[Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously]. / Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea.

OBJECTIVES: To study muscle weakness caused by low doses of rocuronium and rocuronium intolerance in healthy volunteers, with the general aim of producing brief skeletal-muscle relaxation that would have potential applications in clinical situations. PATIENTS AND METHODS: After receiving authorization from the clinical research ethics committee of our hospital, we set out to study the effects on subjective and objective muscle strength of injecting 3 doses of rocuronium (0.1 mg x kg(-1), 0.05 mg x kg(-2), and 0.075 mg x kg(-1)) in healthy volunteers, each dose on a different day. Objective muscle strength was measured using a hand dynamometer. We also recorded the development of expected adverse effects (diplopia, dysarthria, and dysphagia). RESULTS: Five volunteers (all authors) were studied. In the first subject, the dose of 0.1 mg x kg(-1) of rocuronium was unsatisfactory because it was too strong, causing extreme skeletal-muscle weakness and discomfort due to diplopia, dysarthria, and dysphagia. The dose of 0.05 mg x kg(-1) was well tolerated but caused no subjective feeling of weakness or any effect measurable on dynamometry. These doses were not administered to the other subjects. In the 4 remaining volunteers, the dose of 0.075 mg x kg(-1) caused a brief feeling of muscle weakness that was considered to be acceptable, though the findings were compromised by 2 technically defective baseline dynamometry readings. The volunteers also reported brief, mild discomfort, principally due to dysphagia. CONCLUSIONS: Doses of 0.075 mg x kg(-1) of rocuronium in healthy awake subjects breathing spontaneously are acceptably tolerated and cause brief muscle weakness that may be of use in situations that require skeletal muscle relaxation at specific moments.

Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea / Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously

OBJETIVOS: Investigar en voluntarios sanos la debilidadmuscular producida por dosis bajas de rocuronio ysu tolerancia, con la idea general de producir una breverelajación muscular esquelética potencialmente aplicableen situaciones clínicas.PACIENTES Y MÉTODOS: Tras autorización del Comitéde Ética e Investigación Clínica de nuestro hospital, nospropusimos estudiar en voluntarios sanos los efectos detres dosis de rocuronio (0,1, 0,05 ó 0,075mg Kg-1), administradasen diferentes días, sobre la fuerza muscular anivel subjetivo y objetivo (medida con un dinamómetrode puño), y la aparición de efectos adversos previstos(diplopia, disartria, disfagia).RESULTADOS: Se incluyeron cinco voluntarios. En elprimer sujeto la dosis de 0,1 mg Kg-1 de rocuronio resultóinadecuada por exceso de efecto (debilidad extrema dela musculatura esquelética; experiencia desagradablepor diplopia, disartria y disfagia) y la dosis de 0,05 mgKg-1 fue bien tolerada, pero sin sensación de debilidad niefectos apreciables sobre la dinamometría. Estas dosdosis no se administraron al resto de sujetos. En losotros cuatro voluntarios, la dosis de 0,075 mg Kg-1 produjouna breve sensación de debilidad muscular consideradaaceptable (aunque los resultados estuvieroninterferidos por dos dinamometrías basales deficientestécnicamente), con leve y breve sensación desagradable(por disfagia principalmente).CONCLUSIONES: Dosis de rocuronio de 0,075 mg Kg-1en sujetos sanos conscientes y respiración espontáneason aceptablemente toleradas y producen un breve estadode debilidad muscular que podría ser de utilidad ensituaciones que precisen momentos puntuales de relajaciónmuscular esquelética(AU)

OBJETIVES: To study muscle weakness caused by lowdoses of rocuronium and rocuronium intolerance inhealthy volunteers, with the general aim of producingbrief skeletal-muscle relaxation that would havepotential applications in clinical situations.PATIENTS AND METHODS: After receiving authorizationfrom the clinical research ethics committee of ourhospital, we set out to study the effects on subjective andobjective muscle strength of injecting 3 doses ofrocuronium (0.1 mg.kg-1, 0.05 mg.kg-1, and 0.075 mg.kg-1)in healthy volunteers, each dose on a different day.Objective muscle strength was measured using a handdynamometer. We also recorded the development ofexpected adverse effects (diplopia, dysarthria, anddysphagia).RESULTS: Five volunteers (all authors) were studied.In the first subject, the dose of 0.1 mg.kg-1 of rocuroniumwas unsatisfactory because it was too strong, causingextreme skeletal-muscle weakness and discomfort due todiplopia, dysarthria, and dysphagia. The dose of 0.05mg.kg-1 was well tolerated but caused no subjectivefeeling of weakness or any effect measurable ondynamometry. These doses were not administered to theother subjects. In the 4 remaining volunteers, the dose of0.075 mg.kg-1 caused a brief feeling of muscle weaknessthat was considered to be acceptable, though thefindings were compromised by 2 technically defectivebaseline dynamometry readings. The volunteers alsoreported brief, mild discomfort, principally due todysphagia.CONCLUSIONS: Doses of 0.075 mg.kg-1 of rocuronium inhealthy awake subjects breathing spontaneously areacceptably tolerated and cause brief muscle weaknessthat may be of use in situations that require skeletalmuscle relaxation at specific moments(AU)

Análisis de complicaciones e indicadores de calidad en una unidad de CMA / No disponible

Objetivos: Evaluar en una unidad de cirugía ambulatoria los indicadores de calidad básicos en relación con periodos anteriores de la misma unidad, y con los de otras unidades de cirugía ambulatoria. Material y métodos: Estudio prospectivo de los pacientes intervenidos en régimen ambulatorio en el periodo del 1 de enero de 2005 al 31 de diciembre de 2005. Se recogen para ello el número y tipo de complicaciones y los indicadores de calidad básicos de este tipo de cirugía (índice de suspensión, índice de ingresos e índice de sustitución). Resultados: Las complicaciones registradas en el periodo señalado fueron un total de 49 (0,98%) en los 4.966 procedimientos realizados en régimen de cirugía sin ingreso. De ellas, el 65,3% (32 casos) fueron complicaciones menores, frente a un 34,7% de complicaciones mayores. La complicación más frecuente fue la hemorragia del campo quirúrgico, siguiendo en importancia el dolor de herida quirúrgica y con menor incidencia los problemas infecciosos. El índice de sustitución fue de un 58,2%, el de suspensión del 6,95%, y el de ingresos de un 4,03%. Conclusiones: En nuestro estudio hemos podido observar una mejoría progresiva de los indicadores de la unidad de cirugía ambulatoria. Sin embargo, todavía es necesario continuar avanzando para ofrecer condiciones óptimas a los pacientes para la resolución de sus patologías, haciendo especial hincapié en una selección eficaz por parte de cirujano y anestesiólogo, y una evaluación preoperatoria cuidadosa (AU)

Objectives: To evaluate the unit of ambulatory surgery. To analyze and compare the basics quality indicators with previous periods of the same unit and with other centres. Material and methods: Study of the patients operated on program of ambulatory mayor surgery in the period of January, 1st 2005 to December, 31st 2005. In order to accomplish this goal, information is collected such as number and type of complications appeared, major and minor complications, and the basics quality indicators of this type of surgery (suspension index, admission index and substitution index). Results: The complications registered in that period were 49 from 4,966 in all carried procedures (0.98%). From these complications 32 cases, 65.3%, were minor complications, while 34.7% were mayor complications. The complication more frequent is the haemorrhage with 19 cases registered, next in importance is the surgery injure pain and with less incidence infectious problems. The substitution index was 58, 2% in 2005, the suspension index was 6.95% and the admission index was 4.03%. Conclusions: In our study we have noticed a progressive improvement of the indicators of the ambulatory surgery unit. However, it is still necessary to keep advancing in order to offer our patients the optimum conditions for the resolution of their pathologies insisting on an efficient selection by the surgeon and anaesthetist, and a careful presurgery evaluation (AU)