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Biomedical subjects

C Baeza

Publications and source records attributed to C Baeza.

6 recordsLinked to original sources
PubMed1998

[Continuous parascalene block for shoulder surgery].

OBJECTIVE: To evaluate the efficacy and incidence of side effects of parascalene brachial plexus block for shoulder surgery and for postoperative analgesia. PATIENTS AND METHODS: This prospective descriptive study enrolled 186 patients scheduled for conventional (open) and arthroscopic shoulder operations. The parascalene approach to the brachial plexus was used, with an 18-G x 4.5 cm cannula (30 degrees bevel), applying the technique of detecting perforation of the prevertebral fascia. Mepivacaine 1.5% was administered for anesthesia, beginning with a test dose of 5 ml followed by doses of 25 ml. Bupivacaine 0.125% with 1/400,000 adrenaline was given for postoperative analgesia. Two groups were established according to type of surgery. In group A were patients undergoing open surgery and those with articular stiffness undergoing arthroscopic surgery; analgesics were delivered in continuous perfusion of 5 to 8 ml/h. Group B patients, who underwent arthroscopic surgery, received the analgesic in boluses of 10 to 14 ml every 4 to 6 hours. We assessed perception of perforation of the fascia, provocation of paresthesia, number of puncture attempts, anesthetic efficacy, postsurgical analgesia (visual analogue scale from 0 to 10) and complications. RESULTS: Blockade was effective for 155 of the 186 patients (83.33%). In 118 (63.44%) the perception of perforation of the prevertebral fascia was ostensible, in 52 (27.95%) it was slight and in 16 (8.6%) it was undetectable. Paresthesia was triggered by the cannula in 18 cases (9.13%) and by the test dose in 181 cases (97.31%). The mean number of puncture attempts was 1.2 +/- 0.09 per patient. During the early postoperative period analgesia was adequate for 92 (84.40%) of the 109 patients in group A. In group B, 45 patients (97.82%) required 1 to 2 analgesic doses (mean 1.4 +/- 2 doses) and one patient (2.17%) needed 6 doses within the first 24 hours. Catheters remained inserted as long as 36 hours to 10 days (mean 3.5 days) in group A. In group B they had been removed by 24 hours. Complications were transitory and slight. No cases of pneumothorax, no intra- or epidural anesthesia was required and no instances of vascular puncture occurred. CONCLUSIONS: The parascalene approach is easy to use and entails few risks while providing excellent anesthetic conditions for open and arthroscopic shoulder operations. It is useful for ambulatory analgesia to facilitate early rehabilitation after surgery.

Adult↗
PubMed1993

The effects of the posterior sagittal approach on rectal function (experimental study).

The posterior sagittal transsphincteric approach has been used for the treatment of anorectal malformations in children and for other acquired conditions mainly in adults. Although the reports on clinical results indicate that the division of the sphincteric mechanism does not harm the function of the voluntary muscles, there are no experimental objective evaluations of the rectal function and fecal continence after a posterior sagittal transsphincteric approach. Sixteen dogs were studied forming four groups of four animals each. Group I was subjected to a posterior sagittal approach only without opening of the rectum. Group II underwent a posterior sagittal approach plus posterior and anterior rectotomy. Group III underwent a posterior sagittal approach plus a perirectal dissection, and group IV underwent only a perirectal dissection without posterior sagittal incision. All animals were evaluated clinically and manometrically preoperatively and postoperatively and were followed up to 12 weeks. Results indicated that the perirectal dissection with and without posterior sagittal incision provoked the most severe changes in bowel control and manometric parameters. Posterior sagittal approach with or without rectotomy provoked minimal or no changes in bowel function and rectal manometry. This experimental study supports the clinical experiences and indicates that the posterior approach does not interfere with the function of the sphincteric mechanism.

Anal Canal↗
PubMedDate not supplied

[Anesthesia for vertebral osteoclasis in a patient with severe predominantly cervical spondylitis ankylopoietica].

We present a patient suffering severe, mainly cervical, ankylopoietic spondylitis who was scheduled for posterior vertebral osteoclasis under local anesthesia. We describe handling of anesthesia, particularly airway control by flexible bronchoscopy in an awake, locally anesthetized patient sedated with benzodiazepines and inhalational anesthetics as compared with other alternatives: an awake patient who is not intubated, under local anesthesia and sedated with narcotics and gaseous anesthetics, or a patient under general anesthesia with placement of a flexible bronchoscope and neurological monitoring by evoked potentials. The surgical technique was Simmons' posterior vertebral osteoclasis, with the column extended and immobilized with wire.

Anesthesia, Inhalation↗