Intramucosal pH assessment.
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Calibration↗
Biomedical subjects
G Bugedo
Publications and source records attributed to G Bugedo.
[Morphine infusion for postoperative pain management in patients who have undergone upper abdominal surgery].
We compared the efficacy and side effects of postoperative continuous infusions versus intermittent intravenous on-demand morphine, with or without the addition of clonixin. Eighty five healthy patients, aged 18 to 65 years, scheduled for elective cholecystectomy, were prospectively randomized: Group 1 (n = 22) received morphine 2.5 mg i.v. on-demand; group 2 (n = 22) received a clonixin 400 mg/day i.v. infusion; group 3 (n = 19) a morphine 0.4 mg/kg/day i.v. infusion; and group 4 (n = 22) received a clonixin 400 mg/day plus a morphine 0.4 mg/kg/day i.v. infusion. Groups 2, 3 and 4 also received, on-demand, 2.5 mg i.v. bolus doses of morphine. A blind observer recorder analogue and descriptive pain scores, respiratory rates and side-effects for 72 hours postoperatively. Groups with morphine infusions had less overall pain scores for the first day when compared with intermittent dosing (p < 0.05); these groups also had less pain during the night (p = 0.0016) and required less additional morphine (p < 0.0001). Side-effects were similar and no cases of heavy sedation or respiratory depression were observed. We conclude that a morphine 0.4 mg/kg/day infusion is a safe and effective alternative to on demand dosing in healthy patients after elective cholecystectomy, achieving better analgesia without increasing side-effects. Clonixin 400 mg/day seems to add no significant benefits.
Adolescent↗
[Bacterial translocation in a model of small intestine autotransplant in dogs].
BACKGROUND: Sepsis is the commonest complication of small bowel transplantation. These infections are presumably caused by bacterial translocation, due to splanchnic ischemia. AIM: To study bacterial translocation in the immediate postoperative period after a small bowel transplantation in dogs and to relate it to splanchnic ischemia. METHODS: Three groups of dogs were studied. In group A (n = 6) spontaneous episodes of splanchnic ischemia were monitored in the first 18 h of the postoperative period. In group B (n = 5), a 60 min ischemia was induced by superior mesenteric artery occlusion, two hours after small bowel transplantation. In group C (n = 5) a 60 min ischemia was induced by occlusion of mesenteric vein, two hours after transplantation. Bacterial translocation was assessed through bacterial cultures from the mesenteric vein and splanchnic ischemia with intramucosal pH measurement (a pH < 7.2 was considered indicative of ischemia). RESULTS: Twenty eight of 83 cultures were positive, specially for Gram negative bacilli. The incidence of positive cultures was 14% for group A, 17% for group B and 79% for group C (p < 0.01 compared to groups A and B). The higher incidence of bacterial translocation occurred during the first two hours after transplantation, when the lower intramucosal pH recordings were obtained. The percentage of positive cultures was 39% during periods of ischemia, compared to 24% during periods without ischemia (p = NS). CONCLUSIONS: Bacterial translocation occurs during the first two hours after intestinal transplantation, in concomitance with the lower intramucosal pH readings.
Animals↗
Renal function and cardiopulmonary bypass: effect of perfusion pressure.
Controversy continues as to whether hypotension during cardiopulmonary bypass (CPB) impairs intraoperative and postoperative renal function. Therefore, 21 patients with normal renal function (plasma creatinine less than 1.2 mg/dL, creatinine clearance greater than 70 mL/min), aged 50 to 70 years, without associated pathology, scheduled for elective coronary surgery were studied prospectively. Patients were randomized into two groups: group 1 included 14 patients whose arterial blood pressure during CPB was left untreated, and group 2 consisted of 7 patients who received phenylephrine to maintain their arterial pressure above 70 mmHg. Plasma and urine creatinine, sodium, potassium, and osmolality were measured preoperatively, intraoperatively and postoperatively. Creatinine, osmolal and free water clearances, and excreted sodium fraction were calculated. Plasma creatinine remained normal throughout the study in all patients. Creatinine clearances were similar preoperatively (101.9 +/- 36.7 in group 1 and 120.6 +/- 50.7 mL/min in group 2). In group 1, creatinine clearance decreased during CPB to 88.7 +/- 39.7 mL/min, whereas in group 2 it increased to 157.6 +/- 79.5 mL/min; the difference between groups was significant. Early postoperatively, there was no difference: 136.2 +/- 86.6 mL/min in group 1 and 100 +/- 21.4 mL/min in group 2. One week postoperatively, values were 100.5 +/- 37.9 and 101.9 +/- 18.4, respectively. There was a significant correlation between the creatinine clearance and perfusion pressure intraoperatively, but not postoperatively. Osmolal clearance also correlated with perfusion pressure intraoperatively, but it was significantly lower in the phenylephrine group postoperatively. Postoperative renal function was normal in all patients; no deleterious effect of a low arterial pressure during bypass could be identified.
Aged↗
[Respiratory complications in severe acute pancreatitis].
Respiratory complications are important causes of mortality in severe acute pancreatitis. We analyzed the pleuropulmonary complications that occurred in a series f 63 patients with severe acute pancreatitis. The most frequent were respiratory failure (52.4%) and bronchopulmonary infection (33.3%), both associated with sepsis and a high mortality rate. The initial laboratory workup included serial arterial blood gases and chest roentgenogram within the first 24 hours. The latter was useful to predict mortality. The tracheobronchial cultures isolated only enteral bacteriae. We conclude that pleuropulmonary complications are clearly related to the outcome of severe acute pancreatitis, specially when associated to sepsis.
Acute Disease↗
[Acute non-cardiogenic pulmonary edema secondary to upper airway obstruction. Clinical case].
Noncardiogenic pulmonary edema is a well recognized complication of upper airway obstruction. We report the case of a previously healthy 18-year-old male who presented this complication following laryngospasm after anesthesia. He developed severe pulmonary edema with hypoxemia, high cardiac output and low pulmonary capillary pressures. He was managed with mechanical ventilation and PEEP. Pulmonary edema resolved within 24 hours. The clinical picture, etiology, differential diagnosis and prevention are also discussed.
Acute Disease↗
How much epinephrine in a wash.
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Anesthesia, Spinal↗
[Aseptic meningitis following spinal anesthesia. Report of a case].
Aseptic meningitis after lumbar puncture and spinal anesthesia is a rare but serious complication, whose acute onset and clinical symptoms mimic septic meningitis. A 33 year old woman presented this complication 5 h after an uneventful cesarean section under subarachnoid blockade. Though lumbar puncture revealed pleocytosis with negative Gram stains and cultures, she was treated with antibiotics and made a full recovery. The clinical picture, differential diagnosis and value of early lumbar puncture are discussed. The successful use of midazolam to treat psychomotor agitation in this patient is also reported.
Adult↗
[Headache following spinal puncture: treatment with epidural blood patch in a 7-year-old patient].
Lumbar puncture is frequently used for diagnostic and therapeutic purposes in children. Theoretically, this group of patients should have high rates of post lumbar puncture headache. However, the scant available literature points to a surprisingly low incidence and an apparently mild course. We present a 7 year-old patient with a severe post lumbar puncture headache successfully treated with an epidural blood patch. To our knowledge, this has not been reported in children younger than 10 years. We believe this procedure should be considered in pediatric patients with post lumbar puncture headache.
Blood Patch, Epidural↗
[A single left superior vena cava. Pacemaker implantation].
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Adult↗
Influence of polymeric enteral nutrition supplemented with different doses of glutamine on gut permeability in critically ill patients.
OBJECTIVES: To evaluate the effect of glutamine-supplemented polymeric enteral formulas on the recovery of gut-permeability abnormalities in critically ill patients. METHODS: Twenty-three patients were randomized to receive a conventional casein-based enteral formula (ADN), ADN plus glutamine in a dose of 0.15 g x kg(-1) x d(-1) or ADN plus 0.30 g x kg(-1) x d(-1) of glutamine for 8 d. The lactulose mannitol permeability test (L/M) was performed at baseline and at the end of the study. Nineteen healthy volunteers served as controls for the L/M test. RESULTS: An increase in permeability compared with control subjects was observed in patients at baseline (mean +/- standard error of the mean; L/M ratio: 0.11 +/- 0.03 and 0.025 +/- 0.004, respectively; P < 0.02). The L/M ratio improved after the period of enteral nutrition as a whole (initial L/M: 0.11 +/- 0.03, final L/M: 0.061 +/- 0.01; P < 0.03), but no difference was found between groups. CONCLUSIONS: Even though polymeric enteral nutrition was associated with a significant improvement in the L/M ratio, glutamine supplementation did not show a specific influence in improving recovery of gut permeability in critically ill patients.
Adult↗