Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural / Modern approach to an old technique: narrative revision of techniques used to locate the epidural space

Desde la primera descripción de la técnica epidural en los años 1920, el progreso continuo en el conocimiento de la anatomía y de la fisiología del espacio epidural ha permitido desarrollar diferentes técnicas de localización de este espacio para aumentar tanto la seguridad como la eficacia del procedimiento. Las técnicas más utilizadas hoy en día se basan en las 2 principales propiedades descritas del espacio epidural: la diferencia de distensibilidad entre el ligamento amarillo y el espacio epidural y la existencia de una presión negativa en el espacio epidural. Sin embargo, en los últimos años, la evolución tecnológica ha permitido desarrollar nuevas técnicas de localización basadas en otras propiedades físicas de los tejidos. Algunas de ellas están todavía en una fase experimental, pero otras como las técnicas con ultrasonidos han alcanzado una fase clínica y se está expandiendo su uso en la práctica diaria (AU)

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice (AU)

Cardioprotective efficacy of sevoflurane vs. propofol during induction and/or maintenance in patients undergoing coronary artery revascularization surgery without pump: A randomized trial.

PURPOSE: Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS: Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS: The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS: The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.

Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space. / Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural.

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.