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M S Asuero

Publications and source records attributed to M S Asuero.

6 recordsLinked to original sources
PubMed1975

Positive end-expiratory pressure. Effect on arterial oxygenation during respiratory failure in chronic obstructive airway disease.

Changes induced in arterial oxygenation by positive end-expiratory pressure (PEEP) were analysed in twenty-nine instances in seven patients with chronic obstructive airway disease and acute respiratory failure, who were receiving IPPV. A significant decrease in mean PaO2 was found 4 hours after the removal of PEEP (P smaller than 0-01), but after its addition during the same period the PaO2 change was not significant. PaCO2 values were not modified by PEEP. The slight increase in mean PaO2 (20-9 mmHg) encountered during controlled ventilation with PEEP seems of doubtful clinical value. Alveolar-arterial oxygen gradient, while breathing oxygen 100%, was found to be elevated with a mean value of 276 mmHg. It appears from our results that PEEP is of little or no value in the routine ventilatory treatment of patients with chronic obstructive airway disease unless hypoxaemia is believed to be caused by a large intrapulmonary shunt.

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[Plasma histamine levels after the administration of atracurium or pancuronium in patients undergoing general anesthesia].

OBJECTIVES: To compare the release of histamine induced by atracurium and pancuronium. MATERIAL AND METHODS: We studied 20 patients ASA III undergoing vascular surgery under etomidate anesthesia. Patients were randomly treated with either 0.5 mg/kg of atracurium or 0.1 mg/kg of pancuronium as muscle relaxant agents. Plasma histamine concentration, heart rate, arterial blood pressure, PaO2, and PaCO2 were measured at the basal state and 1.2 and 5 min after administration of the muscle relaxant drug. RESULTS: Plasma histamine concentration at baseline were 0.691 +/- 0.6 ng/ml in the atracurium group and 0.756 +/- 0.612 ng/ml in the pancuronium group. These levels raised up to 2.748 +/- 6.278 ng/ml (atracurium) and 2.553 +/- 5.454 ng/ml (pancuronium). These differences were not statistically significant. The course of the remaining parameters studied in these patients was also comparable between the two groups. There were no clinical manifestations associated with the release of histamine. CONCLUSIONS: Plasma levels of histamine after administration of atracurium were not significantly different from those induced by pancuronium.

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[Blood saving].

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Blood Transfusion, Autologous↗
PubMedDate not supplied

[Intraoperative blood replacement in aortic surgery. Autotransfusion technics].

INTRODUCTION: The performance of increasingly invasive surgical techniques involves higher consumption of blood products, along with associated immunological problems and infections. Measures intended to reduce the use of homologous blood products include autologous transfusion and the application of transfusion criteria. We describe our experience with a group of patients scheduled for aortic surgery. PATIENT AND METHODS: Three hundred fifty- eight patients were studied prospectively over a period of 60 months, during which various techniques for conserving blood were applied. Up to 2 units were donated before surgery by patients who had baseline hemoglobin (Hb) counts equal to or greater than 13 g/dl. The donated blood was stored in the form of packed red cells (PRC) and fresh frozen plasma (FFP). Plasmapheresis was performed before surgery whenever a loss of 1,200 ml was expected to occur. Intraoperative salvage of lost blood, with the "Cell- Saver" system, was also used in such cases. No patient was given PRC if Hb was equal to or greater than 10 g/dl; nor was plasma given unless analytical levels indicated need. RESULT: Between 25 and 33% of the patients, depending on age, required no blood products. In up to 55%, self- donated blood was used. Salvage during surgery conserved around 50% of estimated blood lost. The percentage of autologous blood replaced during surgery increase from 21% in 1989 to 38% in 1993. The amount of autologous plasma used also increased with time, reaching nearly 80% of total plasma infused thanks to the introduction of preoperative plasmapheresis. CONCLUSION: The establishment of strict protocols regarding use of blood products and the application of self-donation techniques provided a savings of homologous blood products during the period this study lasted. Preoperative donation of blood was accepted in all cases in which it was indicated and there were no adverse reactions when the autologous blood was replaced.

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[Warm air convection system and heat loss during vascular surgery].

OBJECTIVES: To assess the efficacy of a warm air convection (WAC) system to supplement the usual physical means (electric blanket, warm i.v. fluids and covering of exposed surfaces) for preventing an correcting hypothermia during surgery in 2 patient groups scheduled for vascular surgery. PATIENTS AND METHODS: We studied 70 consecutive patients scheduled for vascular surgery. Group I: a WAC system, in addition to the usual methods, was used to attempt to maintain normal body temperatures in 35 consecutive patients. Fifteen were undergoing aortic surgery (group Ia) and 20 were undergoing revascularization of the lower extremities (group Ib). Group II: only the usual physical methods were used to maintain normal temperature in the remaining 35 patients, 15 of whom required aortic surgery (group IIa) and 20 of whom were undergoing revascularization of the lower extremities (group IIb). Type of anesthesia and monitoring were the same in all cases. Esophageal temperature (ET) and room temperatures were recorded at baseline and every 30 min until the end of surgery. ET was not allowed to fall below 35 degrees C in any patient and WAC was provided to patients in group II if they required it. RESULTS: All patients in group II experienced a gradual decrease in ET, which became significant 30 min after start of surgery in group IIa and 60 min after start of surgery in group IIb. Temperature was stable during surgery in all patients in group I. All patients with ET of 35 degrees C in group II experienced a rise in temperature, which was significant after 60 min. when WAC was used. CONCLUSIONS: In vascular surgery, whether aortic or peripheral, patient temperature fell in spite of use of the usual physical methods for warming. Adding WAC for upper body warming prevented loss of heat. The WAC system was also effective for patients who needed to be rewarmed.

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