[Assessing preoperative use of medicinal plants during preanesthetic interviews]. / Valoración del consumo preoperatorio de plantas medicinales en la consulta preanestésica.

OBJECTIVES: To assess the use of medicinal plant preparations in preanesthetic interviews at a Spanish university hospital. MATERIALS AND METHODS: A total of 500 questionnaires were randomly distributed over a period of 3 months to patients attending a preanesthetic assessment interview. RESULTS: Of the 431 valid questionnaires returned, 154 (35.73%) were from patients who reported consumption of some type of herbal remedy and 55 (12.76%) were from patients who used a medicinal plant considered in the literature to be potentially toxic. Consumption was higher among women (64.28%) (P < 0.001). Among users of these plants, 137 (88.96%) reported that they did not consider them to be medications and 141 (91.55%) would not have told the anesthesiologist about their use during a routine clinical interview. CONCLUSION: There is considerable use of medicinal herbs with potentially adverse interactions with various drugs used during the perioperative period. Anesthesiologists need to be familiar with such herbs and their effects and to ask specific questions about their use during the preanesthetic interview.

Valoración del consumo preoperatorio de plantas medicinales en la consulta preanestésica / Assesing preoperative use of medicinal plants during preanesthetic interviews

OBJETIVOS: Valorar el consumo de plantas medicinales en la consulta preanestésica de un hospital universitario español. MATERIAL Y MÉTODOS: Durante tres meses se llevaron a cabo un total de 500 encuestas repartidas de forma aleatoria en pacientes que acudían a consulta para valoración preanestésica RESULTADOS: De las 431 encuestas válidas, 35,73 % (154) de los pacientes encuestados afirmaron estar consumiendo algún tipo de planta medicinal y el 12,76% (55) afirmaron estar consumiendo alguna planta medicinal recogida en la bibliografía consultada como potencialmente tóxica. El consumo fue mayor en mujeres 64,28% (P<0,001). De los consumidores, 88,96% (137) no consideraban a las plantas medicinales como medicamentos y el 91,55% (141) no habría informado al anestesiólogo de su consumo durante una entrevista clínica rutinaria. CONCLUSIÓN: En la muestra estudiada el consumo de plantas medicinales con potenciales efectos adversos e interacciones farmacológicas con distintos fármacos utilizados habitualmente durante el periodo perioperatorio es importante. Es necesario que los anestesiólogos conozcan dichas plantas medicinales y sus efectos, e interroguen de forma específica sobre su consumo durante la consulta preanestésica

OBJECTIVES: To assess the use of medicinal plant preparations in preanesthetic interviews at a Spanish university hospital. MATERIALS AND METHODS: A total of 500 questionnaires were randomly distributed over a period of 3 months to patients attending a preanesthetic assessment interview. RESULTS: Of the 431 valid questionnaires returned, 154 (35.73%) were from patients who reported consumption of some type of herbal remedy and 55 (12.76%) were from patients who used a medicinal plant considered in the literature to be potentially toxic. Consumption was higher among women (64.28%) (P<0.001). Among users of these plants, 137 (88.96%) reported that they did not consider them to be medications and 141 (91.55%) would not have told the anesthesiologist about their use during a routine clinical interview. CONCLUSION: There is considerable use of medicinal herbs with potentially adverse interactions with various drugs used during the perioperative period. Anesthesiologists need to be familiar with such herbs and their effects and to ask specific questions about their use during the preanesthetic interview

[Induction-intubation sequence in neuroanesthesia. Usefulness of vecuronium in fractionated doses]. / Secuencia de inducción-intubación en neuroanestesia. Utilidad del vecuronio en dosis fraccionadas.

Muscular relaxant vecuronium bromide (Norcuron R, Organon Teknika Española, S.A.) was administered to 20 patients undergoing intracranial surgery with general anesthesia at a dose of 0.01 mg/kg weight followed by 0.1 mg/kg (intubation dose) four minutes later. Two minutes after the second dose and under careful manual mechanical ventilation with O2 100%, a laryngoscopy was performed to evaluate the conditions for intubation. Mean arterial pressure, heart rate, PaO2, and PaCO2 were measured at baseline and immediately before laryngoscopy. Neuromuscular function was monitored observing the response to a train of four stimuli applied on the cubital nerve. During the operation a continuous infusion of vecuronium at a rate of 1 microgram/kg/min was maintained. Conditions for intubation were excellent in 18 patients and good in two cases. Mean heart rate and PaCO2 did not show significant variations. In contrast, during prelaryngoscopy mean arterial pressure decreased and PaO2 increased with respect to the baseline values. During surgery all patients showed a good clinical relaxation. Thus, we believe that vecuronium is a good muscular relaxant agent, safe, and effective to be used in neurosurgery.

[Anesthesia for brain tumor surgery during pregnancy: presentation of a case]. / Anestesia para cirugía de un tumor cerebral durante el embarazo: a propósito de un caso.

We report the case of a 26th-week pregnant woman undergoing craniotomy for excision of brain tumor. Main considerations for anesthetic management of pregnant women undergoing surgical operations are the following: Each pregnant women patient should be considered as "full stomach" regardless fasting period. All measures should be taken to ensure fetal oxigenation by maintaining an optimal placental blood flow. There is no evidence of teratogenesis of anesthesic agents except for nitrous oxide which should be avoided during first and second trimesters. Fetal monitoring should be instituted from week 16 on as well as uterine dynamics periods whenever possible because of the greater frequency of premature labor or abortion. In Neurosurgery, an exhaustive control of blood pressure and PaCO2 of the mother should be carried out and osmotic diuretic agents should be cautiously administered.

[Effect of succinylcholine on serum levels of potassium in patients treated for intracranial aneurysm]. / Efecto de la succinilcolina sobre los niveles séricos de potasio en pacientes intervenidos de aneurisma intracraneal.

A prospective study was carried out on 10 patients who were submitted to intracranial aneurysm clipping and who had bled some days before the operation. All patients received a precurarization dose of pancuronium (0.01 mg/kg) and lidocaine (1.5 mg/kg) during the preinduction and succinylcholine (1 mg/kg) to facilitate orotracheal intubation. The operation took place between the days 5 and 27 following the subarachnoid hemorrhage. Basal potassium plasma levels were determined at 1, 3, 5 and 10 minutes after succinylcholine had been administered. The levels (media +/- SD), expressed in mEq/l, were: basal 3.77 +/- 0.31; at first minute 3.64 +/- 0.38: 3 minutes 3.69 +/- 0.35; 5 minutes 3.78 +/- 0.31, and 10 minutes 3.82 +/- 0.39. Using the analysis of variance, no significant differences (p = 0.11) were observed among the average levels of potassium in the intervals of time studied. There is no significant correlations either between the potassium figures and the time elapsed since the subarachnoid hemorrhage occurred.