[Treatment of pain in the oncology patient]. / Tratamiento del dolor en el paciente oncológico.

Pain is a symptom with a high prevalence in patients with cancer and causes an important deterioration in their quality of life. With the measures laid out by the WHO in 1986, which divides the different therapeutic options available in three ascending steps, pain can be controlled in a high percentage of cases. Those patients who are difficult to control with these measures can benefit from the application of neuromodulation techniques by experts in the treatment of chronic pain. The correct employment of the different medicines (non-steroidal anti-inflammatory medicines, opiates and coadjuvants), knowledge of the secondary effects, loss of fear in the face of opiates and knowledge of the different algic syndromes associated with the oncology patient, must be accompanied by a suitable evaluation of the pain according to the different scales, both in the phase of the treatment's initiation and in the follow-up of the patient.

Tratamiento del dolor en el paciente oncológico / Treatment of pain in the oncology patient

El dolor es un síntoma de alta prevalencia en los pacientes con cáncer y deteriora de forma importante su calidad de vida. Con las medidas enunciadas por la OMS en 1986, que divide en tres escalones ascendentes las distintas opciones terapéuticas de las que disponemos, el dolor puede ser controlado en un alto porcentaje de casos. Aquellos pacientes difíciles de controlar con estas medidas, se pueden beneficiar de la aplicación de técnicas de neuromodulación por expertos en el tratamiento del dolor crónico. El correcto manejo de los distintos fármacos (AINES, opiáceos y coadyuvantes), el conocimiento de sus efectos secundarios, la pérdida del miedo a los opiáceos y el conocimiento de los distintos síndromes álgicos asociados al paciente oncológico, deben ir de la mano con la adecuada valoración del dolor según las distintas escalas, tanto en la fase de instauración del tratamiento, como en el seguimiento del paciente (AU)

Pain is a symptom with a high prevalence in patients with cancer and causes an important deterioration in their quality of life. With the measures laid out by the WHO in 1986, which divides the different therapeutic options available in three ascending steps, pain can be controlled in a high percentage of cases. Those patients who are difficult to control with these measures can benefit from the application of neuromodulation techniques by experts in the treatment of chronic pain. The correct employment of the different medicines (non-steroidal anti-inflammatory medicines, opiates and coadjuvants), knowledge of the secondary effects, loss of fear in the face of opiates and knowledge of the different algic syndromes associated with the oncology patient, must be accompanied by a suitable evaluation of the pain according to the different scales, both in the phase of the treatment's initiation and in the follow-up of the patient (AU)

Bloqueo continuo del plexo braquial / Continuous blockade of the brachial plexus

El bloqueo del plexo braquial mediante técnicas continuas permite la administración de dosis de mantenimiento de un fármaco a lo largo del tiempo, evitando la analgesia en "picos y valles" y sus correspondientes efectos secundarios. Además posibilita la anestesia/analgesia durante la intervención quirúrgica, facilitando la titulación de la dosis para adaptarla a las necesidades de cada paciente.Se han empleado inyecciones intermitentes, sin embargo la infusión continua sería el método de elección. El fármaco más utilizado es la bupivacaina al 0,125-0,25 por ciento, a velocidades de infusión que oscilan entre 7-12 ml.h- 1, siendo muy raros y generalmente leves los síntomas tóxicos que se pueden producir, ya que si aparecen van a ocurrir lentamente en el tiempo. En la actualidad se está utilizando con igual éxito la ropivacaína al 0,1-0,375 por ciento a velocidades entre 4-10 ml.h- 1.El bloqueo continuo del plexo braquial se utiliza para proporcionar analgesia y bloqueo simpático, mejorando el flujo sanguíneo, en la extremidad superior. Se emplea tanto para el tratamiento del dolor agudo (tiempo quirúrgico, analgesia postoperatoria, dolor postraumático, rehabilitación, etc.) como en el tratamiento del dolor crónico (síndrome de dolor regional complejo, dolor isquémico, dolor oncológico, dolor neuropático, etc.). Actualmente también se están utilizando técnicas continuas en anestesia ambulatoria proporcionando una analgesia regional contro l a d a por el paciente en su domicilio.Las complicaciones más frecuentes de estas técnicas son la salida-descolocación del catéter, la punción vascular, el escape de la solución administrada y la infección. En cuanto a la posible toxicidad por el anestésico local debido a su acumulación y aumento de la concentración plasmática, los diferentes estudios realizados encuentran que con el empleo de las técnicas continuas, las concentraciones de anestésico local alcanzadas son muy inferiores a los niveles tóxicos (AU)

[High-frequency jet ventilation with the HFV 970 prototype in laryngeal microsurgery: comparison of 2 injection systems]. / Ventilación con jet a alta frecuencia con el prototipo HFV 970 en microcirugía laríngea: comparación entre dos sistemas de inyección.

OBJECTIVE: To describe the results obtained with the use of a high frequency jet ventilation system with the HFV 970 prototype through two types of injector, an intratracheal cannula and an endotracheal tube, in 12 patients undergoing laryngoscopic microsurgery. PATIENTS AND METHOD: After anesthetic induction with propofol and succinylcholine, an intratracheal cannula was placed in the patients in group A by way of cricothyroid membrane puncture. The tracheas of group B patients were intubated with a number 7 tube, through which was inserted the same type of cannula as had been used with group A patients. A prototype Servo HFV 970 respirator was used with the following protocol: minute volume 120 ml/min, inspiratory time 30%, respiratory rate 120 cycles/min and a FiO2 of 1. Anesthesia was maintained with propofol in continuous perfusion. The parameters studied were peak airway pressure, PCO2, PO2 and pH. Data were recorded at baseline and every 5 min thereafter until the end of surgery. RESULTS: During high frequency jet ventilation there were no statistically significant differences between groups A and B with respect to peak airway pressure. PCO2 in group A increased significantly during surgery, while in group B it decreased significantly. Oxygenation was excellent in both groups, being significantly higher than baseline values at all times studied, with no statistically significant differences between the 2 groups. CONCLUSION: Our results for the efficacy of ventilation and oxygenation with the prototype HFV 970 are similar to those published for conventional high frequency jet ventilation. Using a tracheal tube assures adequate ventilation, but supposes a tendency to entrapment, whereas use of an intratracheal cannula is associated with lower ventilatory efficacy and less entrapment. Oxygenation is excellent with both systems.

[Changes in the renin-angiotensin-aldosterone system during open heart surgery. I. Factors involved in renin secretion]. / Modificaciones del sistema renina-angiotensina-aldosterona durante la cirugía a corazón abierto.

The endocrine, humoral and hemodynamic factors that affect renin secretion are studied during open-heart surgery in a group of 40 patients, 20 with mitral and 20 with aortic valve disease. During the incission period, the PRA (plasma renin activity) increases due to a sympatoadrenergic hyperactivity. These increase is noted also during bypass, and is closely related with the hypotension that extracorporeal circulation produces. It is also discussed the influence of the exclusion of pulmonary circulation, that decreases conversion of angiotensin I to II and catabolism of norepinephrine.