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Biomedical subjects

C Gomar

Publications and source records attributed to C Gomar.

At least 55 records · Page 3Linked to original sources
PubMed1996

Nimodipine fails to enhance the analgesic effect of slow release morphine in the early phases of cancer pain treatment.

We assessed nimodipine's ability to increase the analgesic effect of morphine in 32 patients suffering from cancer pain in a double-blind, placebo controlled cross-over study. Morphine administration began a few days before the start of the study. The analgesic effects of two combinations were compared: morphine (M) plus placebo (P) and morphine plus 90 mg/24 h of nimodipine (N). The study lasted 8 days, including the wash-out period, and the following sequence of treatments was applied: M + P or M + N on days 1, 2 and 3; only M on days 4 and 5; and M + N or M + P on days 6, 7 and 8. Morphine dose was individualised according to the intensity of the patient's pain and the same dose was maintained throughout the study period. Analgesic response was evaluated using four 10 cm visual analogue scales of quantitative variables for pain intensity, pain relief, sleep quality and mood. A verbal rating of qualitative variables was also scored following validated descriptors of pain in the Spanish language. No significant statistical differences were found in analgesic effect between combined treatment with nimodipine or placebo, as measured on any of the scales. In order to take into account both the short duration of treatment (8 days), and nimodipine's pharmacokinetic characteristics (half-life of 6 h and steady state of 36 h), we compared treatment with nimodipine or placebo on the third day of use, at which time, likewise, there were no statistically significant differences on any of the scales. However, when the same statistical tests were used for comparison of results with pre-treatment baseline values, highly significant differences between mean scores on the scales for pain relief and pain intensity were found. Based on these negative results we conclude that nimodipine given orally at a dose of 30 mg every 8 h does not enhance analgesia when associated with morphine in the early phases of treatment for cancer pain. Our study also gives clear evidence of a placebo effect.

Administration, Oral↗
PubMed1996

[Usefulness of the preoperative electrocardiogram in elective surgery].

OBJECTIVES: To assess the prevalence of abnormal electrocardiograms (ECG) recorded routinely in patients undergoing elective surgery as well as the prevalence of ECG abnormalities that could not be predicted by the patient's medical history. To determine the influence of ECG results on patient care. To identify patient groups at high risk for abnormal ECG. PATIENTS AND METHODS: Retrospective study of 2,146 patients scheduled for non cardio-thoracic surgery requiring anesthesia. Two physicians reviewed the preoperative ECG reports in consultation with a cardiologist. The reports were considered normal, abnormal but expected or abnormal and unexpected based on agreement or not with the patient's medical history. RESULTS: The 161 (7.4%) patients for whom data was missing were excluded. Preoperative ECGs were performed in 1,898 (95.6%) cases. Abnormal ECG results were reported for 351 (18.5%), most often for men, patients over 45 years of age, those classified ASA III-V, those with cardiovascular disease, kidney failure and diabetes mellitus. Two hundred seventy unexpected abnormalities were found in 234 (12.3%) patients. Of these, 117 (43.3%) were considered major. The unexpected abnormalities motivated changes of attitude toward 4 (1.7%) patients, but new treatment was established for only 2 (0.8%) of them. The prevalence of unexpected abnormalities was higher in men, patients over 45 years of age and those classified as ASA III-V. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among non cardio-thoracic surgical patients is high but the influence of such results is minimal. The sensitivity and specificity of preoperative ECG for detecting electrocardiographic abnormalities are low. We suggest that performance of ECG before surgery is useful in patients over 45 years of age or in those with cardiovascular disease, chronic kidney failure, diabetes mellitus, physical state ASA III-V and those for whom it has not been possible to obtain an adequate medical history or perform a complete physical.

Adolescent↗
PubMed1995

[Implantable automatic cardioverter-defibrillator: anesthesia experience].

To evaluate the anesthetic management and intraoperative events in patients benefiting from an automatic implantable cardioverter defibrillator. We retrospectively reviewed the charts of 12 male patients in whom we had placed automatic implantable defibrillators (AID). In particular we assessed anesthetic management, recording type of anesthetic and intraoperative monitoring, the technique used to implant the AID and complications during and after surgery. Arterial pressure and heart rate were also analyzed. All patients experienced tachyarrhythmia or ventricular fibrillation. Ten of the 12 patients presented left ventricular ejection fractions (LVEF) between 21 and 28%; LVEF in the other 2 patients exceeded 30% (45 and 62%). All experienced statistically significant decreases in arterial pressure coincident with fibrillation. Three patients required dobutamine for sustained hypotension. Six presented ventricular extrasystoles during surgery. Late complications included 1 sudden death after surgery and 1 infection which obliged removal of the AID. AID implantation is not risk-free, given that the patients involved have heart disease with considerable degrees of deterioration in myocardial function. Nevertheless, with extensive preoperative examination of the patient and proper anesthetic management, complications before and after surgery are rare.

Adult↗
PubMed1993

[Transposition of the great arteries. Its anatomical correction. Our initial experience].

Arterial switch correction of transposition of the great arteries has been performed without mortality on 8 children, 7 neonates and one 6 years old child, at our institution. One infant and the 6 year old child has previous pulmonary artery banding and modified Blalock-Taussig shunts. The coronary cuffs were anastomosed to the neo-aorta using the "trap-door" technique described by Mee and in seven the Lecompte manoeuvre was used. Postoperative management included treatment for persistent pulmonary hypertension and left ventricular dysfunction. All patients were discharged in satisfactory condition, and continue to do so at a maximum follow-up of ten months. These results encourage us to elect the arterial switch procedure as the primary treatment of transposition of the great arteries.

Anastomosis, Surgical↗
PubMed1991

Adverse reactions to vancomycin prophylaxis in cardiac surgery.

Several adverse effects of vancomycin have been reported. The aim of this study was to assess the incidence of adverse responses to antibiotic prophylaxis with vancomycin in cardiac surgical patients. Prospectively, 116 consecutive patients (106 adults and 10 children) undergoing cardiac surgical procedures in this institution from January to June 1990 were studied. After the anesthetic induction, vancomycin, 1 g in adults and 10 mg/kg in children, was intravenously administered over 30 minutes. The infusion rate was slowed if any adverse effect was observed. As a control group, 10 similar patients were evaluated during the same period of 30 minutes after anesthetic induction but prior to vancomycin administration and surgical stimulation. Thirty-one patients (26.72%) developed an adverse effect, mainly hypotension (29 patients, 25%), which was considered severe in 15 patients (12.93%). Seven patients (6.03%) developed a maculopapular erythema that was associated with hypotension (Red-Man's syndrome) in 5 patients and with bronchospasm in 1 patient. The incidence of adverse reactions in children (20%) was similar to the overall incidence. Only 1 patient in the control group (10%) developed hypotension during the period studied. The incidence of adverse reactions was not related to age, body weight, vancomycin dose administered per kilogram body weight, type of surgical procedure, or associated disease. Mean duration of the infusion was similar in patients with and without adverse responses (34.60 +/- 12.41 minutes and 37.38 +/- 14.55 minutes, respectively). It is concluded that perioperative prophylaxis with vancomycin in cardiac surgery produces a high and unpredictable risk of significant hypotension.

Adult↗
PubMed1990

[Transient block of the brachial plexus after catheterization of the subclavian vein].

Two cases are reported of brachial plexus anaesthesia and palsy after catheterization of the subclavian vein. This very rare complication occurred after several unsuccessful attempts to catheterize one or both subclavian veins. This was due to inexperience, with insufficient knowledge of clinical anatomy, infiltration with unnecessarily high doses of local anaesthetic, and accidental puncture of the brachial plexus by an infraclavicular approach. One of the patients also had iatrogenic pneumothorax.

Aged↗
PubMed1990

Amrinone in perioperative low cardiac output syndrome.

Amrinone has been shown to have a beneficial effect on left ventricular function in low output syndrome (LOS), but its use after open-heart surgery has not been extensively revised. We studied 10 patients with LOS post-cardiopulmonary bypass (CPB), who failed to respond to conventional treatment (vasoactive drugs plus intraaortic balloon pump) and were treated with amrinone, 0.75 mg.kg-1 followed by a continuous infusion of 5 to 10 micrograms.kg-1-min-1. One patient failed to respond to the treatment and subsequently died, but in the other nine patients blood pressure and cardiac index increased, left filling pressure decreased and they were successfully weaned from the CBP and survived. These results suggest that amrinone, either alone or combined with other inotropic drugs and mechanical support, is a valuable drug in the management of LOS after CPB.

Aged↗
PubMed1985

Carbon dioxide embolism during laparoscopy and hysteroscopy.

Venous carbon dioxide embolism is a rare but potentially lethal complication of laparoscopy. The risk is increased when it is associated with hysteroscopy. A case is presented of a young women undergoing laparoscopy and hysteroscopy for infertility. Cardiovascular collapse and cardiac arrest, associated with a mill-wheel murmur, occurred during hysteroscopy at the time of a change of position. The patient had irreversible brain damage and died a week later. Early diagnosis and prevention of this serious complication are discussed.

Adult↗
PubMed1985

The effect of ketanserin on post-anaesthetic vasoconstriction and shivering.

Two homogeneous groups of 20 healthy women submitted to elective gynaecological surgery, who presented after anaesthesia with peripheral vasoconstriction and shivering, were included in a randomized, double-blind study. The first group received 10 mg ketanserin, a new pure antagonist of serotoninergic S2 receptors. The second group received 10 ml saline as placebo. Blood pressure, heart rate, pulse wave amplitude, and rectal and cutaneous temperatures were measured before and 5, 15 and 30 min after treatment. Vasoconstriction, shivering and discomfort were classified as intense, moderate or absent at these times. Venous and arterial blood gases were determined before and 15 min after treatment. Blood pressure and heart rate decreased slightly after ketanserin administration and this decrease was statistically significant. Increases in rectal temperature were similar in both groups. Peripheral temperature, measured in the big toe, significantly decreased in the placebo group but did not change after ketanserin. Vasoconstriction, shivering, discomfort and pulse wave amplitude improved significantly following ketanserin. We conclude that ketanserin may be effective in treating this post-operative complication, the possible mechanism being the vasodilatation it causes; a central serotoninergic blockade could also be implied.

Adult↗
PubMed1984

Sacro-iliitis in a heroin addict. A contra-indication to spinal anaesthesia.

A case is presented of a pregnant heroin addict patient, with a septic sacro-iliitis due to Staphylococcus aureus. The incidence of joint infections in heroin addicts and the difficulty of diagnosis is discussed with the potential risks of spinal or extradural anaesthesia when there is infection in joints close to the needle site. Caution is advised with patients addicted to heroin who have low back pain and may have infectious sacro-iliitis.

Adult↗
PubMed1983

Tyrosine serum levels during anesthesia with high doses of fentanyl.

Serum tyrosine levels were determined in two groups of women. First group included 30 healthy volunteers and the second group was formed by 83 patients submitted to gynecological surgery under anesthesia with fentanyl (0.05 mg/kg). The results showed that preoperative tyrosine levels were higher than control values and decreased under fentanyl anesthesia. Surgical stimulation did not modify tyrosine levels. When surgery was ended serum tyrosine levels reached control values. Under fentanyl-anesthesia a direct relationship between serum tyrosine levels, cardiovascular parameters and catecholamine changes as reported by other authors is suggested. We think tyrosine serum determination could be an indirect, easy and unexpensive measure of hormonal stress response.

Adult↗