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C Gomar

Publications and source records attributed to C Gomar.

At least 73 records · Page 4Linked to original sources
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[Drugs that alter hemostasis and regional anesthetic techniques: safety guidelines. Consensus conference].

Patients about to undergo surgery are often taking drugs that alter hemostasis and affect anesthesia, particularly when neuroaxial techniques are used for subarachnoid or epidural anesthesia. The aim of this paper is to provide safety guidelines for regional anesthesia in patients receiving hemostasis-altering drugs, in order to reduce the risk of bleeding. We offer a detailed discussion of patients treated with inhibitors of platelet aggregation (emphasizing that such treatment alone is not a contraindication for neuroaxial blockade although certainly guidelines must be followed), unfractionated heparin (anesthesia should be started at least 4 hours after administration of this drug or 30 minutes before, provided pulmonary arterial pressure is normal), low molecular weight heparin (which should be administered 12 hours before or 12 hours after the anesthetic technique), and oral anticoagulants (provision of regional anesthesia depends mainly on International Normalized Ratio monitoring). We also stress that removal of catheters should follow criteria similar to those listed above, that the risk of complications due to bleeding increases considerably in association with these drugs, and that adequate neurological monitoring is essential during postoperative recovery. Overall, the final decision to use regional anesthesia in patients receiving drugs that alter hemostasis must be made on an individual basis after assessment of benefit and risk.

Administration, Oral↗
PubMedDate not supplied

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Anesthesiology↗
PubMedDate not supplied

Osseous metastases in breast cancer: radiographic monitoring of therapeutic response.

BACKGROUND: Standard radiographs are primary means of evaluation of therapy-induced changes of the skeletal structure in patients with breast cancer metastatic to the bone, but objective quantitation has been difficult to standardize. MATERIALS AND METHODS: Serial radiographs of therapy-induced changes in the structure of bone metastases secondary to breast cancer were analyzed in 274 patients over a period of 10 years and roentgenologic signs of tumor response evaluated with regard to a defined principal metastasis. RESULTS: Indicators of regression were recalcification/reossification of primary osteolysis (11.6%), the formation of marginal sclerosis around the defect (13.5%) and lack of progression over a period of up to at least 12 months (10.5%). Reduction of sclerosis or structural loosening in primary osteosclerotic metastases (2.5%) may also be evidence of regression. Recurrence or progression of tumor was manifested by new metastases and/or increase in lesion size (56.9%) as well as development of lytic areas in primarily sclerotic or mixed metastases (2.5%). One hundred and one out of 157 patients with initially sclerotic or mixed metastases stayed stable or showed a response which lasted 12 months or longer. The duration of response in osteolytic lesions was less favourable. Irradiation and complex treatment (chemotherapy or hormonal therapy plus irradiation) was most often associated with a favourable objective response, 75%, which in 8 cases reflected nonprogression of disease, recalcification of primary osteolysis in 11 cases, the formation of marginal sclerosis around the defect in 8 lesions and disappearance of metastases in 1 case. CONCLUSION: Standard radiographs are useful in the serial evaluation of the effectiveness of therapy for osseous metastases in that anatomic quantitation of lesions as well as the dynamic evolution of lytic lesions to blastic healing may be observed

Adult↗
PubMedDate not supplied

[Obstetric analgesia in 28 women with idiopathic thrombocytopenic purpura].

OBJECTIVE: To assess complications arising from regional analgesia for obstetric labor and delivery in women with idiopathic thrombocytopenic purpura (ITP). MATERIAL AND METHODS: Retrospective study of case records of women with ITP who gave birth at our hospital over the 10-year period from 1993 through 2002. Quality control checklists were applied to case records before including them for study. The chart had to contain information on the type of analgesia/anesthesia used during labor or cesarean section, the results of complete peripartum coagulation tests, and a record of the presence or absence of anesthetic complications. Twenty-eight births involving 24 patients with ITP were studied. RESULTS: Regional analgesia/anesthesia, usually by epidural infusion, was the technique most often used. All patients had prothrombin and cephalin times within the normal ranges. Regional analgesia/anesthesia was never used in cases where the platelet count was less than 70,000/mm3. In such cases, general anesthesia was used for cesareans, with endovenous administration of opioids. No analgesia was used when the patient declined it for normal deliveries. Eleven cesarean deliveries and 17 vaginal deliveries were recorded. No complications were observed either with regional or endovenous techniques. CONCLUSIONS: The regional neuroaxial techniques used in this series of women with ITP, in whom platelet counts exceeded 70,000/mm3, were not associated with hemorrhagic complications.

Adult↗
PubMedDate not supplied

[Use of a new inotropic agent, enoximone, in heart surgery].

We report our experience with the use of enoximone in 5 patients with severely depressed preoperative myocardial function who underwent cardiac surgery. In patients 1 and 2, enoximone was administered as the inotropic of choice before cardiopulmonary bypass (CPB) and a substantial improvement of cardiac index was achieved; in these patients, enoximone administration after CPB permitted to overcome low cardiac output which persisted after high dose dobutamine in patient 1, and in patient 2 right ventricular contractility improved. In patient 3 the use of enoximone permitted the discontinuation of CPB, which had not been previously possible with the association of dopamine and dobutamine. In this patient, adrenaline perfusion improved the low cardiac output syndrome but resulted in poorly tolerated side effects. However, in patient 4 the administration of enoximone during pre-CPB did not improve in a reduction in filling pressures without an increase in the cardiac index because the patient was hypovolemic. In patient 5, the administration of enoximone permitted to interrupt the infusion of dobutamine and to reduce the dose of sodium nitroprusside, which had resulted in significant tachycardia, with increased myocardial contractility and a reduction of vascular peripheral and pulmonary resistances. We conclude that enoximone, single or in association with other inotropics, should be considered a drug of choice in patients undergoing cardiac surgery who develop a low cardiac output syndrome.

Adrenergic beta-Agonists↗
PubMedDate not supplied

[Survey of nursing roles in anesthesiology, postoperative recovery care and pain management in Catalonia, Spain: analysis of the current situation].

OBJECTIVE: To determine nursing functions in anesthesiology, postoperative recovery care, and pain management in Catalan hospitals and to analyze the roles of nurses in this specialty. METHODS: Development of a mail questionnaire sent to 70 public and private hospitals in Catalonia, to be filled in and returned separately by the nursing supervisor and by the anesthesiology department of each hospital. The survey included questions on whether tasks were or were not carried out by nurses. RESULTS: Responses were received from 31% of nursing supervisors and 45% of anesthesiology departments. Only 22% of the hospitals employed nursing staff with duties exclusively in the anesthesiology department. Nurses took on more responsibilities in major outpatient surgery services and postanesthetic recovery care units than in other areas. Significant discrepancies were found between answers given by nursing supervisors and those returned by anesthesiology departments regarding tasks of nurses in this specialty. Items with the greatest agreement were those related to maintenance of material. Those with the lowest agreement were related to drug management. CONCLUSIONS: Although responses came from only a third of the target population, the information obtained suggests a lack of definition in Spain of nursing tasks in the field of anesthesiology. This situation is different from that of most European countries and of the United States of America.

Anesthesia↗
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An electronic device (Episensor) for detection of the interpleural space.

Complications associated with interpleural block are often related to difficulty with needle and catheter placement. Thus there exists need for refinement of the puncture technique. We present our initial experience identifying the interpleural space with a new electronic detector (Episensor, Palex, Spain) that is sensitive to negative pressure. Twenty-five patients undergoing cholecystectomy (subcostal incision), nephrectomy or mastectomy were included in the study. All patients had an interpleural catheter placed after completion of surgery, but before extubation, using the Episensor. The technique was successful in all cases. The mean time from needle insertion to taping the catheter to the skin was 6.3 +/- 3.6 minutes. No patient developed a pneumothorax. Four patients (16%) complained of chest pain during the interpleural injection of radiopaque medium. Pain relief during the 48-hour observation period was good. Supplemental analgesia was required in nine nephrectomy patients. We believe the Episensor may be a valuable adjunct to the initiation of interpleural anesthesia.

Adult↗
PubMedDate not supplied

[Comparative study of detection methods in epidural anesthesia: Episensor and loss of resistance].

The aim of the present study is to evaluate an electronic detector of negative pressure (Episensor, Palex, Spain) designed for the identification of epidural space. Ninety patients were randomly assigned to two groups: group 1 (n = 47) received epidural anesthesia as perioperative analgesic technique with Episensor method and group 2 (n = 43) received epidural anesthesia with the classic method of loss of resistance with gas mandrin. The following parameters were studied: a) demographic features, b) characteristics of epidural anesthesia, and c) complications occurring during space detection. There were no statistical differences in the analysis of demographic variables neither in the quality of the epidural anesthesia achieved in both groups. With respect to complications, group I presented the highest number of complications although only the lack of detection of epidural space achieved statistical significance (8.5%, p less than 0.05); the incidence was lower than that reported in the literature as physiologically possible in the lumbar epidural segment. We conclude that progressive knowledge of Episensor may decrease the initial incidence of complications with a success rate similar to that of classic techniques of identification of epidural space.

Adult↗
PubMedDate not supplied

[Localization of lumbar epidural space by loss of resistance and using the Episensor: a comparative study].

Since the existence of negative pressure in the epidural space was reported, its technique of localization has undergone changes directed to improve objectivity, reliability and safety. The aim of the present study was to evaluate a new electronic divide to localize the epidural space, i.e. the Episensor (Palex, Spain). To this end, 71 patients, both males and females, undergoing elective urological surgery and in whom catheterization of the lumbar epidural space had been planned, were prospectively evaluated and randomly assigned to two homogeneous groups. In group I (n = 35) the epidural space was localized by the classical technique of loss of resistance, while in group II the Episensor was used. In both groups several technical parameters, the qualification of the operator and the complications of the procedure were evaluated. There were no significant differences between both groups regarding the quality of epidural blockade or the subjective technical difficulty of the operator. The incidence of complications of the technique of puncture was significantly higher in group II (p less than 0.05); the most common were dura mater puncture in 13 group II patients and in one group I patient (p less than 0.001). There was no correlation between the qualification of the operator and the development of complications. It was concluded that the use of Episensor to localize lumbar epidural space did not improve the effectiveness of blockade but increased the iatrogenic effects of the puncture. Our lack of experience with this new technique and the low negative pressure of lumbar epidural space might have been the causes of the poor results, that we consider as initial in the evaluation of this new method.

Adult↗
PubMedDate not supplied

[Effect of the peridural methadone concentration in postoperative analgesia].

The analgesic characteristics of 3 to 6 mg epidural methadone administered in two different concentrations for postoperative analgesia have been compared in two homogeneous groups of patients submitted to surgical procedures on trunk or legs. Methadone was given at a concentration of 0.1% in group I (70 patients) and diluted in 10 ml saline in group II (35 patients). Methadone doses were calculated on the basis of age and weight of the patient and the performed surgical procedure. Mean latency for analgesia was 25 +/- 11 min in group I and 28 +/- 13 min in group II. The duration of the analgesia was significantly longer (p less than 0.01) in group I (9.7 +/- 5.6 h) than in group II (5.7 +/- 2.4 h). Side effects were not frequent and without clinical significance in both groups. Epidural methadone is an effective method for postoperative pain relief. Drug concentration modifies the duration of the analgesia and concentration of 0.1% gives better results than more diluted preparations.

Adolescent↗