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Biomedical subjects

J Alvarez Escudero

Publications and source records attributed to J Alvarez Escudero.

At least 19 recordsLinked to original sources
PubMed2006

[Techniques to block the sciatic nerve by a lateral approach through the popliteal fossa].

Lateral approaches to the sciatic nerve through the popliteal fossa have recently been described as useful for providing adequate anesthesia and postoperative analgesia for foot and ankle surgery. Numerous publications have appeared on the approach in recent years, proposing new anatomical landmarks to facilitate location of the nerve, reduce the rate of complications, and increase the rate of success. When the lateral popliteal approach has been compared to other approaches to the sciatic nerve, similar success rates have been observed. However, when this technique is used certain factors must be borne in mind because they can influence both latency time and success. This review describes the lateral popliteal approach, its main variations, the factors that can affect latency time or success, and the possibility of providing continuous analgesia. We also sought to compare this approach to other techniques for blocking the sciatic nerve.

Humans↗
PubMed2003

[Peripheral nerve block for surgical anesthesia and postoperative analgesia of the legs].

Even though peripheral nerve blocks (PNB) on the lower limb offer advantages over neuroaxial blockades and general anesthesia, their use has not been fully established. The infrequency with which PNBs are used may be due to inadequate learning, the need to make several injections, the time until onset of block, or anesthesiologists' and surgeons' lack of familiarity with the benefits of regional blocks. Interest seems to have increased in recent years, as numerous publications have focused on lower limb PNBs for surgery and postoperative analgesia. Our aim was to review the main approaches used and the indications for each.

Analgesia↗
PubMedDate not supplied

[Sciatic nerve block by the lateral route at the level of the popliteal fossa with 0.75% ropivacine: advantages of a more proximal approach].

OBJECTIVES: To assess the efficacy of a sciatic nerve block using a lateral approach 11 cm cephalad to the lateral femoral epicondyle for providing surgical anesthesia and postoperative analgesia in scheduled foot surgery (hallux valgus) after a single injection of 30 mL of 0.75% ropivacaine. METHODS: A block was performed in 30 patients using a point of puncture 11 cm cephalad to the most prominent point of the lateral femoral epicondyle in the groove between the biceps femoris and vastus lateralis muscles. Once the nerve had been located with a stimulator (2 Hz, 0.5 mA), 30 mL of 0.75% ropivacaine was injected. Data recorded were time until block, number of attempts, depth at which the nerve was found, sciatic nerve response obtained, and time until the sensory block was complete. We evaluated quality of anesthesia during surgery, duration of postoperative analgesia, and patient discomfort during performance of the block. RESULTS: Time required to perform the block was 4.3 +/- 1.2 minutes and only one puncture attempt was needed in 27 patients. The nerve was located at 5.5 +/- 0.4 cm, with response located in the common peroneal nerve in 18 patients and in the posterior tibial nerve in 12. The time needed to achieve a full sensory block was 19.3 +/- 5.1 minutes. Twenty-six patients (86%) were very satisfied with the anesthetic quality of the block, 2 were moderately satisfied, and 2 were dissatisfied. Postoperative analgesia lasted 19 +/- 3.4 hours. Four patients reported minimal discomfort during performance of the block. No complications were observed. CONCLUSIONS: The sciatic nerve block from a lateral approach 11 cm cephalad to the lateral femoral epidondyle is an appropriate anesthetic technique for foot surgery. It is safe, effective and easy to perform. Infusion of 30 mL of 0.75% ropivacaine provided adequate anesthesia and long-lasting postoperative analgesia for our patients.

Adult↗
PubMedDate not supplied

[Post-infarction left ventricular free wall rupture].

We report four cases of subacute left ventricular free wall rupture after myocardial infarction successfully treated with emergency surgery. Some aspects dealing with clinical presentation, diagnosis and treatment are discussed.

Aged↗
PubMedDate not supplied

[Intracardiac knotting of a Swan-Ganz catheter. Detection using intraoperative trans-esophageal echocardiography].

Transoesophageal echocardiography is a new technique that allows continuous and noninvasive assessment of cardiac function during surgery. More recently this technique is being used to detect the presence of external objects into the cardiac cavities. We report a case of Swan-Ganz catheter knotting confirmed by this echocardiography technique. He was a 57 year old male with previous history of arterial hypertension and ischemic heart disease who was scheduled for surgery because poor response to medical therapy. After anesthetic induction a thermodilution catheter was introduced percutaneously into the right internal jugular vein under continuous pressure monitoring from the distal catheter hole. In view of the difficulties in introducing the catheter into the pulmonary artery an intravascular catheter knotting was suspected and a bidimensional transesophageal echocardiogram confirmed the diagnosis. During extracorporeal circulation the catheter was withdrawn through a right auriculotomy. Monitoring with a Swan-Ganz catheter, as other invasive monitoring techniques, is followed by a certain degree of complications which should be avoided by a careful manipulation. Echocardiography is a valuable diagnostic procedure to identify the position of monitoring catheters into the cardiac cavities.

Catheterization, Swan-Ganz↗
PubMedDate not supplied

[Reliability of cardiac output by thermodilution. Effect of marker temperature].

Classically, the cardiac output is measured by the thermodilution method, employing a standard volume of 5% D/W at 4 degrees C. Recently, however, a room-temperature (17-24 degrees C) measurements have been used, in such a way that a lower gradient between the injectate and the patient temperature is established. This lact could question the sensitivity and reliability of the technique evaluated. We have studied 20 patients undergoing different operations, in whom the cardiac output was measured by injecting a standard volume of 5 ml 5% D/W at room-temperature or at 5 degrees C, randomly assigned, in order to evaluate any difference between the two techniques. Over a total of 100 cardiac output determinations taken in normothermic conditions (19-24 degrees C) the mean was 4.24 +/- 1.13 l/min (means +/- SD). In hypothermic conditions the cardiac output was 4.28 +/- 1.14 l/min (means +/- SD). Results showed no statistical difference between both methods.

Aged↗
PubMedDate not supplied

[Tracheal injury during transhiatal esophagectomy without thoracotomy. Anesthesiologic management].

A patient with carcinoma of the lower third of esophagus suffered an extensive tracheal tear during transhiatal esophagectomy without thoracotomy, with severe impairment of ventilatory and hemodynamic status. A right thoracotomy was required for the repair of the tracheal lesion, which extended to the origin of left bronchus. During the maneuvers for bronchial intubation, the hypoxia worsened and cardiac arrest caused by ventricular fibrillation appeared. The arrhythmia was reverted. Operative mortality of transhiatal esophagectomy without thoracotomy is 8%. Pneumothorax is the most common operative complication. Tracheal laceration is reported in 1% of cases; usually it is not severe and is easily treated, although it can have significant severity and result in death as in the present case. After the operation, the patient persisted hemodynamically unstable, developing a new gasometric deterioration and bilateral pleural effusion, with impairment of coagulation. The patient died 39 hours after operation. The anesthetic management of peroperative tracheal tear is reviewed.

Anesthesia↗