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L Olmedo

Publications and source records attributed to L Olmedo.

8 recordsLinked to original sources
PubMed1995

[Comparative study of single-dose intradural anesthesia and continuous intradural anesthesia with or without fentanyl].

OBJECTIVE: To compare the hemodynamic effects, level of anesthetic blockade and advantages of single-dose versus continuous intrathecal anesthesia with hyperbaric bupivacaine with and without fentanyl. PATIENTS AND METHOD: Prospective study in 45 patients under 65 who were scheduled for elective surgery of the lower abdomen, randomly divided into 3 groups. Group 1 and 2 received continuous intrathecal anesthesia with 10 mg hyperbaric bupivacaine; group 2 also received 25 mcg fentanyl. Patients in group 3 were given a single intrathecal dose of 15 mg hyperbaric bupivacaine. Mean arterial pressure and heart rate were recorded at baseline and 10, 20 and 30 minutes after the start of anesthesia. The level of block achieved was recorded after 10, 30 and 60 minutes. Hemodynamic changes, differences in blockade and side effects were analyzed. RESULTS: Hemodynamic changes were greater in group 2 (fentanyl) than in groups 1 and 3 (p < 0.05), with group 3 showing the greatest degree of hemodynamic stability. Level of blockade was always higher in group 2, with significant differences at 30 min (p < 0.05). Seven and 5 reinjections by catheter were necessary in groups 1 and 2, respectively. Two patients in group 3 required general anesthesia when blockade was inadequate. Apart from pruritus in group 2 (40%), no side effects due to anesthesia were observed. CONCLUSIONS: A single dose intrathecal anesthesia, produces less hemodynamic changes than a continuous intrathecal block. Nevertheless, continuous intrathecal block, allows the maintenance of the block as long as required. The association of fentanyl enhances the hemodynamic changes with no other beneficial effects.

Adult↗
PubMedDate not supplied

[Headache following dural puncture in pregnant patients at term. Comparative study with non-obstetric patients].

OBJECTIVES: To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients. PATIENTS AND METHODS: A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced. RESULTS: Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups. CONCLUSIONS: The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.

Adolescent↗
PubMedDate not supplied

[Explicit and implicit memory during inhalation and intravenous anesthesia].

OBJECTIVE: Patients rarely report memory or knowledge of surgery after general anesthesia. During apparently adequate surgical anesthesia, however, information processing of high level functions, such as language comprehension and learning, can continue unconsciously. Our objective is to assess whether different anesthetic techniques (two inhalational and two intravenous) guarantee the absence of both types of memory. PATIENTS AND METHOD: One hundred patients were randomly assigned to receive the following anesthetic procedures: desflurane/N2O (group 1), isoflurane/N2O (group 2), fentanyl/N2O (group 3) and total intravenous anesthesia (group 4). A cassette with the same music was played in all cases, and an order requiring a nonverbal response was given to 15 randomly chosen patients in each group. Response was evaluated at a visit 24 to 48 hours after surgery. Fifteen patients, therefore, constituted the study group for each anesthetic procedure, and 10 patients formed the control group. We assessed the presence of explicit memory in a structured interview, and implicit memory by way of the relation between the number of times the nonverbal order was obeyed and the time of the interview. RESULTS: Explicit memory was absent in all patients. The presence of implicit memory was confirmed, however, in the isoflurane (p = 0.02) group. Significant differences between the isoflurane group and both the desflurane and total intravenous anesthesia groups (p = 0.03) were found. CONCLUSION: Explicit memory was absent with all four anesthetic techniques used in our study. Implicit memory was more difficult to inhibit, however, with isoflurane/N2O.

Adolescent↗