[Hemodynamic repercussion of epidural bupivacaine in thoracic injuries]. / Repercusión hemodinámica de la bupivacaína epidural en los traumatismos torácicos.

Systemic and pulmonary hemodynamic effects of 8 to 10 ml of 0.25% bupivacaine containing 1:200,000 adrenaline administered at the midthoracic level were prospectively assessed in 20 patients (aged 45 +/- 16 years) with thoracic trauma presenting 6 +/- 2 rib fractures and pulmonary contusion of different extent and radiologic density. The study was carried out at comparable evolving times, 24 h after trauma, during the second or third day of treatment, and when the hemodynamic stability of the patient was achieved. Hemodynamic measurements were performed before and 30 min after administration of the analgesic agent using a Swan-Ganz catheter. The results indicate that administration of moderate doses of epidural bupivacaine at the middle thoracic level in patients with normovolemic thoracic traumatism were not followed by alterations in the hemodynamic function except for a slight decrease in systemic arterial and pulmonary pressure. The mean arterial pressure decreased by 8% (p less than 0.05), the cardiac index showed a 4% reduction (p = 0.05), and the mean pulmonary pressure experienced a 14% decrease (p less than 0.05).

[A controversial entity: myocardial contusion in 51 patients with thoracic trauma]. / Una entidad controvertida: la contusión miocárdica en 51 pacientes con traumatismo torácico.

We studied the incidence of myocardial contusion following thoracic trauma in a group of 51 patients. The goal of this review is an assessment of the repercussion of this lesion in mortality and treatment. Also we considered the diagnostic options. Our finding show that this lesion is relatively frequent, 8 patients were considered with myocardial contusion (15.7%), but generally is not worth of extraordinary treatment. We considered the ECG a valuable diagnostic procedure and the CPK-MB a specific test, but brief and often with troubled interpretation due to the great rhabdomyolysis and the huge liberation of total CPK. In 4 patients there was obvious elevation of CPK-MB levels. All but one were in the ECG group. Other diagnostic procedures in those patients were not available.