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4.
Anaesthesia ; 74(6): 751-757, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30933322

RESUMO

The TotaltrackTM is a new video laryngeal mask, which combines a supraglottic airway with a videolaryngoscope. We evaluated the performance of this device in an observational study in 300 adult patients. The Totaltrack was inserted at the first attempt and the glottis seen in all cases. In 249 patients (83%; 95%CI 78.7-87.3%) the glottis was seen at the first attempt. Adequate ventilation and tracheal intubation were achieved in all patients. The median time to visualisation of vocal cords, to confirmation of ventilation and to successful tracheal intubation was 5 s, 13 s and 24 s, respectively. Nineteen patients (6.3%; 95%CI 3.55-9.05%) suffered minor complications, such as mucosal lesion or blood staining. The Totaltrack appears effective for airway management.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Máscaras Laríngeas , Gravação de Videoteipe/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Rev. esp. anestesiol. reanim ; 65(9): 537-540, nov. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177205

RESUMO

El síndrome de Klippel-Feil es una enfermedad que se caracteriza por la fusión congénita de vértebras cervicales, que condiciona una limitación e inestabilidad cervical. En estos casos la mejor opción es la intubación orotraqueal con fibrobroncoscopio con el paciente despierto. La ventaja es que se minimizan los movimientos cervicales que podrían conllevar un daño neurológico. En estos pacientes una sedación adecuada, junto con la instilación de anestésico local en la faringe y la hipofaringe es clave para reducir las molestias del paciente y conseguir la intubación orotraqueal con éxito. La dexmedetomidina es un agonista selectivo de los receptores α-2 adrenérgicos que produce sedación y ansiolisis al nivel del locus coeruleus, sin provocar depresión respiratoria, y preservando la colaboración del paciente. Presentamos el caso de un paciente con síndrome de Klipple-Feil y vía aérea difícil en el que utilizamos una perfusión de dexmedetomidina a dosis de 0,6μg/kg/h como sedación para la intubación orotraqueal con fibrobroncoscopio con el paciente despierto


Klippel-Feil Syndrome is a disease characterised by congenital fusion of cervical vertebra, which leads to cervical limitation and instability. In these cases, the best option is the orotracheal intubation with the fibre-optic bronchoscope with the patient awake. The advantage is that cervical movements that could lead to neurological damage are minimised. In these patients, adequate sedation, together with instillation of local anaesthetic in the pharynx and hypopharynx, is the key to reducing patient discomfort and achieving successful orotracheal intubation. Dexmedetomidine is a selective α2- adrenergic receptor agonist that produces sedation and analgesia at the locus coeruleus without producing respiratory depression, as well as maintaining patient collaboration. The case is presented of a patient with Klippel-Feil Syndrome and difficult airway management, who was given a dexmedetomidine infusion at 0.6μg/kg/h as sedation for an awake fibre-optic endotracheal intubation


Assuntos
Humanos , Masculino , Adulto , Dexmedetomidina/uso terapêutico , Anestesia/métodos , Síndrome de Klippel-Feil/complicações , Manuseio das Vias Aéreas/métodos , Sedação Consciente/métodos , Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal/métodos , Broncoscopia/métodos
9.
Rev. esp. anestesiol. reanim ; 65(8): 473-476, oct. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-177154

RESUMO

Presentamos el caso de una paciente adulta con epilepsia farmacorresistente secundaria a una inflamación extensa del hemisferio cerebral derecho, que fue programada para realizársele una hemisferectomía funcional. Se trata de una cirugía habitual en pediatría, pero con pocas publicaciones en pacientes adultos. Durante el intraoperatorio se utilizó el espectrograma perteneciente al sistema de monitorización VISTATM del índice biespectral bilateral (BIS). Se objetivó un aumento de potencia en las bandas de baja frecuencia (0,1-4Hz) y en las bandas alfa (8-12Hz) del hemisferio cerebral derecho, donde se encontraba el foco epileptógeno. Durante la desconexión del lóbulo frontal se observó una marcada disminución de potencia en dichas bandas, sin objetivarse cambios durante la desconexión de las otras áreas cerebrales. Pensamos que se necesitan más estudios para saber si el espectrograma puede ser una herramienta útil para monitorizar la efectividad de la hemisferectomía funcional


We present the case of an adult patient with drug-resistant epilepsy caused by extensive inflammation in the right cerebral hemisphere. She was scheduled to undergo right functional hemispherectomy, which is common in pediatric surgery, but about which few studies have been published with respect to adult patients. During the intraoperative period, the density spectral array of the bilateral bispectral index (BIS) VISTATM monitoring system was used. We observed a power increase in low frequency (0.1-4Hz) and alpha bands (8-12Hz) in the right hemisphere, where the epileptogenic focus was. During disconnection from the frontal lobe, there was a marked decrease of power in low frequency and alpha bands on the right side, with no changes during disconnection from other areas of the brain. We think that further studies are needed to determine whether the density spectral array can be a useful tool for monitoring the effectiveness of functional hemispherectomy


Assuntos
Humanos , Feminino , Adulto , Hemisferectomia/métodos , Espectrografia/métodos , Monitorização Fisiológica/métodos , Epilepsia Resistente a Medicamentos/cirurgia , Análise Espectral/métodos , Malformações do Desenvolvimento Cortical/complicações
10.
Rev Esp Anestesiol Reanim (Engl Ed) ; 65(9): 537-540, 2018 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29887292

RESUMO

Klippel-Feil Syndrome is a disease characterised by congenital fusion of cervical vertebra, which leads to cervical limitation and instability. In these cases, the best option is the orotracheal intubation with the fibre-optic bronchoscope with the patient awake. The advantage is that cervical movements that could lead to neurological damage are minimised. In these patients, adequate sedation, together with instillation of local anaesthetic in the pharynx and hypopharynx, is the key to reducing patient discomfort and achieving successful orotracheal intubation. Dexmedetomidine is a selective α2- adrenergic receptor agonist that produces sedation and analgesia at the locus coeruleus without producing respiratory depression, as well as maintaining patient collaboration. The case is presented of a patient with Klippel-Feil Syndrome and difficult airway management, who was given a dexmedetomidine infusion at 0.6µg/kg/h as sedation for an awake fibre-optic endotracheal intubation.


Assuntos
Manuseio das Vias Aéreas/métodos , Broncoscópios , Dexmedetomidina/uso terapêutico , Tecnologia de Fibra Óptica , Hipnóticos e Sedativos/uso terapêutico , Síndrome de Klippel-Feil , Adulto , Humanos , Masculino , Vigília
11.
Rev Esp Anestesiol Reanim (Engl Ed) ; 65(8): 473-476, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29673722

RESUMO

We present the case of an adult patient with drug-resistant epilepsy caused by extensive inflammation in the right cerebral hemisphere. She was scheduled to undergo right functional hemispherectomy, which is common in pediatric surgery, but about which few studies have been published with respect to adult patients. During the intraoperative period, the density spectral array of the bilateral bispectral index (BIS) VISTATM monitoring system was used. We observed a power increase in low frequency (0.1-4Hz) and alpha bands (8-12Hz) in the right hemisphere, where the epileptogenic focus was. During disconnection from the frontal lobe, there was a marked decrease of power in low frequency and alpha bands on the right side, with no changes during disconnection from other areas of the brain. We think that further studies are needed to determine whether the density spectral array can be a useful tool for monitoring the effectiveness of functional hemispherectomy.


Assuntos
Anestesia Geral , Monitores de Consciência , Hemisferectomia , Monitorização Intraoperatória/métodos , Adulto , Feminino , Humanos
12.
Rev. esp. anestesiol. reanim ; 65(2): 108-111, feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170015

RESUMO

La cirugía de la epilepsia es un tratamiento bien establecido para pacientes con epilepsia farmacorresistente. El éxito de la cirugía depende de una localización prequirúrgica precisa de la zona epileptógena. Existen diferentes técnicas para determinar su localización y extensión. A pesar de las mejoras en los tests diagnósticos no invasivos, en aquellos pacientes en los que no son concluyentes, se necesitarán técnicas más invasivas como la electrocorticografía intraoperatoria. La electrocorticografía intraoperatoria se utiliza para guiar la resección quirúrgica de la lesión epileptógena y para comprobar que la resección ha sido completa. Sin embargo, se puede ver afectada por algunos de los fármacos anestésicos que utilizamos. Nuestro objetivo con este caso clínico es revisar qué fármacos se pueden utilizar en la cirugía de epilepsia con electrocorticografía intraoperatoria (AU)


Epilepsy surgery is a well-established treatment for patients with drug-resistant epilepsy. The success of surgery depends on precise presurgical localisation of the epileptogenic zone. There are different techniques to determine its location and extension. Despite the improvements in non-invasive diagnostic tests, in patients for whom these tests are inconclusive, invasive techniques such intraoperative electrocorticography will be needed. Intraoperative electrocorticography is used to guide surgical resection of the epileptogenic lesion and to verify that the resection has been completed. However, it can be affected by some of the anaesthetic drugs used by the anaesthesiologist. Our objective with this case is to review which drugs can be used in epilepsy surgery with intraoperative electrocorticography (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Anestesia/métodos , Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Eletrocorticografia , Monitorização Intraoperatória/métodos
14.
Rev Esp Anestesiol Reanim (Engl Ed) ; 65(2): 108-111, 2018 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28964504

RESUMO

Epilepsy surgery is a well-established treatment for patients with drug-resistant epilepsy. The success of surgery depends on precise presurgical localisation of the epileptogenic zone. There are different techniques to determine its location and extension. Despite the improvements in non-invasive diagnostic tests, in patients for whom these tests are inconclusive, invasive techniques such intraoperative electrocorticography will be needed. Intraoperative electrocorticography is used to guide surgical resection of the epileptogenic lesion and to verify that the resection has been completed. However, it can be affected by some of the anaesthetic drugs used by the anaesthesiologist. Our objective with this case is to review which drugs can be used in epilepsy surgery with intraoperative electrocorticography.


Assuntos
Anestesia Geral/métodos , Anestésicos/farmacologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrocorticografia/efeitos dos fármacos , Epilepsias Parciais/cirurgia , Monitorização Neurofisiológica Intraoperatória , Procedimentos Neurocirúrgicos , Tonsila do Cerebelo/cirurgia , Anticonvulsivantes/uso terapêutico , Ondas Encefálicas/efeitos dos fármacos , Terapia Combinada , Dexmedetomidina/farmacologia , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Eletrocorticografia/métodos , Epilepsias Parciais/tratamento farmacológico , Feminino , Fentanila/farmacologia , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Pessoa de Meia-Idade , Propofol/farmacologia , Remifentanil/farmacologia , Rocurônio/farmacologia
16.
Rev. esp. anestesiol. reanim ; 64(7): 415-418, ago.-sept. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-164838

RESUMO

La afección cervical aguda puede determinar un serio compromiso de la vía aérea como consecuencia de la distorsión anatómica secundaria a la obstrucción o desviación de la vía aérea superior, escenarios en los que cualquier dispositivo puede fracasar. El paso de un fibrobroncoscopio para exponer la glotis puede ser muy difícil, y la traqueotomía puede ser imposible o arriesgada en casos avanzados. Presentamos el uso del TotalTrack VLM en cirugía urgente para asegurar la vía aérea en 2 pacientes no cooperadores con vía aérea difícil debido a una angina de Ludwig y a un hematoma cervical, respectivamente, ambos acompañados de trismus (AU)


Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Intubação Intratraqueal/instrumentação , Anestesia Endotraqueal/instrumentação , Anestesia Endotraqueal , Angina de Ludwig/tratamento farmacológico , Trismo/tratamento farmacológico , Manuseio das Vias Aéreas/métodos , Extubação/métodos , Edema/complicações
17.
Rev Esp Anestesiol Reanim ; 64(7): 415-418, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28262247

RESUMO

Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus.


Assuntos
Intubação Intratraqueal/instrumentação , Adulto , Obstrução das Vias Respiratórias/terapia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade
18.
Acta Physiol (Oxf) ; 220(1): 150-166, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27683007

RESUMO

AIM: Increased thromboxane A2 and peroxynitrite are hallmarks of cerebral ischaemia/reperfusion (I/R). Stimulation of thromboxane/prostaglandin receptors (TP) attenuates endothelium-derived hyperpolarization (EDH). We investigated whether EDH-type middle cerebral artery (MCA) relaxations following TP stimulation are altered after I/R and the influence of peroxynitrite. METHODS: Vascular function was determined by wire myography after TP stimulation with the thromboxane A2 mimetic 9,11-dideoxy-9α, 11α -methano-epoxy prostaglandin F2α (U46619) in MCA of Sprague Dawley rats subjected to MCA occlusion (90 min)/reperfusion (24 h) or sham operation, and in non-operated (control) rats. Some rats were treated with saline or the peroxynitrite decomposition catalyst 5,10,15,20-tetrakis(4-sulfonatophenyl)porphyrinato iron (III) (20 mg kg-1 ). Protein expression was evaluated in MCA and in human microvascular endothelial cells submitted to hypoxia (overnight)/reoxygenation (24 h) (H/R) using immunofluorescence and immunoblotting. RESULTS: In U46619-pre-constricted MCA, EDH-type relaxation by the proteinase-activated receptor 2 agonist serine-leucine-isoleucine-glycine-arginine-leucine-NH2 (SLIGRL) was greater in I/R than sham rats due to an increased contribution of small-conductance calcium-activated potassium channels (SKCa ), which was confirmed by the enlarged relaxation to the SKCa activator N-cyclohexyl-N-2-(3,5-dimethyl-pyrazol-1-yl)-6-methyl-4-pyrimidinamine. I/R and H/R induced endothelial protein tyrosine nitration and filamentous-actin disruption. In control MCA, either cytochalasin D or peroxynitrite disrupted endothelial filamentous-actin and augmented EDH-type relaxation. Furthermore, peroxynitrite decomposition during I/R prevented the increase in EDH-type responses. CONCLUSION: Following TP stimulation in MCA, EDH-type relaxation to SLIGRL is greater after I/R due to endothelial filamentous-actin disruption by peroxynitrite, which prevents TP-induced block of SKCa input to EDH. These results reveal a novel mechanism whereby peroxynitrite could promote post-ischaemic brain injury.


Assuntos
Endotélio Vascular/fisiopatologia , Infarto da Artéria Cerebral Média/fisiopatologia , Ácido Peroxinitroso/metabolismo , Traumatismo por Reperfusão/fisiopatologia , Vasodilatação/fisiologia , Animais , Western Blotting , Linhagem Celular , Modelos Animais de Doenças , Endotélio Vascular/metabolismo , Imunofluorescência , Humanos , Infarto da Artéria Cerebral Média/metabolismo , Ataque Isquêmico Transitório/metabolismo , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Artéria Cerebral Média , Oligopeptídeos/farmacologia , Ratos , Ratos Sprague-Dawley , Receptores de Prostaglandina/metabolismo , Receptores de Tromboxanos/metabolismo , Traumatismo por Reperfusão/metabolismo , Vasodilatação/efeitos dos fármacos
19.
Angiología ; 68(4): 322-330, jul.-ago. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154031

RESUMO

Revisión de evidencia y opciones terapéuticas del factor de crecimiento epidérmico recombinante humano bioidéntico (rhEGF) en úlceras vasculares. El rhEGF ha evidenciado eficacia, tolerabilidad y seguridad, considerándose tratamiento adyuvante o emergente en guías de práctica clínica basadas en la evidencia. Se dispone de rhEGF mediante formulación magistral, asegurando estabilidad, efectividad y seguridad, permitiendo la individualización (adición de principios activos, cambios de galénica). Los compuestos con rhEGF mediante formulación magistral pueden considerarse indicados en el tratamiento de úlceras vasculares


Review of scientific evidence and therapeutic options of recombinant human bioidentical epidermal growth factor (rhEGF) for vascular ulcers. Efficacy, with excellent tolerability and safety has been demonstrated with rhEGF, and it has been considered as an adjuvant or emerging treatment in evidence based clinical practice guidelines. rhEGF is available by magistral prescription, ensuring stability, effectiveness and safety, allowing individualisation (addition of active principles or dose personalisation). Compounds with rhEGF can be considered for managing vascular ulcers


Assuntos
Humanos , Masculino , Feminino , Úlcera da Perna/terapia , Bandagens , Curativos Biológicos/classificação , Curativos Biológicos/normas , Curativos Biológicos , Recombinação Genética/fisiologia , Fator de Crescimento Epidérmico/metabolismo , Fator de Crescimento Epidérmico/uso terapêutico , Fator de Crescimento Epidérmico/administração & dosagem , Fator de Crescimento Epidérmico/deficiência , Antiulcerosos/uso terapêutico , Silicones/uso terapêutico
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