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Biomedical subjects

F Escolano

Publications and source records attributed to F Escolano.

At least 19 recordsLinked to original sources
PubMed2004

[Severe anaphylactic reaction to metamizol during subarachnoid anesthesia].

A 59-year-old man with no relevant medical history underwent a right saphenectomy under subarachnoid anesthesia with mepivacaine. Administration of intravenous metamizol for postoperative analgesia was followed by severe anaphylactic reaction with respiratory failure and ventricular fibrillation. The patient recovered after orotracheal intubation and defibrillation. High serum tryptase levels 2 and 6 hours after the episode and positive skin prick tests confirmed the diagnosis of anaphylactic reaction mediated by immunoglobulin-E antibodies. Anaphylactic reactions to metamizol may be more common than would appear based on reports in the literature. When signs present suddenly with cardiovascular or respiratory involvement, symptomatic treatment should be started even in the absence of cutaneous or mucosal signs and allergy tests should be carried out immediately.

Analgesia↗
PubMed2003

[Spinal cord compression caused by hematoma related to neuroaxial anesthesia in Spain].

OBJECTIVES: Spinal cord compression from a hematoma is a rare serious complication of neuroaxial anesthesia. Our objective was to investigate cases reported and published by Spanish authors. MATERIAL AND METHODS: Cases of spinal cord compression related to neuroaxial hematomas (epidural, subarachnoid, or both) reported at congreses and meetings in Spain or published in Medline-indexed journals from 1989 through December 2002 were reviewed. The clinical characteristics, risk factors, treatments, and outcomes were described for each case. RESULTS: Since 1996, when the first cases were reported, 20 cases in all have appeared: 8 related to sub-arachnoid anesthesia, 8 to epidural anesthesia, 1 to a combination, and 1 to diagnostic lumbar puncture. In 2 cases, the neuroaxial technique used was poorly defined. Factors that might have caused the complication could be identified in 11 cases, among which there were 7 cases of anesthetic puncture or manipulation of an epidural catheter during a period of hemorrhagic risk because of antithrombotic therapy. The hematoma was evacuated surgically in 11 cases, and medical treatment was provided in 9 cases. The neurologic outcome was satisfactory in 14 cases. CONCLUSIONS: The number of compressive spinal hematomas reported or published by Spanish authors is fairly high, and there are cases related to both sub-arachnoid and epidural anesthesia. Nonsurgical treatment was provided in 45% of the cases and the outcome was satisfactory in 70%. Risk factors were identified in over half of the reported cases.

Adult↗
PubMed2002

[Cardiorespiratory arrest: a rare complication of subdural block].

We report a case of accidental subdural block after epidural anesthesia that manifested as cardiac arrest due to extensive spinal blockade 20 minutes after administration of 50 mg of 0.5% bupivacaine. The event resolved without sequelae. Subdural placement of the catheter was verified by computed axial tomography contrast medium. Clinical signs of subdural block are highly variable, extensive neural block being among the possible rare presentations, with latency ranging from a few minutes to as long as 30. Recent electron microscope observations with new methods for fixing and preparing tissues suggest that the dubdural space does not exist naturally, but rather forms artificially within a low-resistance cell plane composed of neurothelial cells, as a result of trauma or the injection of a local anesthetic. The characteristics of the space depend, therefore, on factors that come together at the site. These data explain the great variability in the clinical manifestations of a subdural block. The case of cardiopulmonary arrest we report is rare in the literature.

Aged↗
PubMed2002

[Failure in the functioning of an implanted automatic defibrillator due to pneumothorax occurring during its implantation ].

A 67-year-old man with chronic bronchitis and coronary artery disease was scheduled to receive an implantable cardioverter defibrillator (ICD) after an episode of sustained monomorphic ventricular tachycardia. During implantation through the left subclavian vein, oxygen saturation decreased to slightly below baseline. Nevertheless, the procedure continued, given that the patient experienced neither breathing difficulties nor pain. When the ICD failed to reverse ventricular fibrillation induced to test the device, an external defibrillator was used. At that point, left-sided pneumothorax was observed by x-ray. Air in the pleural cavity caused an increase in the defibrillation threshold. After insertion of a thoracic drain, the ICD implantation procedure was completed successfully.

Aged↗
PubMed1998

[Drug allergy in a population of surgical patients].

OBJECTIVES: To determine the prevalence of drug allergies in a population of surgical patients. To establish a clinical classification of events as being very or not very likely to be allergic reactions. To detect which drug groups are associated with greater incidence of anaphylactic reaction and to analyze the severity of such reactions. PATIENTS AND METHODS: Epidemiological study. During a preoperative interview, patients were asked if they were aware of the existence of any episode of allergy to drugs. If a patient answered yes, a specific data collection questionnaire on allergies was completed. Based on signs and symptoms described by the patient, reactions were classified as indicating high likelihood of allergy, low likelihood of allergy, or as being of unknown origin. RESULTS: We questioned 1,218 patients (754 women/464 men), of whom 159 (13.05%) reported being allergic to drugs. The total number of drugs employed was 212 (1.34 drugs/patient). Antibiotics (54.7%), nonsteroidal anti-inflammatory drugs (NSAIDs) (19.3%), radiological contrast media (6.1%) and local anesthetics (4.7%) were the substance groups most often mentioned. We classified 74.5% of the reactions as indicating high likelihood of allergy, 19.8% as indicating low likelihood, and 5.6% to be of unknown origin. The skin was involved in 72.1% of the reactions that were highly likely to have been caused by allergy; 6.9% of these reactions involved the respiratory tract, 4.4% the circulatory system, 12% the skin plus respiratory tract, and 4.4% the skin plus respiratory and circulatory systems. The most severe reactions (16.4%) were associated with radiological contrast media (36.4%), NSAIDs (33.3%) and intravenous administration (38.1%). Signs of latex allergy were seen in 0.4% and signs of allergy to hair dyes in 0.9%. All allergy tests were negative in all these patients. CONCLUSIONS: Drug allergy is reported by 13% of patients. It is highly likely that 74.5% of reactions are due to allergy. Antibiotics are the most frequently implicated drugs, followed by NSAIDs. The most serious reactions are caused by radiological contrast media and NSAIDs. Intravenous administration causes the most serious reactions.

Adolescent↗
PubMed1997

[Efficacy of ondansetron in the prevention of nausea and vomiting after laparoscopic cholecystectomy].

To assess the efficacy of 4 mg of intravenous ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV) in cholecystectomy, a type of surgery that is highly emetic. A random, double blind, placebo controlled study of 40 women over 18 years of age who were scheduled for non urgent laparoscopic cholecystectomy under general anesthesia. The patients were assigned to two groups to receive ondansetron (n = 23) or placebo (n = 17). Premedication and anesthesia were similar for all. The severity of PONV in the first 24 hours after surgery was recorded. There were no significant differences between the two groups with respect to biological characteristics or other factors that might influence the presentation or severity of PONV. The percentage of PONV-free patients was significantly higher in the ondansetron group than in the control group (73.91 and 11.76%, respectively; p < 0.001). Intravenous administration of 4 mg ondansetron is significantly superior to placebo for PONV prophylaxis after laparoscopic cholecystectomy.

Adult↗
PubMed1996

The efficacy and optimum time of administration of ranitidine in the prevention of the acid aspiration syndrome.

In order to evaluate the efficacy of a single oral dose of ranitidine 150 mg and the optimum time for its administration, we studied pH and volume measurements in 138 surgical patients, who formed six groups according to the time elapsed from ranitidine administration to gastric fluid aspiration as follows: group A: no ranitidine, group B: 60-90 min, group C: 91-120 min, group D: 121-150 min, group E: 151-180 min and group F: > 180 min. The patients from groups B, C, D, E and F had a significant increase in gastric pH and a significant decrease in gastric fluid volume when compared to the patients from group A. 33.3% (95% CI 16.63-53.22%) of patients in group A were deemed 'at risk' of acid aspiration compared to 0.9% (95% CI 0.02-4.90%) in the other groups. No significant differences were found between the patients receiving ranitidine after 60 min with respect to risk of acid aspiration. It is concluded that a single oral dose of ranitidine 150 mg is effective against the acid aspiration syndrome 60 min after administration.

Adult↗
PubMed1996

[Allergic reactions during anesthesia].

Anaphylactic reaction during anesthesia is a constant source of concern for anesthesiologists, given that the rates of death and serious complications are high and predicting which patients will be susceptible is impossible. All substances used in the perioperative period carry a certain risk of releasing histamine and triggering an allergic reaction, though muscle relaxants are the drugs usually implicated. The incidence of serious anaphylaxis ranges between 1:4,000 and 1:23,000 anesthetic procedures, with mortality set at 3-9% and morbidity 10 times higher. Clinical signs vary from mild symptoms to anaphylactic shock and cardiac arrest. The diagnostic procedure to follow upon observing an allergic reaction is to first identify the responsible mechanism and later the responsible agent, as well as drugs that can be used safely. Prophylaxis is based mainly on recognizing predisposed patients before surgery and following recommendations and pharmacological protocols based on better understanding of the pathophysiological mechanisms that cause anaphylactic reaction and on experience in managing them.

Analgesics↗
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↗