[Intradural anesthesia with a 27-gauge Sprotte needle for arthroscopic knee surgery in ambulatory patients under 40 years of age]. / Anestesia intradural con aguja 27 G de Sprotte para la cirugía de artroscopia de la rodilla en los pacientes ambulatorios menores de 40 años.

OBJECTIVE: To assess the clinical usefulness of intradural anesthesia through a 27 gauge Sprotte ("pencil point") needle for arthroscopic knee surgery in outpatients under 40 years of age. PATIENTS AND METHOD: A retrospective study of 116 patients under 40 scheduled for arthroscopic knee surgery, analyzing the incidence of post-dural puncture headache and backache after anesthesia provided with a 27 gauge (0.4 mm) Sprotte needle. Follow-up assessments were performed 24, 48 and 72 hours after surgery. We also studied technical difficulty and failure rate encountered in achieving blockade with this type of needle. RESULTS: We recorded one case of headache (0.86%) that resolved within 48 hours with conservative treatment. Backache was reported by eight patients (6.8%) and was described as slight in all cases. The small caliber and design of the spinal needle caused no technical difficulties and anesthesia was successfully provided for all patients. Time of hospital stay ranged from 330 to 420 minutes (mean 360 +/- 45 minutes). No patient had to stay overnight. CONCLUSIONS: The results confirm that intradural anesthesia with 27 gauge Sprotte needles is an acceptable anesthetic technique for outpatient surgery in young patients given that the rate of complications is low.

[Anesthesia for cesarean section in a case of Emery-Dreifuss muscular dystrophy]. / Anestesia para cesárea en un caso de distrofia muscular tipo Emery-Dreifuss.

We describe the anesthetic technique used in a patient with Emery-Dreifuss muscular dystrophy, a rare form whose genetic transmission is usually linked to the X-chromosome but which can be dominant, thus occasionally affecting women. A woman with vaginal condylomata was scheduled for elective cesarean. She presented proximal muscle weakness in the upper extremities, flexion contracture of both elbows and neck and, occasionally, respiratory difficulty. Surgery was performed with epidural anesthesia with no noteworthy complications. The anesthetic implications of this clinical picture depend on the likelihood of malignant hyperthermia, difficult intubation, arrhythmias or respiratory insufficiency due to muscle weakness. Continuous epidural or spinal anesthesia provides a more progressive level of blockade and greater control.

[Electroencephalographic effects of subhypnotic doses of midazolam in healthy subjects and in brain disease patients]. / Estudio de las repercusiones electroencefalográficas de dosis subhipnóticas de midazolam en pacientes sanos y con patología cerebral.

The aim of this study was to analyze the electroencephalographic alterations produced by minimum doses of midazolam and look for a theoretic base for these changes in the benzodiazepinic receptor. To do so, the possible abnormal responses provoked by midazolam on the EEG of patients with ischemic cerebral infarctions were studied. Sub-hypnotic infusions of midazolam (0.15 mg kg/min) were administered prior to anesthetic induction in three groups of patients: control group, patients with tumoral cerebral pathology group, and ischemic cerebral infarctions group. In addition to the known modifications obtained in the patients of the control group, those presenting bioelectric activity alterations due to tumoral pathology did not show modifications. In the group of patients with ischemic infarctions, the intravenous perfusion of midazolam induced moderate increase in the localized theta and delta frequency and a lower representation of the beta rhythm which was also of lower amplitude. Midazolam is capable of making slow rhythms on the EEG, following it administration at low doses, in ischemic zones of the brain.