OBJECTIVES: To study the prevalence of abnormalities in preoperative chest X-rays taken of patients undergoing elective surgery; to determine radiological abnormalities not expected based on the patient's case history and their influence on treatment; and to identify patients with high risk of presenting abnormal radiographs. PATIENTS AND METHODS: This retrospective study included 2,146 consecutive patients entering the hospital over a period of one year for non-cardiopulmonary surgery requiring anesthesia. Two physicians reviewed the radiodiagnostic reports on routine preoperative chest X-rays requested by surgeons. The reviewers classified the results as normal, expected abnormal and unexpected abnormal based on concordance or not between the patient's case history and the radiologist's report. RESULTS: Of the original 2,146 patients, 160 (7.4%) were excluded from the study because of incomplete case histories and/or physical exams. X-rays were taken of 1,880 (94.6%) of the 1,986 patients remaining in the study. Abnormalities were found in 508 (27%), most often in men, patients over 45, those classified as ASA III-V and those with a history of cardiovascular or lung disease, or smokers of more than 20 cigarettes/day. In 254 (13.5%), the abnormalities were not expected based on the patient's history; the physician's attitude changed toward 11 of these (4.3%), 5 of whom had cancer. Unexpected abnormalities were detected in 2 patients (0.8%) during physical examination and the real index of unexpected attitude changes based on case history and physical examination was 9 (3.5%). A new treatment based on unexpected radiological abnormalities was chosen for only 2 (0.8%) patients. The prevalence of unexpected radiological abnormalities was higher in men, in those over 45 years old and in those classified as ASA III-V. CONCLUSIONS: The prevalence of unexpected abnormalities in routine preoperative chest X-rays taken before non-cardiothoracic elective surgery is high, but the influence of their detection on patient management is minimal. The results of our study suggest that X-rays should be recommended for patients over 45; those with a history of cardiovascular or lung disease, or of cancer; smokers of more than 20 cigarettes/day; those classified as ASA III-V; and those with incomplete case histories or physical examinations.

Adolescent↗

PubMedDate not supplied

[The European Union of Medical Specialists (UEMS)].

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Education, Medical, Graduate↗

PubMedDate not supplied

[Effects of premedication in children with congenital cardiopathy].

OBJECTIVES: To evaluate the effects of premedication in children with congenital heart disease. MATERIAL AND METHODS: Twenty-five children scheduled for surgical repair of congenital heart defects were studied. Two groups were formed based on whether cardiopathy was noncyanotic (group CNC) or cyanotic (group CC). Patients were premedicated rectally with 4 mg/kg pentobarbital and, 15 minutes later, with 0.15 mg/kg of morphine chloride by subcutaneous perfusion. SpO2 was monitored, as was the degree of sedation and airway obstruction prior to premedication (T1), 15 minutes after administration of pentobarbital (T2) and 30 minutes after morphine (T3). RESULTS: In the children with cyanotic cardiopathy, SpO2 increased over T1 (75.5 +/- 8.7%) at times T2 (76.2 +/- 7.7%) and T3 (78.1 +/- 8%), although the change was not statistically significant. In group CNC, average SpO2 did not change, although one case of clinically significant desaturation due to hypoventilation was observed at T3. Adequate sedation was attained in 36% of patients at T2 and in 80% at T3 (p < 0.002). There were no cases of airway obstruction. CONCLUSION: Premedication with 4 mg/kg pentobarbital rectally does not provide adequate sedation. Addition of 0.15 mg/kg subcutaneous morphine chloride increased the effect considerably, providing stability in SpO2 and even improving it in group CC.

Administration, Rectal↗

PubMedDate not supplied

[Epidural hematoma after removal of an epidural catheter].

Epidural hematoma is a rare but serious neurological complication of epidural anesthesia. We report the case of a 61-year-old man with squamous cell carcinoma of the lung who suffered an epidural hematoma after undergoing right double lobectomy. Before anesthetic induction an epidural catheter was inserted to the D5-D6 space for postoperative analgesia. Surgery was without noteworthy events and the patient was extubated in the operating room; 5,000 IU of low molecular weight heparin was injected subcutaneously every 24 hours and 5 mg of methadone was provided by epidural catheter every 8 hours. After removal of the catheter three days after surgery, lumbar back pain and hypoesthesia, and weakness in both legs appeared. Epidural hematoma was suspected and treatment with 30 mg.kg-1 of methylprednisolone i.v. was started. Nuclear magnetic resonance imaging of the lumbar spine confirmed the presence of a hematoma at D6-D8. Neurologic symptoms improved in the following hours and additional surgery was not required. The patient was released without neurological symptoms 10 days after lung surgery. We discuss the prevalence, etiology and treatment of epidural hematoma related to epidural anesthesia.

Aged↗