[Effectiveness of adenosine as a pulmonary vasodilator during weaning from extracorporeal circulation after mitral valve replacement in a patient with severe pulmonary hypertension]. / Efectividad de la adenosina como vasodilatador pulmonar a la salida de la circulación extracorpórea tras recambio mitral en una paciente con hipertensión pulmonar grave.

A 75-year-old woman with mitral stenosis and tricuspid insufficiency underwent mitral valve replacement surgery. After insertion of a catheter into the pulmonary artery, upper respiratory system pressure was seen to rise above systemic arterial pressure. To relax the pulmonary vessel, we administered adenosine, a drug that is metabolized rapidly during its first pass through the lungs before hypotension or other adverse side effects occur systemically. Adenosine decreased pulmonary artery pressure and vascular resistance, optimizing right cardiac function with successful output to extracorporeal circulation.

[Tramadol in elastomeric continuous perfusion for analgesia after gynecologic surgery]. / Tramadol en perfusión continua mediante elastómeros para analgesia postoperatoria de cirugía ginecológica.

Quality of analgesia provided by continuous infusion of tramadol through an elastomeric infuser (Baxter PC1071) was studied in a group of 40 women undergoing laparotomy to treat non tumoral disease. After a loading dose of 100 mg of tramadol in the recovery room, the elastomeric infuser was connected, loaded with 300 mg of tramadol in 48 ml of saline. The patient was then transferred to the ward. Analgesic quality was assessed on a visual analog scale (VAS) of 1 to 10 and on a semantic scale. Side effects, the need for supplemental analgesia and the opinion of the nurse were all recorded. The highest VAS score in the 24 h period was 2.69. Pain was described as slight by 52.5% of the women, moderate by 12.5% and absent by 35%. The main side effects were nausea and vomiting (12.5%). Three patients needed supplementary analgesia. The technique was described by 85% of the nurses as good (62.5%) or very good (22.5%). Elastomeric infusers are an effective way to deliver analgesics, and tramadol proved to be a valid analgesic for continuous infusion.

[Anesthesia in two patients with motor neuron disease]. / Anestesia en dos pacientes con enfermedad de la motoneurona.

We report two cases of patients diagnosed of motoneuron disease. First patient had amyotrophic lateral sclerosis with bulbar involvement and developed prolonged apnea after general anesthesia for elective hemorrhoidectomy. Second patient had Kugelberg-Welander disease or type III hereditary mononeuron disease, underwent laparotomy and had no anesthetic complications. Patients with motoneuron disease should be considered as high anesthetic risk patients because they may develop respiratory complications accordingly to their previous muscle involvement so neurologic and respiratory assessment is basic. The use of succinylcholine should be limited to cases in whom external denervation and muscle atrophy may be ruled out. Short half-life muscle relaxants such as atracurium and vecuronium are advised with monitoring of neuromuscular function. Currently, local-regional techniques are not contraindicated.