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J Carceller

Publications and source records attributed to J Carceller.

11 recordsLinked to original sources
PubMed1995

Cold saline is more effective than room temperature saline in inducing paresthesia during axillary block.

Confirmation of the perivascular position of the needle by the injection of cold saline may be helpful to the perivascular technique, since the elicitation of a paresthesia indicates the correct positioning of the needle. In this prospective, randomized study of 48 patients, we found a 100% incidence of successful block with saline at 8-11 degrees C compared to 75% in a control group with saline at room temperature. The paresthesia induced by cold saline appears to be due to thermic stimulation and not to mechanical nerve compression by the saline entering the axillary space. A more frequent rate of correct positioning of the needle was found in the group with cold saline.

Axilla↗
PubMedDate not supplied

[Design of an expert system for decision-making in an emergency situation].

OBJECTIVES: To study the clinical applicability of the expert system URGSANT as a help in making up decisions in emergencies. MATERIAL AND METHODS: URGSANT is an expert system implemented in INSIGT 2+ which is structured in a modular and hierarchical form. It contemplates 44 urgent situations relating to the central nervous system, hematopoietic, cardiovascular, respiratory, gastrointestinal, genitourinary, endocrinological, and miscellaneous group. Validation of the program was made by four anesthesiologists who evaluated the performance of the program in 25 emergency cases and in 25 other situations that were treated by other specialists. RESULTS: The rationale of the system was basically correct. In most cases the program was considered efficient or very efficient during the different clinical situations and only in one case its guidance was wrong. CONCLUSIONS: The URGSANT expert system is an efficient and useful method for the clinician during emergency situations.

Anesthesiology↗
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

[Doctoral theses and memoirs about anesthesia. Documents for a history of Spanish anesthesia].

Based on the importance of document files and first-hand bibliographic sources for studying the history, we have recently investigated the chapter of Doctoral Thesis and Reports on anesthetic topics since we believe that these are fundamental to gain insight into the knowledge of our history. This investigation was planned to find such documents by reviewing the data of several Spanish archives and libraries. We collected 80 works: 14 Reports and 66 Doctoral Theses performed during a period of 95 years (heuristic limits 1847-1942). These papers were classified in several subgroups according to the subjects they deal with: 21 works on inhalation anesthesia, 7 on intravenous general anesthesia, 20 on spinal anesthesia, 10 on locoregional, 7 on anesthesia and metabolism, 12 on obstetric anesthesia, and 3 works on varied anesthesia issues. Analysis of these documents revealed that the authors (physicians and Spanish medical corporations) undertook an accurate consideration of the more relevant scientific subjects at the time of their investigation. We conclude that the works analyzed in the present study represented the beginning of the Spanish investigation on anesthesia. Further investigations may contribute to enrich our historiography.

Academic Dissertations as Topic↗
PubMedDate not supplied

[History of the introduction of ether anesthesia in Spain. A new contribution to its study].

Ether anesthesia was introduced in Spain on January 13, 1847. Dr. Diego de Argumosa y Obregón, from Madrid, was the first Spanish surgeon who operated with the help of sulphuric ether. Almost at the same time, by the end of January, the dentist Oliverio Machechan administered ether to 2 patients in whom he performed dental operations. Subsequently, ether was used in several parts of Spain: Barcelona, Pamplona, Motril, and by several Madrid surgeons through February and March. In Santiago de Compostela ether was also introduced very soon, and, on the basis of the data from the studies of Dr. José González Olivares (the surgeons who first tried it in that town), most authors dealing with this issue state that it was probably in Santiago de Compostela where these experiments were carried out simultaneously with those by Argumosa in Madrid or even before. We have in some occasions defended that thesis; however, we were not satisfied with it and we decided to reinvestigate the facts. We had access to other sources and we concluded that anesthetics were really used a very early phase in Santiago de Compostela, but in the case of ether it was later than Argumosa and Oliverio Machechan used it in Madrid and Mendoza in Barcelona. In the present article we analyze these facts in detail, with emphasis on those that we consider historically relevant and that had not been previously dealt with by any other author addressing these issues.

Anesthesia, Dental↗
PubMedDate not supplied

[Severe accidental hypothermia: rewarming by total cardiopulmonary bypass].

We present a case of a 20-year-old male with a history of habitual drug use who suffered extreme hypothermia (26 degrees C) after several hours' accidental exposure to low ambient temperature. The patient presented in deep coma with recurring ventricular fibrillation that yielded to electrical defibrillation once a central temperature of 27.4 degrees C was reached through internal rewarming with intravenous liquids and gastric lavage with warm water. Because this method was slow, we decided to continue rewarming with extracorporeal circulation through cannulation of the femoral vein and artery. The patient recovered consciousness after three hours, with no neurological secuelae. Emergency room staff have available the means for recognizing hypothermia and a protocol for its management. Extracorporeal circulation is an effective method for internal rewarming and must be used when the patient requires cardiopulmonary resuscitation or presents signs of severe hemodynamic instability.

Adult↗
PubMedDate not supplied

[Arm adduction does not increase block extension in anesthesia of the brachial plexus by the axillary approach].

INTRODUCTION: Arm abduction of 90 degrees during injection of local anesthetic followed by adduction of the arm has been recommended traditionally to favor proximal distribution of local anesthetic and extension of the blockade in the brachial plexus by the axillary route. A recent study demonstrated that there are no clinical or radiological differences between axillary blockades performed with abduction or adduction. OBJECTIVE: To compare the extension of sensory blockade in axillary anesthesia performed with adduction or abduction. MATERIAL AND METHODS: Forty patients were randomly distributed in two groups, 20 in the adduction group and 20 in the abduction group. The axillary catheter was inserted 3 cm in the proximal direction and a mixture of 40 ml of 1.5% mepivacaine without adrenaline and 4 ml of 8.4% bicarbonate soda was injected into each patient. RESULTS: No statistically significant differences in extension of sensory blockade, including circumflex, musculocutaneous and radial nerve blockade, were observed. CONCLUSIONS: Axillary rotation of the arm is not a determining factor in sensory blockade in brachial plexus anesthesia by the axillary route.

Anesthetics, Local↗