Masa cervical gigante. Un reto anestésico / Giant cervical mass. An anesthetic challenge

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Eficacia de la asociación paracetamol-metamizol vs. paracetamol-dexketoprofeno en manejo de dolor agudo postoperatorio / No disponible

Objetivo: El uso de farmacos con mecanismos diferentes combinados entre si para el tratamiento del dolor, en concreto del dolor agudo postoperatorio, forma parte fundamental de un tipo de analgesia llamada multimodal. El objetivo de este trabajo es evaluar la eficacia de la asociacion de paracetamol mas metamizol y compararla con la asociacion de paracetamol mas dexketoprofeno en dolor agudo postoperatorio. Métodos: Disenamos un estudio prospectivo de intervencion en el que se incluyeron 42 pacientes sometidos bajo anestesia general a cirugias de probable bajo nivel algesico y duracion < 120 minutos. Todos ellos fueron tratados con un gramo de paracetamol intraoperatorio y, posteriormente en reanimacion, cuando la puntuacion en la escala numerica simple fue mayor de 3, recibieron el farmaco del grupo al que fueron asignados (metamizol: grupo M; dexketoprofeno: grupo D), evaluando las variaciones en la puntuacion de dicha escala. Se examinaron en ambos grupos las variables demograficas, las variables relacionadas con la anestesia, aquellas relacionadas con la cirugia, las variaciones en la escala numerica simple (ENS), la aparicion de complicaciones y las incidencias durante el proceso. Resultados: 20 pacientes fueron estudiados en el grupo M y 22 pacientes en el grupo D. Los dos grupos siguieron una distribucion similar en cuanto a variables demograficas, antecedentes medicos, tipo y duracion de la cirugia a la que se sometieron. En ambos grupos se observo una disminucion clinicamente relevante en la puntuacion de la escala numerica simple (p < 0,05). Sin embargo, no existieron diferencias en la disminucion de ENS al comparar los dos grupos entre si (p > 0,05). Conclusión: Nuestros resultados sugieren que la combinación de paracetamol y metamizol como terapia combinada para el manejo de dolor agudo postoperatorio es eficaz y equiparable a la combinación de paracetamol y dexketoprofeno, pudiendo constituir, por tanto, una alternativa a esta última (AU)

Objective: The use of drugs with different mechanisms, in combination for the treatment of pain, particularly acute postoperative pain, is a main part of the multimodal analgesia. The aim of this study was to evaluate the efficacy of metamizol plus paracetamol and compare it with the association of paracetamol plus dexketoprofen in acute postoperative pain. Methods: We designed a prospective interventional study that included 42 patients undergoing general anesthesia for probably low algesic and duration of surgery < 120 minutes. All were treated with one grame of intraoperative paracetamol and then, in the resuscitation unit, when the score on the simple numeric scale was > 3, they received the drug of the group that they were assigned (metamizol: group M; dexketoprofen: group D), with evaluation of variations in the scale score. We examined in both groups demographic variables, variables related to anesthesia and surgery, simple numeric scale (NSE) changes, complications and the incidents during the process. Results: 20 patients were studied in the M group and 22 patients in D group. Both groups had a similar distribution in terms of demographic variables, medical history, type and duration of surgery. Both group showed a clinically relevant decrease in the score of the simple numeric scale (p < 0.05). No differences were in the decrease of NSE when we compared the two groups together (p > 0.05). Conclusion: Our results suggest that the combination of paracetamol plus metamizol in combined therapy for management of acute postoperative pain is effective and comparable to the combination of paracetamol plus dexketoprofen and can constitute an alternative therapy (AU)

Reparación de hendidura laríngea en un paciente con síndrome de Opitz G/BBB / Repair of a laryngeal fissure in a patient with Opitz G/BBB syndrome

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Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes / Relationship between arginase activity and the storage time of packed red blood cells

Objetivos. Dada la creciente evidencia a favor de una relación entre el tiempo de conservación de los concentrados de hematíes y las complicaciones postransfusionales, nos planteamos analizar la relación existente entre los niveles de enzima arginasa, parámetros bioquímicos y de hemólisis, con el tiempo de conservación de concentrados de hematíes transfundidos. Material y métodos. Diseñamos un estudio prospectivo que incluyó 24 unidades de concentrado de hematíes, que habían sido transfundidos consecutivamente a pacientes de nuestro hospital. Luego de registrar el tiempo de conservación de cada bolsa, se extrajeron 15ml de sangre para determinar la actividad arginasa, los datos bioquímicos y de hemólisis. Se realizó un análisis univariante de todos los parámetros registrados y se incluyeron aquellos que resultaron significativos en un modelo de regresión múltiple (p<0,05). Resultados. El tiempo promedio de conservación fue de 18,6±6,1 días (rango: 6-31 días), con un hematocrito de 59,8%±0,05%, una hemoglobina 20,3±1,8g/dl, un pH de 6,5±0,1 y una actividad arginasa de 140,1±124,0 mU/ml. Se observó una relación lineal en el análisis univariante entre el tiempo de conservación y el pH (p=0,001), el HCO3act (p=0,001), el índice hemolítico (p=0,035) y la SpO2 (p=0,01). Una vez ajustados las variables de confusión procedentes del modelo univariante, se observó una relación lineal entre la actividad arginasa y el tiempo de conservación (p=0,031). Conclusiones. Nuestro trabajo muestra una relación lineal directamente proporcional entre el tiempo de conservación de los concentrados de hematíes y la actividad arginasa presente en los mismos. Sugerimos que estos hallazgos podrían estar relacionados con la elevada incidencia de complicaciones tras la transfusión que puede ser directamente proporcional a su tiempo de conservación(AU)

Objectives. Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. Material and methods. We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). Results. The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actualHCO3 (P=.001), the haemolysis index (P=.035) and the SpO2 (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). Conclusions. Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time(AU)

[Relationship between arginase activity and the storage time of packed red blood cells]. / Relación entre la actividad arginasa y el tiempo de conservación de los concentrados de hematíes.

OBJECTIVES: Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. MATERIAL AND METHODS: We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15 ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). RESULTS: The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8 g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0 mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actual HCO(3) (P=.001), the haemolysis index (P=.035) and the SpO(2) (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). CONCLUSIONS: Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time.

Réplica al artículo «Comentarios al artículo Cefalea postpunción dural en obstetricia» / Reply to the article "Comments on the article Postdural puncture headache in obstetrics"

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Cefalea postpunción dural en obstetricia / Postdural puncture headache in obstetrics

La cefalea postpunción dural es la complicación mayor más habitual tras la anestesia neuroaxial, y es especialmente frecuente en obstetricia. Suele ser una complicación benigna y autolimitada, pero sin tratamiento puede conducir a otras complicaciones más graves e incluso puede producir la muerte. Se han propuesto múltiples medios de profilaxis y tratamiento, pero en muchos casos la evidencia científica es insuficiente. Para su profilaxis tras una punción dural accidental la única medida eficaz es dejar el catéter en posición intradural; la morfina epidural también podría serlo. Una vez instaurado el cuadro clínico, debe prescribirse un tratamiento conservador durante las primeras 24 horas. Si fracasa, la medida más efectiva continúa siendo el parche hemático epidural, que no se debe demorar más de 24-48 horas para no prolongar el sufrimiento de la paciente. Si son necesarios más de dos parches, hay que descartar otra causa potencialmente grave de la cefalea(AU)

Postdural puncture headache is the most common major complication following neuraxial anesthesia; this adverse event is particularly frequent in obstetrics. The headache is usually benign and self-limited but if left untreated can lead to more serious complications that may be life-threatening. Many treatments and prophylactic measures have been suggested, but evidence supporting them is scarce in many cases. After accidental dural puncture the only effective preventive measure is to leave the catheter inside the dura; epidural morphine infusion may also help. Once symptoms begin, treatment is conservative for the first 24 hours. If this approach fails, the most effective intervention continues to be a blood patch, which should not be delayed beyond 24 to 48 hours in order to avoid suffering. If more blood patches are required, other possible causes of headache should be ruled out(AU)

[Postdural puncture headache in obstetrics]. / Cefalea postpunción dural en obstetricia.

Postdural puncture headache is the most common major complication following neuraxial anesthesia; this adverse event is particularly frequent in obstetrics. The headache is usually benign and self-limited but if left untreated can lead to more serious complications that may be life-threatening. Many treatments and prophylactic measures have been suggested, but evidence supporting them is scarce in many cases. After accidental dural puncture the only effective preventive measure is to leave the catheter inside the dura; epidural morphine infusion may also help. Once symptoms begin, treatment is conservative for the first 24 hours. If this approach fails, the most effective intervention continues to be a blood patch, which should not be delayed beyond 24 to 48 hours in order to avoid suffering. If more blood patches are required, other possible causes of headache should be ruled out.

Extremely prolonged neuromuscular blockade after rocuronium: a case report.

It is known that the duration of rocuronium action can be prolonged in elderly patients and that such action shows important interindividual variability. We report a case of prolonged neuromuscular block lasting 11 h, in a woman subjected to kidney transplantation. The possible causes of such prolonged action, inherent to the drug, or related to external factors, are commented.

Evaluación de un dispositivo de CPAP sin respirador en lainsuficiencia respiratoria aguda en pediatría / Evaluation of a continuous positive airway pressure system without a ventilator to treat acute respiratory failure in children

OBJETIVO: La CPAP en ventilación no invasiva es utilizadaampliamente en el paciente pediátrico con insuficienciarespiratoria aguda. Sin embargo la escasez deinterfases específicas, respiradores adecuados y la escasatolerancia de la técnica en estos pacientes pueden hacerfracasar su aplicación. El objetivo de este estudio fueanalizar la eficacia de un sistema de CPAP formado porun circuito respiratorio de Mapleson modificado, durantela IRA en pediatría.MATERIAL Y MÉTODOS: Estudio prospectivo observacionalrealizado en niños con insuficiencia respiratoriaaguda con indicación de ventilación no invasiva. LaCPAP se aplicó mediante un circuito respiratorio MaplesonD provisto de un manómetro y un tubo nasofaríngeocomo interfase. Se recogieron previo al tratamiento y 2horas después, frecuencia cardiaca, frecuencia respiratoria,fracción inspirada de oxígeno, presión arterial deoxígeno, de dióxido de carbono y pulsioximetría.RESULTADOS: Se incluyeron 16 pacientes de edadmedia 3,8 años durante un periodo de 18 meses. Observamosuna disminución PaCO2 desde 66,8±18,08 mmHga 46,48±5,9 mmHg tras CPAP (p=0,16) y un aumento enla relación PaO2/FiO2 de 201±111 a 262±115 mm Hg trasCPAP (p=0,30). La FC descendió de 156±22 a 127±18l/min (p=0,05) y la FR de 53±15 a 33±13 resp/min(p<0,05). No se registraron complicaciones graves y latolerancia fue adecuada. La técnica se consideró exitosaen 12 pacientes (75%).CONCLUSIONES: La aplicación de CPAP sin respiradormediante circuito Mapleson D puede ser utilizado comoventilación no invasiva en pacientes pediátricos con insuficienciarespiratoria aguda con elevada tasa de éxito (AU)

OBJETIVE: Noninvasive continuous positive airwaypressure (CPAP) is widely used in pediatric patients withacute respiratory failure. However, the lack of specificinterfaces and appropriate ventilators and poor tolerance ofthe technique by these patients can lead to failure of theapplication. The aim of this study was to analyze the efficacyof a CPAP system using a modified Mapleson breathingcircuit during acute respiratory failure in pediatric patients.MATERIAL AND METHODS: We performed a prospectiveobservational study in children with acute respiratoryfailure in whom noninvasive ventilation was indicated.CPAP was applied through a Mapleson D circuit fittedwith a manometer and a nasopharyngeal tube as theinterface. Heart rate, respiratory rate, inspired oxygenfraction (FiO2), PaO2, PaCO2, and pulse oximetry weremeasured before treatment and after 2 hours of treatment.RESULTS: Sixteen patients with a mean age of 3.8 yearswere studied for a period of 18 months. We observed amean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to46.48 (5.9) mm Hg after CPAP (P=.16) and a mean changein the PaO2/FiO2 ratio from 201 (111) to 262 (115) afterCPAP (P=.30). The mean heart rate fell from 156 (22)beats/min to 127 (18) beats/min (P=.05) and the meanrespiratory rate from 53 (15) breaths/min to 33 (13)breaths/min (P<.05). No severe complications wererecorded and tolerance was satisfactory. The techniquewas considered a success in 12 patients (75%).CONCLUSIONS: CPAP without a ventilator, through aMapleson D circuit, can be used with a high success rateto provide noninvasive ventilation for pediatric patientswith acute respiratory failure (AU)

[Evaluation of a continuous positive airway pressure system without a ventilator to treat acute respiratory failure in children]. / Evaluación de un dispositivo de CPAP sin respirador en la insuficiencia respiratoria aguda en pediatría.

OBJECTIVE: Noninvasive continuous positive airway pressure (CPAP) is widely used in pediatric patients with acute respiratory failure. However, the lack of specific interfaces and appropriate ventilators and poor tolerance of the technique by these patients can lead to failure of the application. The aim of this study was to analyze the efficacy of a CPAP system using a modified Mapleson breathing circuit during acute respiratory failure in pediatric patients. MATERIAL AND METHODS: We performed a prospective observational study in children with acute respiratory failure in whom noninvasive ventilation was indicated. CPAP was applied through a Mapleson D circuit fitted with a manometer and a nasopharyngeal tube as the interface. Heart rate, respiratory rate, inspired oxygen fraction (FiO2), PaO2, PaCO2, and pulse oximetry were measured before treatment and after 2 hours of treatment. RESULTS: Sixteen patients with a mean age of 3.8 years were studied for a period of 18 months. We observed a mean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to 46.48 (5.9) mm Hg after CPAP (P=.16) and a mean change in the PaO2/FiO2 ratio from 201 (111) to 262 (115) after CPAP (P=.30). The mean heart rate fell from 156 (22) beats/min to 127 (18) beats/min (P=.05) and the mean respiratory rate from 53 (15) breaths/min to 33 (13) breaths/min (P<.05). No severe complications were recorded and tolerance was satisfactory. The technique was considered a success in 12 patients (75%). CONCLUSIONS: CPAP without a ventilator, through a Mapleson D circuit, can be used with a high success rate to provide noninvasive ventilation for pediatric patients with acute respiratory failure.

Hematoma en pared torácica tras la canalización de la vena subclavia en un paciente oncológico / No disponible

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Terapia electroconvulsiva en el tercer trimestre de la gestación. A propósito de un caso / Electroconvulsive therapy in the third trimester of pregnancy: a case report

El tratamiento electroconvulsivo o electrochoque(TEC) es una forma terapéutica efectiva en la prácticapsiquiátrica. En la mujer gestante, la necesidad de untratamiento psiquiátrico eficaz junto con la reducción defármacos psicotrópicos ha estimulado el desarrollo delTEC en los últimos 50 años. Presentamos una pacientede 35 años, gestante de 30 semanas, ingresada en nuestrohospital por un episodio depresivo grave. Tras iniciarsetratamiento médico, presentó una evolución desfavorable,por lo que se estimó la posibilidad de TEC,recibiendo tres sesiones semanales hasta un total de nueve.Durante los TEC la paciente recibió anestesia generalcon propofol, succinilcolina e intubación endotraqueal.No encontramos variaciones significativas en lasvariables hemodinámicas de la madre y el feto, ni indiciosde sufrimiento fetal. La paciente experimentó unaclara mejoría y dos días después del último TEC comenzóespontáneamente con trabajo de parto, dando a luzpor vía vaginal un niño sano

Electroconvulsive or electroshock therapy is aneffective psychiatric treatment. The need for effectivepsychotherapy in the pregnant patient and the need tolimit application of psychotropic drugs have encouragedthe use of electroshock therapy in the past 50 years. Wereport the case of a 35-year-old woman at 30 weeks'gestation who was hospitalized with severe depression.When her condition worsened after initiation of medicaltreatment, electroshock therapy was considered. Shereceived a total of 9 sessions (3 per week). Duringtreatments the patient received general anesthesia withpropofol and succinylcholine with insertion of a trachealtube. Significant variations in the hemodynamicvariables of mother and fetus were not observed; norwere there signs of fetal distress. The patientexperienced clear improvement and 2 days after the lasttreatment spontaneous labor commenced. A healthy boywas born by vaginal delivery

[Electroconvulsive therapy in the third trimester of pregnancy: a case report]. / Terapia electroconvulsiva en el tercer trimestre de la gestación. A propósito de un caso.

Electroconvulsive or electroshock therapy is an effective psychiatric treatment. The need for effective psychotherapy in the pregnant patient and the need to limit application of psychotropic drugs have encouraged the use of electroshock therapy in the past 50 years. We report the case of a 35-year-old woman at 30 weeks' gestation who was hospitalized with severe depression. When her condition worsened after initiation of medical treatment, electroshock therapy was considered. She received a total of 9 sessions (3 per week). During treatments the patient received general anesthesia with propofol and succinylcholine with insertion of a tracheal tube. Significant variations in the hemodynamic variables of mother and fetus were not observed; nor were there signs of fetal distress. The patient experienced clear improvement and 2 days after the last treatment spontaneous labor commenced. A healthy boy was born by vaginal delivery.

[Epidural spinal cord stimulation for interstitial cystitis]. / Tratamiento de la cistitis intersticial mediante la estimulación de cordones posteriores.

INTRODUCTION: Interstitial cystitis, a chronic inflammatory disorder of the bladder wall, is highly painful and incapacitating. Urinary frequency and urgency develop, as well as nocturia, dysuria, perineal pain and reduction of bladder capacity. The condition seems to arise from a variety of factors with multiple and diverse pathogenic mechanisms and is refractory to medical and surgical treatment. Because treatments are ineffective and recent studies have implicated an inflammatory neurogenic mechanism in the pathogenesis of interstitial cystitis, neuromodulation by epidural spinal cord stimulation has been suggested for treating patients in whom other measures have failed. CASE DESCRIPTION: A 66-year-old woman with a 9-year history of urinary incontinence, urinary urgency and suprapubic pain was diagnosed of interstitial cystitis. She was referred to our pain clinic with persistent symptoms after repeated attempts to treat the condition medically. After implantation of a cephalocaudal (retrograde) epidural spinal cord stimulator, pain decreased 80% and the improvement has been maintained with no complications. CONCLUSION: Results from this and previous reports allow us to state that retrograde epidural spinal cord stimulation seems to be a relatively non-invasive therapeutic approach for treating interstitial cystitis that is refractory to conventional treatments.

Eficacia de la administración peridural de soluciones salinas isotónicas en la profilaxis y tratamiento de las cefaleas postpunción dural / Effectiveness of epidural administration of saline solutions to prevent or treat postdural puncture headache

La anestesia epidural es la más versátil y más ampliamente usada de las técnicas de anestesia regional. La cefalea postpunción dural es la complicación más común, asociada con la anestesia epidural o subaracnoidea. La pérdida de líquido cefalorraquídeo a través del agujero dural puede ser un agente causal importante de esta cefalea.Se han recomendado múltiples métodos para la prevención y tratamiento de la cefalea postpunción dural.Una modalidad es la administración de suero salino, bien en bolo bien en infusión, en el espacio epidural y así incrementar la presión tanto en el espacio epidural como en el subaracnoideo. Realizamos una revisión de los trabajos que evalúan la eficacia de esta técnica, desde 1967 hasta 2004, utilizando los términos de búsqueda "anaesthesia, spinal; anaesthesia, epidural; analgesia, epidural; headache; postdural puncture treatment or profilaxis; epidural injection; epidural saline".Encontramos un número reducido de trabajos, con tamaños muestrales pequeños y la mayoría, sin grupo control. Las dosis y métodos de administración de las soluciones isotónicas epidurales es muy variable. Los resultados, con frecuencia, son contradictorios.Concluimos que la aplicación de esta técnica para la prevención y/o tratamiento de la cefalea postpunción dural es difícil de justificar (AU)