Utilización de la mascarilla laríngea proseal en un paciente con un aparato de ortodoncia en la arcada dental superior / No disponible

No disponible

[Subarachnoid anesthesia with minimal doses of lidocaine in ambulatory arthroscopic surgery of the knee]. / Anestesia subaracnoidea con dosis mínimas de lidocaína en la cirugía artroscópica de rodilla en régimen ambulatorio.

The objective is demonstrate that subarachnoid anesthesia with 2% isobaric lidocaine at low doses (0.5 mg/kg) is safe and effective for outpatient arthroscopic surgery of the knee. This was a prospective study of 150 ASA I-III patients undergoing arthroscopic knee surgery as outpatients under subarachnoid anesthesia. With no prior vascular filling, we provided blockade by administering 2% isobaric lidocaine at a dose of 0.5 mg/kg through a Sprotte 25G needle without vasoconstrictor. We assessed effectiveness and degree of sensory-motor blockade, cardiovascular repercussions, recovery time (until reversal of blockade, ambulation, micturition and discharge) as well as side effects observed. The mean dose of lidocaine used was 33.44 +/- 4.16 mg. The sensory-motor blockade achieved provided optimum conditions for prevention of ischemia and the practice of the surgical procedure in all cases. Surgery lasted a mean 38 +/- 10 min. Hemodynamic changes were not clinically significant and no patients additional fluids, atropine or vasopressors. Time from start of blockade until ambulation, micturition and discharge from the recovery unit were 123 +/- 8.3, 175 +/- 12.4 and 194 +/- 13.4 min, respectively. Micturition was spontaneous in all cases. Complications recorded were cephalea and backache. In conclusion, subarachnoid anesthesia at low doses of 2% isobaric lidocaine provides excellent conditions for practicing arthroscopic surgery of the knee on outpatients, with minimum side effects.

Pneumocephalus after accidental dural puncture during epidural anesthesia.

BACKGROUND. Pneumocephalus developed in a 45-year-old woman after epidural anesthesia was performed to treat her low back pain. The cause was thought to be the loss of resistance to air technique. The clinical symptoms were immediate headache independent of posture, pallor, bradycardia, and hypotension. These symptoms disappeared during the first 24 hours with no neurologic sequelae. CONCLUSION. This case suggests that using the loss of resistance technique with saline versus air should prevent this complication, especially after unintentional dural puncture or when, in difficult placements, the technique is repeated frequently in the same patient.

[Experience with the Du Pen epidural catheter in chronic cancer pain]. / Experiencia con el catéter epidural Du Pen en dolor crónico oncológico.

We evaluate the results obtained with the use of Du Pen's epidural catheter in a series of patients with chronic oncologic pain. There were 27 patients with neoplasms of different etiologies who received a total number of 30 catheters. Inclusion criteria were established. All patients received bolus of morphine chloride free of conservers. Follow-up controls were carried out at least every week and consisted on the evaluation the dosage efficacy, dose adjustments, catheter condition, physical activity, neurologic state, and requirements of adjuvant medication. The documented use of the 30 catheters implanted in this study lasted up to 1452 days with a mean of 48.5 days. There were no complications related to catheter insertion. However we observed complications related to the use of the catheter: reflow at the site of catheter implantation in 4 cases, infection of the external (one case) and internal (one case) catheter route without antibiotic resolution, and infection of the epidural space responding to antibiotherapy without catheter withdrawal in one patient. Twenty patients died. Mortality was not attributed to catheter complications in any case. The present study confirms that placement of the catheter is technically easy and provides an efficacious opiate analgesia with minimal complications.