Respuesta a unidades de dolor infantiles de "Alta Eficiencia" / No disponible

No disponible

[Pediatric acute postoperative pain management service: 6 years' experience]. / Unidad para el tratamiento del dolor agudo postoperatorio pediátrico: una experiencia de seis años.

OBJECTIVE: [corrected] To describe the introduction and activities of a low-cost acute postoperative pain management service for children. PATIENTS AND METHODS: A descriptive study of patients treated with patient-controlled analgesia (PCA), nurse-controlled analgesia (NCA), continuous epidural analgesia (CEA), and patient-controlled epidural analgesia (PCEA) from October 1998 through December 2004. We analyzed demographic information and data on most frequent surgical procedures, analgesic techniques, pain on our nurse observation scale, side effects (nausea and/or vomiting, pruritus, urinary retention, excessive sedation, respiratory depression), and parent and patient satisfaction. RESULTS: Three hundred treatments per year were performed, for a total of 1870; 46.6% were in children under 5 years old. Orthopedic operations with osteotomy (22.5%) and laparotomies (13.4%) were the most common procedures. The most frequently used approach was NCA (53%), followed by PCA with bolus doses (24.5%), PCA with infusion (16.9%), and continuous epidural analgesia or PCEA (5.6%). On the nurse observation scale (no pain; slight, moderate or intense pain) absence of pain or slight pain was observed in 82%, 90%, and 94% of the patients on days 1, 2, and 3 after surgery. Postoperative nausea and vomiting were observed in 20% of the patients and respiratory depression in 0.16%. Satisfaction was good or very good for 98% of the parents and 94% of the children interviewed. CONCLUSIONS: The pain management service in our hospital was able to control postoperative pain safely and effectively.

Unidad para el tratamiento del dolor agudo postoperatorio pediátrico: una experiencia de seis años / Pediatric acute postoperative pain management service: 6 years’ experience

OBJETIVO: Describir la implantación y actividad deuna unidad del dolor agudo (UDA) de bajo coste en elpostoperatorio en niños.PACIENTES Y MÉTODOS: Estudio descriptivo de lospacientes tratados con PCA (Analgesia Controlada porel Paciente), NCA (Analgesia Controlada por la enfermera),EC (Epidural Continua), y PCEA (Analgesia EpiduralControlada por el Paciente), desde octubre de1998 hasta diciembre de 2004. Se analizaron datosdemográficos, intervenciones quirúrgicas más frecuentes,técnica analgésica, dolor según escala propia deobservación por la enfermería, efectos secundarios,(náuseas y/o vómitos, prurito, retención vesical, sedaciónexcesiva, depresión respiratoria), satisfacción paterna ydel paciente.RESULTADOS: Se han realizado 1.870 tratamientos(300/ año), el 46,6% en menores de 5 años. Las intervencionesortopédicas con osteotomía (22,5%), y laslaparotomías (13,4%) fueron las más frecuentes. LaNCA fue la técnica más utilizada (53%), seguida de laPCA con bolus (24,5%), PCA con infusión (16,9%) yEpidural Continua y PCEA (5,6%). Con escala observacionalpor la enfermería (no dolor, leve, moderado,intenso) se observó ausencia de dolor o dolor leve en el82, 90 y 94% de los pacientes, en los días 1º, 2º y 3º depostoperatorio respectivamente. Aparecieron náuseas yvómitos postoperatorios en el 20% de los pacientes.Depresión respiratoria en el 0,16%. La satisfacción fuebuena y muy buena en el 98% de los padres y en el 94%de los pacientes encuestados.CONCLUSIONES: En nuestro hospital la UDA ha permitidoun control del dolor postoperatorio de manera seguray eficaz

OBJETIVE: To describe the introduction and activitiesof a low-cost acute postoperative pain management servicefor children.PATIENTS AND METHODS: A descriptive study of patientstreated with patient-controlled analgesia (PCA), nursecontrolledanalgesia (NCA), continuous epidural analgesia(CEA), and patient-controlled epidural analgesia (PCEA)from October 1998 through December 2004. We analyzeddemographic information and data on most frequent surgicalprocedures, analgesic techniques, pain on our nurseobservation scale, side effects (nausea and/or vomiting,pruritus, urinary retention, excessive sedation, respiratorydepression), and parent and patient satisfaction.RESULTS: Three hundred treatments per year wereperformed, for a total of 1870; 46.6% were in childrenunder 5 years old. Orthopedic operations with osteotomy(22.5%) and laparotomies (13.4%) were the mostcommon procedures. The most frequently used approachwas NCA (53%), followed by PCA with bolus doses(24.5%), PCA with infusion (16.9%), and continuousepidural analgesia or PCEA (5.6%). On the nurse observationscale (no pain; slight, moderate or intense pain)absence of pain or slight pain was observed in 82%,90%, and 94% of the patients on days 1, 2, and 3 aftersurgery. Postoperative nausea and vomiting were observedin 20% of the patients and respiratory depression in0.16%. Satisfaction was good or very good for 98% ofthe parents and 94% of the children interviewed.CONCLUSIONS: The pain management service in ourhospital was able to control postoperative pain safelyand effectively

Hipernatremia en cirugía laparoscópica de quiste hidatídico hepático en paciente pediátrico / Hypernatremia in laparoscopic surgery for a hydatid liver cyst in a pediatric patient

No disponible

[Usefulness of isoflurane in anesthesia in elective cesarean section]. / Utilidad del isofluorano en la anestesia de la cesárea electiva.

A series of 25 patients undergoing iterative cesarean section under general anesthesia received isoflurane at 0.75% together with a mixture of O2 and N2O at 50% for anesthetic maintenance. The inhalant agent was withdrawn when closing fascia. There was no case of regaining of consciousness during the operations. Uterine contraction was acceptable as evaluated by the surgeon at the end of the operation. Mean hematocrit value was 31.43 (SD 1.27) at 6 hours of operation. Fetal arterial gasometric values and Apgar score at 5 and 10 minutes fell within acceptable limits.

[Late postpartum eclampsia. Apropos of a case]. / Eclampsia tardía posparto. A propósito de un caso.

We report the case of a 32-year-old multipara who presented preeclampsia on the fourth day after childbirth without receiving proper treatment that progressed to eclampsia 4 days later. Pregnancy and delivery had been uneventful. The patient presented proteinuria (30 mg/dl), serum total proteins 5.3 g/dl and serum albumin 3.3 g/dl. Blood pressure was controlled with methyldopa, 500 mg at six-hour intervals by intravenous route. The patient presented hypoxemia secondary to bilateral pleural effusion and aspirative pneumonia requiring mechanical ventilation and invasive hemodynamic monitoring. Treatment with cefotaxime, 1 g at six-hour intervals by intravenous route and clindamycin, 600 mg at six-hour intervals by intravenous route was initiated. Sedation was maintained with thiopental sodium, 3 mg/kg/hour in continuous infusion. At dismission, the patient was completely recovered from her clinical picture and needed no antihypertensive therapy. Physiopathologic features and the aforementioned complications are discussed with particular reference to differential diagnosis.

[Obturator nerve block in transurethral surgery]. / Bloqueo del nervio obturador en la cirugía transuretral.

The obturator nerve passes in close proximity to the bladder as it courses through the pelvis. During transurethral operations, resection may result in stimulation of the obturator nerve, causing violent adductor contraction. Bladder perforation and incomplete tumor resection are the most important complications. All techniques proposed since transurethral surgery began, until nowadays are reviewed: neuromuscular blockade, electric circuit modifications, transparietal endoscopic blockade, periprostatic and subvesical infiltration, obturator nerve blockade and the "3 in 1 block" described by Winnie. Practical advices are proposed finally.

[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.

[Acute pulmonary edema following airway obstruction and cardiac tamponade related to mediastinal tumor]. / Oedème aigu du poumon par obstruction des voies aériennes et tamponnade cardiaque en relation avec une tumeur médiastinale.

A case is reported of acute airway obstruction and pulmonary oedema of mixed origin (cardiogenic and non cardiogenic), occurring in a patient after surgical treatment for pericardial tamponade due to a mediastinal tumour. This 45 year old female patient had a non-Hodgkin lymphoma, mostly located within the anterior and middle mediastinum. When she developed cardiac tamponade, emergency cardiac decompression was carried out. The surgical procedure went well, despite an episode of severe hypotension. Immediately after extubation, she developed paradoxical breathing with retraction and cyanosis. She was reintubated and ventilated. The chest X-ray showed bilateral alveolar infiltrates, mostly around the hilar. Two hours later, she was again extubated and developed again the same respiratory failure. This time, she was intubated and ventilated for 48 h. She was then extubated with no problem. It seemed most probable that transmission to the interstitial space of a negative intrapleural pressure due to the inspiratory efforts made against an occluded airway was the principal mechanism responsible for the accumulation of fluid to this space.