autologous veins. Patients and methods. Between June 2001 and August 2005, eight procedures were performed in eight patients (two female and six male), with a mean age of 73 years (range: 55-82 years). In two cases a composite CAA-residual vein bypass was realized. In another two cases two segments of CAA were used. Indications for operation were critical leg ischaemia in seven cases and infection in the other. In five cases, there was at least one previous revascularization on the same limb. CAA were obtained from cadaveric donors in a multidisciplinary organs explant program. Distal anastomosis was to the bellow knee popliteal artery in two cases, to a tibial artery in five cases and to a perimaleolar artery in one case. In all cases we searched for the existence of alternate autologous vein with Doppler scan. The surveillance was clinic and with Doppler scan. Results. During follow-up (mean: 14 months; range: 1-46 months), four grafts failed. These failures were two thrombosis, one stenosis and one aneurysmatic degradation. Due to this, a major amputation and a CAA-prosthetic replacement were performed. The global patency rate was 75% (6/8) and the limb salvage rate was 87.5% (7/8). One patient died at four month after procedure, with patent bypass. Conclusion. Even knowing that this is a small group of patients, we think CAA could be an option in infrapopliteal bypass surgery in case of absence of autologous vein
