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Biomedical subjects

F Escolano

Publications and source records attributed to F Escolano.

35 records · Page 2Linked to original sources
PubMed1996

[Succinylcholine induces hyperpotassemia in patients in critically ill patients].

OBJECTIVE: To study changes in kalemia caused by succinylcholine administration to patients in critical care, and the possible association of succinylcholine with clinical and analytical data, severity-of-disease classification, duration of stay in the intensive care unit (ICU) and immobility. PATIENTS AND METHODS: Twenty-three patients admitted to the ICU, none of whom suffered burns, polytrauma or neuromuscular disease, and who had received 1.5 mg/kg succinylcholine on 28 occasions, usually to facilitate tracheal intubation. Kalemia was analyzed before neuromuscular relaxation and 5 and 30 min afterwards. Electrocardiographic II and V5 derivations and invasive arterial pressure were monitored in all patients. The increase in kalemia at 5 min correlated with age, sex, weight, APACHE II score, days in ICU, current and accumulated immobility, and analytical parameters such as glycemia, creatinine, GOT, bilirubinemia, pH and creatine kinase. The kalemia of these patients was compared with that of 15 patients in acceptable general state who had undergone scheduled surgery. RESULTS: Kalemia increased significantly from a mean baseline level of 4.2 (0.9) mEq/l to 5.5 (1.4) at 5 min and 4.6 (0.9) at 30 min in ICU patients. In the non ICU patients there were no statistically significant changes. Kalemia at 5 min was correlated with baseline (r = 0.84; p < 0.0001), days in the ICU (r = 0.39; p < 0.05) and weight (r = 0.46; p < 0.05). The mean increase in kalemia at 5 min was 0.5 mEq/l in patients who stayed less than 10 days, 1.8 mEq/l in those whose stay was from 10 to 30 days and 1.4 mEq/l in patients who stayed longer than 30 days. The percent increase in kalemia correlated directly (r = 0.7; p < 0.001) with days in the ICU and with accumulated immobility in patients whose ICU stay was less than 30 days. For ICU stays longer than 30 days the correlation was negative (r = -0.98; p = 0.03). Electrocardiographic changes were recorded in 2 patients with brief sinus bradycardia having no hemodynamic repercussions. CONCLUSIONS: The use of succinylcholine in critically ill patients causes a brief but significant increase in kalemia, with slight and rare electrocardiographic changes. The effect varies according to the length of time spent in the ICU and the degree of immobility, with maximum increases seen when the ICU stay is between 10 and 30 days. Patient immobility may play an important pathophysiological role. The indications for use of succinylcholine in critically ill patients should be very strict, particularly during the period of greatest sensitivity.

Adult↗
PubMed1995

[Prolonged sedation with midazolam in critically ill patients undergoing artificial ventilation].

OBJECTIVES: To analyze the dose of midazolam needed for induction and maintenance of sedation, as well as its hemodynamic repercussions in critically ill patients requiring mechanical ventilation. PATIENTS AND METHODS: We studied 20 adult patients requiring mechanical ventilation for respiratory failure in the intensive care unit. An induction dose of 1 mg/min midazolam was given until the patient became drowsy (eyes closed but opened again) and this level of sedation was maintained by continuous intravenous perfusion. We calculated induction dose, maintenance dose and their correlation with age, weight, general state (APACHE-II index), liver function, hematocrit and blood chemistry. RESULTS: The induction dose was 4.76 +/- 3.4 mg and correlated with weight and plasma albumin levels. The maintenance dose of 6.4 +/- 3.97 mg/h did not correlate with any of the parameters studied. A statistically significant reduction in arterial pressure was observed. CONCLUSIONS: The sedation dose of midazolam in critically ill patients is related to weight and plasma albumin levels. Recovery time is related to mean maintenance dose.

APACHE↗
PubMed1995

[Prevalence of viral hepatitis in candidates for orthopedic surgery].

OBJECTIVES: To study the prevalence of positive serology results for hepatitis B and C viruses among patients scheduled for elective orthopedic surgery, to establish risk groups and to assess the economic cost involved in testing patients in such groups. PATIENTS AND METHODS: We performed a retrospective study of 1090 preoperative charts for patients awaiting elective orthopedic surgery between November 1993 and January 1995. Variables recorded were age, sex, physical status, history of alcoholism or addiction to injected drugs, associated disease (liver disease, chronic kidney failure and hemodialysis, and coagulation disorders), history of blood products transfusion, preoperative liver enzymes and blood levels of AcVHC and AgVHB as determined by enzyme immunoassay. RESULTS: Mean age was 51.8 (SD 17.5). Women predominated, accounting for 60.6% of the sample. ASA I and ASA II patients accounted for 84.9%, 72 (6.61%) had had previous transfusions, 51 (4.6%) suffered liver disease, 4 (0.36%) had coagulation disorder, 5 (0.45%) were receiving hemodialysis for chronic kidney failure, and 5 (0.45%) admitted having injected drugs. We discovered alterations in preoperative liver enzyme levels in 116 (10.6%) cases. Sixty-five (5.96%) were positive for AcVHC and 13 (1.19%) were positive for AgVHB. Factors that predicted positive results for hepatitis C and B were liver disease, previous administration of blood products, chronic kidney failure requiring hemodialysis, drug addiction and high preoperative liver enzyme levels. Serologic testing for viruses performed on patients in this risk group would have detected 76.6% of the positive cases, resulting in savings of 90% of the cost of indiscriminate testing. CONCLUSIONS: We believe that patients with histories of liver disease, blood product transfusion, chronic kidney failure with hemodialysis or drug addiction, or with high liver enzyme levels should be tested for hepatitis B and C before surgery.

Adult↗
PubMed1992

Effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in patients undergoing elective surgery.

We have compared the effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in a double-blind study in 110 patients undergoing elective surgery. Three hours before operation, the patients received, orally, omeprazole 40 mg, ranitidine 150 mg, famotidine 40 mg or placebo. Gastric volume and pH were measured immediately after induction of anaesthesia. Omeprazole, ranitidine and famotidine produced a significant increase in gastric pH and a significant decrease in gastric volume compared with placebo. When the effects of omeprazole on gastric volume were compared with those of ranitidine and famotidine, no significant difference was found, but omeprazole was significantly less effective in increasing gastric pH. The number of patients having a pH less than 2.5 and a volume greater than 0.4 ml kg-1 were: none in the ranitidine group, one (3%) in the famotidine group, four (15%) in the omeprazole group and six (23%) in the placebo group. We conclude that omeprazole 40 mg given 2-4 h before surgery does not afford adequate prophylaxis for the acid aspiration syndrome.

Adolescent↗
PubMed1989

Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery.

A randomised double-blind comparison of oral famotidine and ranitidine given 2 hours before induction, on gastric secretion (volume and pH) was carried out on 93 patients undergoing elective surgery. Gastric contents were aspirated immediately after tracheal intubation. Famotidine significantly reduced the gastric volume, compared with the other groups, including ranitidine. Both famotidine and ranitidine significantly elevated gastric pH towards neutral, compared with the other groups. There was no significant difference between ranitidine and famotidine in respect of the pH. The patients premedicated with famotidine and ranitidine were well protected against Mendelson's syndrome, whereas 38% of patients from the other groups remained at risk.

Adolescent↗
PubMedDate not supplied

[Prospective epidemiologic study of perioperative anaphylactoid reactions occurring in Catalonia (1996-7)].

OBJECTIVES: To determine the incidence, immunological mechanisms, severity and clinical course of perioperative allergic reactions. PATIENTS AND METHODS: Prospective epidemiological study lasting 2 years (1996-97). In 20 hospitals in Catalonia (Spain), we studied patients who suffered allergic reactions equal to or greater than grade Ib according to the classification of Laxenaire. Serum and urine samples were collected during the first and sixth hours after the onset of a reaction. Complement factors, total serum and latex-specific serum IgE antibodies, hemostatic markers, serum tryptase and urinary methylhistamine were assayed. Tests for allergy to the drugs used during the perioperative period were performed on all patients who consented. RESULTS: Anesthetic procedures were performed 328,430 times in the 20 hospitals. Thirty-two allergic reactions were reported (1 case/10,263 anesthesias); the frequency was greater during general anesthesia (1 case/6,978 anesthesias). Women suffered 58.3% of the reactions, and the mean patient age was 47.8 +/- 16.5 years. Fifty-six percent of the reactions were severe (grades III-IV), and 68.7% occurred upon immediate exposure. Induction was the moment of greatest risk (50%). Treatment was required by 90.6% of the patients, but no deaths or serious sequelae occurred. Complete analyses could be carried out immediately for 25 patients. High urinary methylhistamine and/or serum tryptase levels were found for 57% of the patients with grade Ib reactions, for 80% of those with grade II reactions, and for 91.7% of those with grade III reactions (p = 0.05). High serum tryptase levels were the only findings for 53.8% of the grade III reactions (p = 0.007). Skin tests were positive for 62.5% of the patients. CONCLUSIONS: The frequency of allergic reactions in Catalonia is 1 case per 10,263 anesthesias performed, but the rate is higher in general anesthesia. Fifty-six percent of the reactions were severe. Most developed immediately and the moment of induction involved the greatest risk. Early assessment of methylhistamine and tryptase levels has been shown to be useful and positivity is linearly associated with severity of reaction. In 62.5% of the patients, positive results were seen in skin tests performed later.

Adolescent↗
PubMedDate not supplied

[Respiratory distress in adults and disseminated intravascular coagulation after administration of iodinated contrast].

We report a patient with urinary sepsis who, during intravenous urography with iodinated contrast (70 mg Na, Ca diatrizoate and meglumine) developed dyspnea, tachypnea, sinus tachycardia and moderate hypoxemia (pO2: 72 with FiO2 of 0.21). She subsequently developed adult respiratory distress syndrome (ARDS) with refractory hypoxemia (pO2: 40 mmHg with FiO2 of 0.5) and disseminated intravascular coagulation (DIC) (prothrombin index: 5%, platelets: 20,000/mm3, APTT: 102/37 min, FDP: 80 ng/ml, and fibrinogen: 120 mg %). The patient required mechanical ventilation and treatment with inotropic drugs, antibiotics, corticosteroids, plasma, platelets and erythrocytes. The outcome was favorable, and she could be discharged from the Reanimation Service 7 days after admission. In severe systemic reactions to iodinated contrasts (SRIC), ARDS and DIC are common. In our patient, the close temporal association between the administration of iodinated contrast and the development of the clinical picture made us suspect their possible causal relation. A higher predisposition to SRIC in patients with sepsis has been reported. We review the SRIC in which the anesthesiologist may play a role for reanimation.

Contrast Media↗
PubMedDate not supplied

[Allergic reactions to local anesthetics].

We studied 35 patients which had been sent by various specialists to the Allergy department of a general hospital because they had an adverse reaction to some type of local anesthetic. The subjects underwent three types of tests: a prick test, an intradermoreaction test and a provocation test using three local anesthetics: procaine 2%, lidocaine 2%, mepivacaine 1% with no vasoconstrictors or parabens in order to rule out the possibility that the reaction was due to these substances rather than the local anaesthetic being tested. The results indicated that both the prick test and the provocation test of the local anesthetics included in the study were negative for all of the patients. One patient who had an adverse reaction to Hostacain was tested with that same anesthetic. The patient tested positive in the intradermoreaction test with a 1/10 solution but was not able to be tested with a solution free of parabens due to lack of availability. The results of our study coincide with the bibliographic research done in that real allergic reactions to local anesthetics are infrequent. The methodology used effectively distinguishes those patients with a risk of real allergic reactions there by indicating to the physician the safest local anesthetic for the patient.

Adolescent↗
PubMedDate not supplied

[Usefulness of preoperative chest radiography in elective surgery].

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

[Cardio-circulatory response to laryngoscopy. Comparative study between Macintosh and McCoy laryngoscopes].

To assess the cardiocirculatory repercussions of laryngoscopy performed with the Macintosh or McCoy laryngoscopes, we studied 20 patients randomly divided into 2 groups of 10 to undergo laryngoscopy with one or the other of the aforementioned instruments. All patients were in good health overall (ASA I or II) and presented no criteria for difficult intubation (Mallampati I or II, distance between the thyroid and the menton greater than 7 cm and maximum distance between the incisors greater than 3.5 cm). The McCoy laryngoscope was associated with significantly lower systolic arterial pressure and heart rate.

Adolescent↗