A 30-year-old woman with von Willebrand's disease was admitted in labor. As epidural analgesia was ruled out due to risk of spinal hematoma, a pump for patient-controlled analgesia (PCA) was provided with boluses of remifentanil and set for intravenous infusion of 24 micrograms with a lockout time of 5 minutes. The patient reported analgesia to be satisfactory. Later, because of abnormal fetal positioning, an emergency cesarean was performed with the patient under general anesthesia with remifentanil, with propofol and succinylcholine for induction. A healthy girl was born free of respiratory depression. Von Willebrand's disease is a hemorrhagic disorder of autosomal dominant inheritance due to a quantitative or functional factor VIII deficit. Various subtypes and degrees of severity of abnormal bleeding have been described. It is the most common genetic hemostatic disorder affecting obstetric procedures, and although epidural analgesia has been used with strict hematologic monitoring, that technique carries a risk of hematoma. PCA is useful in patients for whom regional techniques are contraindicated. With adequate fetal and maternal monitoring, remifentanil in PCA is safe and more effective than other opiates for labor pain.

Adult↗

PubMed2003

[Bradycardia-tachycardia syndrome during spinal anesthesia].

A 78-year-old man developed bradycardia with decreased level of consciousness followed by sinus arrest during femoropopliteal bypass surgery under subarachnoid anesthesia. Early in the recovery period, a similar clinical picture developed, with bradycardia but no change in level of consciousness. Sinus node automaticity or sinoatrial conduction abnormalities were suspected, and a 24-hour Holter electrocardiogram revealed bradycardia-tachycardia syndrome. The patient was prescribed amiodarone and anticoagulant therapy with acenocoumarol; no further episodes occurred during hospitalization. Bradycardia-tachycardia syndrome is a sinus node disorder that manifests intermittently. It can become apparent during or shortly after surgery, leading to problems of differential diagnosis.

Aged↗

PubMed2002

Anaesthetic and postoperative analgesic effects of spinal clonidine as an additive to prilocaine in the transurethral resection of urinary bladder tumours.

BACKGROUND AND OBJECTIVE: The alpha 2-adrenoceptor agonist clonidine has potent central antinociceptive properties. The study was designed to investigate the effects of the combined subarachnoid administration of clonidine and prilocaine on spinal block and postoperative analgesia for the transurethral resection of tumours in the urinary bladder. METHODS: The controlled, prospective, double-blind study enrolled 40 patients scheduled for elective transurethral resection of bladder tumours under spinal anaesthesia with prilocaine. Patients were randomly assigned to receive an intrathecal injection of prilocaine 75 mg alone (control group) or in combination with clonidine 75 micrograms. We assessed haemodynamic changes (non-invasive arterial pressure, heart rate), pulse oximetry, the upper level of block, the onset and duration of sensory and motor block, postoperative analgesia and any adverse effects. RESULTS: There were no statistically significant differences in demographic data, heart rate, onset time or the levels of sensory or motor block. Analgesia lasted significantly longer in the clonidine group (498.4 +/- 226.9 versus 187.2 +/- 103.1 min; P < 0.05). The duration of motor block was longer in the clonidine group (165.5 +/- 30.6 min) than in the control group (139.7 +/- 40.4 min; P < 0.05) and the duration of sensory block was also longer in the clonidine group (157.3 +/- 24.5 min) than in the control group (137.2 +/- 31.2 min; P < 0.05). Fewer patients in the recovery room needed metamizol (dipyrone) in the clonidine group (5%) than in the control group (50%). Arterial pressure decreased significantly in the clonidine group 75-135 min after the block. CONCLUSIONS: The addition of clonidine 75 micrograms to prilocaine 75 mg for subarachnoid anaesthesia increased the duration of sensory and motor block and reduced the need for additional postoperative analgesics by providing excellent analgesia for about 8 h during recovery from transurethral resection of bladder tumours.

Aged↗

PubMed2002

[Spanish doctoral dissertations on anesthesiology and the scientific publications of their authors].

OBJECTIVES: To determine whether obtaining a doctorate is a factor that promotes the research careers of the authors. To analyze the dissemination of Spanish doctoral theses in anesthesiology by looking at the publications they generate. MATERIAL AND METHODS: The TESEO data base was searched for theses on anesthesiology written between 1976 and June 2001. The Medline database was then searched for publications related to each author's thesis. The search identified papers related to each thesis as well as those in which the thesis director was a coauthor. RESULTS: Two hundred twenty-eight theses (9.12 theses/year) were found. Twenty-four authors were not anesthesiologists. The universities of Barcelona (28), Valencia (24), Navarra (23), Autónoma de Barcelona (21), Complutense de Madrid (18) and Cádiz (18) accounted for most of the theses read. The doctoral degree recipients also co-authored 1,833 publications, as the first authors of 649 articles, of which 216 (33.3%) were published before the corresponding thesis was read. Only 127 articles were related to theses. Ninety-seven authors (42.5%) published no article as first author and 22 (9.6%) accomplished no publication as co-author. The thesis director was listed in 154 of the 228 theses in the TESEO database. In this subgroup, 39 doctoral thesis authors published 58 related articles, with the director included among the co-authors in 41 of them. CONCLUSION: Spain produces few doctoral theses on anesthesiology. Most writers of doctoral theses do not publish the results in journals with international readerships. These findings call into question the efficacy of the doctoral thesis as a factor that promotes research.

Academic Dissertations as Topic↗

PubMed2002

[Placement of a double-lumen tube using a 6 mm diameter fibro-bronchoscope and a Cook exchange catheter in a patient with unforeseen tracheal intubation difficulty].

The trachea of a 74-year-old man undergoing left pneumonectomy could not be intubated in two attempts after induction of anesthesia with midazolam, fentanyl, propofol and rocuronium. Difficult intubation had not been foreseen, but inspection through the laryngoscope revealed Cormack and Lehane grade IV conditions. Because a small-caliber fiberoptic bronchoscope was unavailable for intubation with a double-lumen endobronchial tube, we inserted a No. 9 orotracheal tube with a 6 mm bronchoscope as far as the left main bronchus. Intubation was aided by a universal adaptor for fiberoptics with a face mask and a Williams cannula. We were then able to ventilate the patient manually with 100% oxygen during bronchoscopy. As selective ventilation was required during surgery, a No. 11 Cook-type airway exchange catheter was inserted into the left main bronchus, the tracheal tube was removed, and was used to guide a No. 39F left double-lumen endobronchial tube through the bronchus. Insertion was uncomplicated and selective ventilation was satisfactory. The technique described is a new application for the Cook exchange catheter that allows selective bronchial in difficult cases when a small-caliber fiberoptic bronchoscope is unavailable.

Aged↗

PubMed2001

[Survey of the deficit of anesthesiologists in Catalonia and analysis of the situation made by 47 department heads].

Explore the source record for details and available documents.

Anesthesia Department, Hospital↗

PubMed2001

[Pregnancy and partum in the woman with a spinal cord lesion in chronic phase].

A 34-year-old pregnant paraplegic woman with a T12 medullary lesion in chronic phase underwent cesarean delivery in the thirty-seventh week due to pelvic-cephalic disproportion. After failure of epidural anesthesia related to technical difficulties, general anesthesia was provided. A hypertensive crisis developed during surgery but was resolved within minutes after administration of hydralazine. No further complications arose. Pregnancy in a patient with medullary lesion in chronic phase is considered high risk, requiring special care due to extraordinary changes in pathophysiology caused by the lesion in addition to changes directly related to gestation. The main complications that arise are decreased respiratory volume and arterial pressure, increased incidence of thromboembolic events, anemia, urinary tract infections, premature birth, unusual progression of delivery and autonomic hyperreflexia, which is the most serious. When a hypertensive peak develops in such patients, the anesthesiologist must first rule out autonomic hyperreflexia, which has an incidence of 85% in lesions over T7 and has also been described in patients with lower lesions.

Adult↗

PubMed2001

[Expected versus real impact factors of publications from Spanish departments of anesthesiology (1991-1996)].

OBJECTIVE: To identify publications by Spanish anesthesiologists in journals indexed by Journal Citation Report from 1991 through 1996; to count the number of citations received and compare the results with the impact factor (IF) of the journals in which they were published. MATERIAL AND METHODS: Articles for which the first author was a member of a Spanish anesthesiology department were searched for in MEDLINE, Science Citation Index and EMBASE. Only publications for which the IF was known were included for analysis. We then counted the number of citations each article received over the two years following publication, recording the source journal in which the citation appeared and country of origin of each citing author. We then calculated the real IF (RIF) of each article, the RIF of all the Spanish articles, and the mean RIF. Also calculated for each article was the expected IF (EIF), based on the IF of the source journal, the overall EIF and the mean EIF. RESULTS: One hundred seventy-two articles were published; 49 of them were letters to the editors. Specialist anesthesiology journals published 72.7%. A total of 186 citations were received. American authors cited the articles more often than did other Spanish authors. Thirty-seven citations (19.9%) were self-citations. Ninety-two articles (53.5%) were never cited. With letters to the editor excluded, the RIF was 85.48 and the global EIF was 213.28; the mean EIF was 1.734 and the RIF was 0.695. Therefore, the rate of citation of the Spanish authors in the period studied was only 40% of the citation rate of the entire population of authors from all countries. The authors of the published articles worked mainly in hospitals in Barcelona, Madrid, La Coruña, Valencia, Cantabria and Murcia. Hospital Germans Trias i Pujol (Badalona, Barcelona) had the largest number of publications and the highest EIF (39.41). Hospital del Mar (Barcelona) had the highest mean RIF and the highest global RIF.A gradual increase in the annual productivity of Spanish scientists can be discerned in a progressive increase in the number of publications as well as their EIF and RIF. CONCLUSIONS: Research by Spanish anesthesiologists is concentrated in only a few hospitals. Although the number of publications is increasing, their international repercussion has still not reached the desired level.

Anesthesia Department, Hospital↗

PubMed2001

[Remifentanil or propofol for sedation in subarachnoid anesthesia. Effects on ventilation, hemodynamic stability and bispectral index].

OBJECTIVES: To compare depth of sedation, hemodynamic and respiratory effects, and bispectral index (BIS) in surgical patients under subarachnoid anesthesia with intravenous perfusion of 1 mg/kg/h of propofol or 3 microgram/kg/h of remifentanil or placebo. PATIENTS AND METHOD: Fifty-one elective surgery patients were randomly assigned to one of 3 groups: propofol (n = 17), remifentanil (n = 17) or placebo (n = 17). We monitored ECG, blood pressure (BP), respiratory frequency (RF), oxygen saturation by pulse oximetry (SpO2), nasal end tidal carbon dioxide pressure (PETCO2), BIS and sedation on the Observer's Assessment of Alertness/Sedation scale (OAA/S). Five minutes after starting subarachnoid anesthesia, we initiated the assigned intravenous perfusion. Measurement of hemodynamic variables, BIS, PETCO2, RF and OAA/S score occurred at baseline, every 5 minutes during surgery and after withdrawal of sedation at intervals until recovery of baseline values. RESULTS: Patient data and SpO2 were similar in the 3 groups. PETCO2, FR and OAA/S did not change significantly from baseline in the placebo group but were significantly different in the other groups. BIS was significantly lower in the propofol group than in either the remifentanil or the control group. Times to recovery were similar in the two sedation groups. Slight complications were observed in 35.3% patients in the propofol group, 53.3% in the remifentanil group and 7.7% in the placebo group; complications were mainly nausea, pruritus and hypoventilation in the remifentanil group and venous pain in the propofol group. CONCLUSIONS: The sedation regimens used were safe and adequate. Propofol is associated with fewer complications than remifentanil.

Anesthesia, Spinal↗

PubMed2000

[Anesthesia in the first decades of the 21st century].

Explore the source record for details and available documents.

Anesthesia↗

PubMed2000

[Effectiveness of isobaric 0.5% bupivacaine and 5% lidocaine in continuous subarachnoid anesthesia with microcatheters].

OBJECTIVES: To study the clinical effect of two isobaric local anesthetics infused through microcatheters for continuous subarachnoid anesthesia. MATERIAL AND METHODS: Patients undergoing surgery under continuous subarachnoid anesthesia were enrolled prospectively over 12 months. Twenty-seven-gage catheters were inserted through 22 G Sprotte (Intralong) needles. The two isobaric anesthetics (0.5% bupivacaine and 5% lidocaine) were studied in two successive six-month periods. One milliliter of local anesthetic was administered, followed by incremental doses of 0.5 ml until the required anesthetic level was reached. Hemodynamic variables were recorded, as were levels of anesthetic and motor blockade and complications developing during the surgical and postoperative periods. RESULTS: Thirty-one patients were anesthetized with isobaric 0.5% bupivacaine and 40 with isobaric 5% lidocaine. A high blockade was observed in three patients in the bupivacaine group and in 15 in the bupivacaine group (p < 0.05). The highest anesthetic level reached was T4. Hypotension occurred in one patient in the bupivacaine group and in 10 in the lidocaine group (p < 0.05). Blockade was difficult to increase to the appropriate level in 11 lidocaine patients and in one bupivacaine patient, whereas blockade of distal roots was difficult in 13 bupivacaine patients and in 7 lidocaine patients (p < 0.005). The total doses infused were 11.0 +/- 3.0 mg of 0.5% bupivacaine and 95.6 +/- 24.6 mg of 5% lidocaine. CONCLUSIONS: Isobaric 0.5% bupivacaine provides a more predictable anesthetic blockade with greater hemodynamic stability and a lower rate of difficulty in raising the level of blockade than does 5% lidocaine when administered through microcatheters for continuous subarachnoid anesthesia.

Anesthesia, Spinal↗

PubMed2000

[Abdominal compartmental syndrome in non-injured patients].

Abdominal compartment syndrome (ACS) is characterized by increased intraabdominal pressure and a set of secondary pathophysiological changes in the abdominal. ACS has reappeared in the literature recently in relation to the surgical concept to damage control, applied particularity in contexts of severe abdominal injury polytraumatized patients. We report two cases of ACS that appeared after scheduled abdominal surgery: one after repair of a large eventration and the other in the context of septic shock due to fecaloid peritonitis. Both patients died of multisystem organ failure in spite of surgical decompression. We wish to emphasize that ACS can appear in contexts other than surgery for damage control, and we stress the need to measure intravesical pressure as a reflection of intraabdominal pressure, particularly in certain high risk patients in the postoperative recovery ward. Finally, we review the pathophysiology of ACS and its management, which is based on early treatment to prevent multisystem organ failure with an associated high risk of death.

Abdomen↗