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F López-Timoneda

Publications and source records attributed to F López-Timoneda.

6 recordsLinked to original sources
PubMed1998

[Indices of prediction of neurologic focality during carotid endarterectomy carried out under regional anesthesia].

OBJECTIVES: To examine the relations between the development of neurologic events and the following variables: degree of stenosis of the contralateral carotid artery, prior neurologic symptoms and stump pressure of the ipsilateral internal carotid artery in patients undergoing carotid endarterectomy under regional anesthesia. PATIENTS AND METHODS: We undertook a prospective study of 92 patients undergoing carotid endarterectomy with a blockade of the superficial and deep cervical plexus. Neurological integrity was assessed and internal carotid artery stump pressure was monitored. Contralateral carotid artery stenosis and neurologic disease present before surgery were studied. RESULTS: Neurologic events developed when the carotid artery was clamped in 9.7% of patients. Mean stump pressure was significantly lower in symptomatic patients (43 +/- 11 mmHg) than in asymptomatic patients (74.6 +/- 24 mmHg) (p < 0.001). Neurologic symptoms developed during clamping of the carotid in 27.2% of the patients with stump pressure less than or equal to 50 mmHg, but in only 4.2% of those with stump pressure surpassing 50 mmHg. Stump pressure was significantly lower in patients with contralateral carotid stenosis. The incidence of neurologic events during clamping was unrelated to contralateral carotid condition, however. Likewise, neurologic symptoms before surgery was also unrelated. In six of the nine patients with neurologic events, internal carotid stump pressure was less than or equal to 50 mmHg, indicating that the sensitivity of this parameter to the development of neurologic events in our series was 66%. CONCLUSIONS: Although internal carotid artery stump pressure identifies a subset of patients likely to have a higher incidence of neurologic events during carotid artery clamping, it can not be considered the only criterion for placement of an intraluminal shunt to prevent such events. The state of the contralateral carotid artery and preexisting neurologic symptoms are not objective screening criteria for identifying patients at high risk of neurologic events during carotid clamping.

Aged↗
PubMed1995

[Surgery for the repair of renal arteriovenous fistula and its hemodynamic impact].

The case of a 42-year-old woman with an arteriovenous fistula on the left kidney is described. Twenty-six years before presentation, a percutaneous renal biopsy had been obtained. The patient presented with arterial hypertension, angina and dyspnea. We studied the hemodynamic parameters before and after surgical repair of the fistula. Pulmonary artery pressure was very high but fell to normal after surgery, indicating that the fistula was responsible for hemodynamic complications that increased the level of surgical risk.

Adult↗
PubMed1995

[Carotid endarterectomy using cervical plexus block].

To evaluate the efficacy and level of patient satisfaction, as well as the incidence of neurological manifestations, hemodynamic changes and other perioperative complications of cervical plexus block. This was a prospective study of 52 patients undergoing carotid endarterectomy under superficial and deep cervical plexus block. The anesthetic technique was effective in all cases. Supplementation with local anesthetic was needed for 25% of the patients and none required general anesthesia. The technique was considered good by 92% of the patients, who stated that would accept the same technique in case of having to undergo surgery on the contralateral carotid artery. Hypertension was the hemodynamic change observed most often (in 30%) during surgery. No serious complications related to the anesthetic technique were observed, though transient dysphonia was the most frequently seen effect (in 36.5%). Eight (15.4%) patients showed neurological signs when the carotid was clamped, with symptoms resolving with placement of a shunt. Two deaths due to myocardial infarction occurred after surgery and 1 patient suffered a permanent cerebrovascular accident. Regional anesthesia with deep and superficial cervical plexus block during carotid endarterectomy allows for continuous evaluation of the patient's neurological status and facilitates the selective use of intraluminal shunt for the prevention of stroke accident during surgery. The technique is well-tolerated by patients, does not make surgery more difficult, does not give rise to serious complications and the incidence of local complications is low.

Aged↗