Anestesia subaracnoidea continua en obstetricia / Continuous spinal anesthesia in obstetrics

A pesar de las teóricas ventajas de la anestesia continua en la paciente obstétrica (bloqueo de gran calidad con dosis bajas, gran estabilidad hemodinámica, rapidez de acción y ausencia de riesgo de toxicidad), existe poca bibliografía sobre esta técnica y su uso en la mujer embarazada. Tampoco hallamos muchos estudios que valoren su eficacia y seguridad, bien sean descriptivos o comparando con otras técnicas anestésicas. Esto se debe, probablemente, a la incertidumbre que crea esta técnica sobre la aparición de posibles efectos secundarios, principalmente complicaciones neurológicas y cefalea postpunción dural. El objetivo de este artículo es analizar las ventajas y desventajas, indicaciones, efectos secundarios de la anestesia subaracnoidea continua, así como revisar la bibliografía publicada sobre su utilización en la paciente obstétrica(AU)

Despite the theoretical advantages of continuous anesthesia in obstetric patients (good-quality blockade at low doses, good hemodynamic stability, rapid onset of effect, and no risk of toxicity), little has been published on this technique and its use in pregnancy. Moreover, few descriptive studies or comparative trials have evaluated the efficacy and safety of continuous spinal anesthesia, probably because of concerns about potential adverse effects— principally neurologic complications and postdural puncture headache. We review the literature on the use of continuous spinal anesthesia in obstetric patients, analyzing the advantages and disadvantages, indications, and adverse effects of this technique(AU)

Notas históricas relativas a la Neurocirugía y a la Neuroanestesia en España / No disponible

El presente articulo trata de esclarecer algunos aspectos relativos al desarrollo histórico de la Neurocirugía y de la Neuroanestesia en España durante la primera mitad del siglo XX. El objetivo es el de analizar aspectos puntuales de la historia de la neurocirugía y procurar hacer una aproximación a las primeras experiencias llevadas a cabo por cirujanos españoles; al mismo tiempo que se trata de de perfilar cómo nuestros cirujanos resolvieron los problemas que la anestesia les iba planteando en la nueva cirugía. Basamos nuestra investigación en datos dispersos que hemos hallado en la bibliografía médica española, que analizados nos permiten asegurar que en España se iniciaron las técnicas Neuroquirúrgicas simultáneamente con lo ocurrido en otros países de nuestro entorno sociocultural; sin embargo, estos primeros ensayos no tuvieron continuidad, ya que tan sólo unos pocos cirujanos siguieron practicando muy tímidamente esta cirugía. Antes de los comienzos de la guerra civil española, algunos cirujanos decidieron especializarse en esta nueva rama de la cirugía, y para ello visitaron algunas clínicas especializadas en el extranjero. La guerra civil de 1936-1939 supuso un hándicap importante para poder asistir a clínicas extranjeras por razones obvias, pero en la postguerra inmediata fueron ya más los que iniciaron en España la nueva especialidad y se crearon varios servicios neuroquirúrgicos en Barcelona y Madrid. La Neurocirugía siguió entre nosotros una evolución paralela a lo acontecido en otros países y la neuroanestesia supo responder puntualmente a los muchos retos que aquella le fue presentando a lo largo de la primera mitad del siglo XX, pudiéndose diferenciar claramente cómo los primeros ensayos fueron realizados con anestesia inhalatoria; después, a partir de principios del siglo XX, fue la local y ya en la década de los años cuarenta se inician las modernas técnicas con intubación traqueal y relajación muscular (AU)

In this paper we will clarify several points about the historical development of neurosurgery and neuroanaesthesia in Spain in the first half of XX th century. Our aim is an analysis of specific events of the history of neurosurgery with an approach to the first experiences of Spanish surgeons in this field. Also we will study how the surgeons faced the anaesthesia problems caused by this new surgery. We have based our investigation in the sparse data we found in Spanish medical literature, and we can verify that the beginning of neurosurgery in Spain was in the same period than in other nearby countries. However, apart from isolated experiences, there was not continuity in the neurosurgical practice, and only a small number of surgeons kept on with this activity. Before the onset of the Spanish civil war (1936-1939), a few surgeons decided to specialize in neurosurgery and visited several foreign hospitals. Obviously, the war complicated these stays, but after the war a greater number of surgeons involved in neurosurgery, and several departments of neurosurgery established in Barcelona and Madrid. Neurosurgery followed an evolution similar to that of other western countries, and also neuroanaesthesia evolved accordingly to cope with the new problems of this type of surgery in the first half of XX th century. Inhalatory anaesthesia was the choice in the first trials of neuroanaesthesia, followed by local anaesthesia at the beginning of XX th century. The modern techniques of anaesthesia, including endotracheal intubation and muscle relaxation began in the forties in Spain (AU)

Scophedal (SEE) was it a fad or a miracle drug?

The German firm E. Merck released in 1928, an injectable mixture of scopolamine, oxycodone, and ephedrine under the name SEE. This drug, renamed Scophedal in 1942 caused deep and prolonged analgesia, sedation, euphoria and amnesia without significant respiratory or circulatory depression. Used extensively by the German and Central European surgeons in the 1930s, Scophedal enjoyed immense popularity with the Wehrmacht's medical officers treating frontline mass casualties during World War II. The use of Scophedal declined after 1945, and its production was discontinued in 1987. Despite the clinical enthusiasm it raised, SEE was never critically investigated. This drug may deserve a rigorous re-evaluation.

Dr F.P. de Caux--the first user of curare for anesthesia in England.

Curare was used in the 19th century in England by a wide variety of scientists, physicians and veterinarians. Their experiments indicated many of the properties of the drug, but its clinical usage remained very limited and was reserved for cases of tetanus, hydrophobia and strychnine poisoning. Griffith and Johnson are usually credited with the introduction of curare into clinical anaesthesia in 1942, but a Dr F.P. de Caux working at the North Middlesex Hospital, London, in 1928 utilised curare in a series of seven patients. His work was not widely publicized and this contribution to anaesthetic history has been overlooked by subsequent authors.