Anestesia espinal y cirugía ambulatoria / Spinal anesthesia in Ambulatory Surgery

En los últimos años hemos asistido a un abandono de la anestesia espinal como técnica habitual en pacientes ambulatorios por el auge de la anestesia general. Esto se debe a los efectos adversos clásicamente asociados a su empleo y al retraso en el alta domiciliaria. Sin embargo, la irrupción en el mercado de los nuevos anestésicos locales de corta duración y la utilización de la anestesia subaracnoidea selectiva en procedimientos ortopédicos ha suscitado un interés creciente por esta técnica anestésica. Con este artículo pretendemos hacer una revisión de la anestesia espinal, de las indicaciones, contraindicaciones y de los efectos adversos asociados a la técnica. Finalmente, proponemos un resumen breve de los nuevos anestésicos locales de acción corta y unas recomendaciones para la cirugía proctológica y del miembro inferior (AU)

Recently, we have witnessed a drop of spinal anesthesia as a routine technique in outpatients by the rise of general anesthesia. This is due to the adverse effects typically associated with its employment and delayed discharge home. However, the introduction of new local anesthetics of short duration and the use of selective spinal anesthesia in orthopedic procedures has led to a growing interest in the anesthetic technique. We intend with this article to make a review of spinal anesthesia, including indications and contraindications and associated technical side effects. Finally, we provide a brief summary of the new short-acting local anesthetics and recommendations for the proctologic and lower limb surgery (AU)

Inducción inhalatoria con sevoflurano versus inducción inhalatoria con sevoflurano y remifentanilo en anestesia ambulatoria / Inhalatory induction whit sevoflurane versus inhalatory induction with sevoflurane and remifentanilo in ambulatory surgery

Objetivos: Determinar las condiciones de intubación orotraqueal, efectos secundarios y características hemodinámicas de la inducción anestésica inhalatoria con sevoflurano con o sin remifentanilo en pacientes sometidos a cirugía mayor ambulatoria sin relajantes neuromusculares. Material y métodos: Se realizó un estudio prospectivo, comparativo, aleatorizado y doble ciego en una muestra de 85 pacientes programados para timpanoplastia y septorinoplastia en régimen ambulatorio. La inducción anestésica se realizó por vía inhalatoria mediante dos técnicas: Grupo S (sevoflurano) y Grupo SR (sevoflurano y remifentanilo). Se evaluó el tiempo de pérdida del reflejo palpebral, el tiempo para alcanzar un valor de BIS menor o igual a 50, la aparición de eventos adversos durante la laringoscopia e intubación, las condiciones de intubación, variables hemodinámicas y respiratorias. Asimismo, se valoró el grado de satisfacción y confort de los pacientes con estas técnicas anestésicas. Resultados: De los pacientes incluidos inicialmente en el estudio se excluyó del análisis estadístico uno de cada grupo. Los tiempos de pérdida del reflejo palpebral fueron de 1,30 minutos en el grupo S vs. 1,24 minutos en el grupo SR y para alcanzar un valor de BIS menor o igual a 50 fue significativamente menor (p < 0,05) en el grupo SR (4,51 minutos) vs. grupo S (5,64 minutos). En el grupo S, las (..) (AU)

Objectives: To determine the intubation conditions, side effects and hemodynamic characteristics of inhalational anesthetic induction with sevoflurane with or without remifentanil in patients undergoing outpatient surgery without using neuromuscular relaxants. Materials and Methods: We performed a prospective, comparative, randomized, double-blind in a sample of 85 patients scheduled for tympanoplasty and septorhinoplasty on an outpatient basis. Anesthetic induction was performed by inhalation using two techniques: Group S (sevoflurane) and group SR (sevoflurane and remifentanil). We evaluated the time to loss of eyelid reflex, time to reach a BIS value less than or equal to 50, the occurrence of adverse events during laryngoscopy and intubation, intubation conditions and hemodynamic and respiratory variables. Also assessed the degree of satisfaction and comfort of patients with these anesthetic techniques. Results: Of the patients initially included in the study, one from each group was excluded from statistical analysis. Time to loss of eyelid reflex was 1.30 minutes in S group vs. 1.24 minutes in the SR group. The time to achieve a BIS value less than or equal to 50 was significantly lower (p <0.05) in the SR group (4.51 minutes) vs. the S group (5.64 minutes). In S group, hemodynamic variables remained significantly more stable and 30% of patients had good intubation conditions, 49% excellent and 21% were classified as poor. In the SR group, 42.5% of patients had good intubation conditions, 47.5% excellent and 10% poor. Regarding respiratory variables in S group, 2.3% of patients lost spontaneous breathing compared with 80% of patients in the SR group. Differences between groups in the incidence of complications during induction were observed; the occurrence of cough (..) (AU)

[Anesthetic treatment of patients with osteogenesis imperfecta]. / Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta.

BACKGROUND AND OBJECTIVE: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients' quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. PATIENTS AND METHODS: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. RESULTS: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. CONCLUSIONS: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease.

Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta / Anesthetic treatment of patients with osteogenesis imperfecta

Objetivos: La osteogénesis imperfecta es una enfermedad hereditaria con una baja prevalencia, pero gran impacto en la calidad de vida de los pacientes. Se presenta la experiencia en el manejo perioperatorio de estos pacientes en nuestro hospital. Pacientes y métodos: Estudio descriptivo retrospectivo de las intervenciones realizadas en nuestro centro durante los años 1991 a 2009, en los pacientes con esta enfermedad. Se analizan los datos demográficos, variante de la enfermedad, alteraciones asociadas, procedimientos quirúrgicos, tipo de anestesia y complicaciones intraoperatorias y postoperatorias. Resultados: Desde el año 1991 hasta el 2009 se han realizado un total de 105 intervenciones en 29 pacientes con osteogénesis imperfecta (37,9% mujeres, 62,1% varones), con una edad que oscila entre 1 a 25 años. El tipo más frecuente de osteogénesis imperfecta fue el tipo III (65,5%). El 93% de los pacientes no presentaron enfermedades asociadas. Dos pacientes eran alérgicos al látex. El 62% de las intervenciones transcurrieron sin complicaciones. Se registró un caso de hipertermia no maligna y una fractura de fémur contralateral en el quirófano. Conclusiones: La osteogénesis imperfecta es una enfermedad de baja prevalencia que precisa un tratamiento multidisciplinar. Es necesario un adecuado conocimiento de las alteraciones tanto esqueléticas como extraesqueléticas de esta enfermedad para un correcto tratamiento perioperatorio(AU)

Background and objective: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients’ quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. Patients and methods: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. Results: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. Conclusions: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease(AU)