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Biomedical subjects

P Monedero

Publications and source records attributed to P Monedero.

At least 19 recordsLinked to original sources
PubMed2001

[Anesthesia for the patient with cancer].

Surgery and radiotherapy provide the basis for local and regional control of cancer. The cancer patient has special characteristics that have implications for anesthesia. Tumors may involve the airways and affect ventilation, hemodynamics and intracranial pressure. Remote tumors can occur in endocrine cancer and in paraneoplastic syndromes. Other systemic complications of the cancer patient include hemostatic changes, immunosuppressant anemia and altered metabolism. Radiotherapy causes changes with anesthetic implications when treatment is directed at the head and neck, mediastinum, lung or surgical area. Chemotherapy is associated with non-specific toxic effects such as mucositis, aplasia and immunosuppression, alopecia and vascular injury; in addition, each chemical has other more specific toxic effects. Chemicals that are toxic for the heart and lungs have the greatest implications for anesthesia. Preoperative assessment should ascertain the effects caused by both the tumor and its treatment. Preparation for surgery includes improving nutrition and possibly inserting a venous port. Management during surgery depends on type of intervention and the patient's physical status, as they will determine the need for invasive monitoring and vessel access. The patient can be given antiemetic and antithrombotic prophylaxis. Important issues in postoperative care are the need for adequate analgesia; provision of early nutrition; antibiotic, antithrombotic and antiemetic prophylaxis; and prevention of ulcers caused by pressure.

Anesthesia↗
PubMed2000

A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia.

UNLABELLED: We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg x kg(-1) x h(-1) of magnesium sulfate over 20 h. The nimodipine group received 30 microg x kg(-1) x h(-1) of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24-48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery. IMPLICATIONS: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.

Administration, Oral↗
PubMed1997

Is management of anesthesia in achondroplastic dwarfs really a challenge?

STUDY OBJECTIVE: To review our eight-year anesthetic experience with achondroplastic patients. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: 15 achondroplastic patients who underwent 53 surgical procedures of orthopedic surgery between 1987 and 1994. INTERVENTIONS: Anesthetic technique, drugs, number of incidents, and complications in the intraoperative and postoperative period were recorded. MEASUREMENTS AND MAIN RESULTS: Adequate premedication before the transfer to the operating room was very useful to reduce anxiety and increase cooperation. Inhalation induction was well tolerated and allowed easy peripheral venous cannulation. Only one patient presented difficulties during intubation (on two occasions). In the other patients, we found small difficulties only during ventilation with a face mask, which was easily corrected by modifying the position of the patient and/or inserting an oropharyngeal airway. No adverse effect was identified for any particular anesthetic drug or technique used. CONCLUSIONS: Although the characteristic deformities of achondroplastic patients can impede the management of anesthesia, in our study we found no special difficulties. Airway complications did not occur. Thus, no specific optimal anesthetic regimen can be recommended.

Achondroplasia↗
PubMed1996

Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting.

We studied 100 ASA I-II females undergoing general anaesthesia for major gynaecological surgery, in a prospective, double-blind, placebo-controlled, randomized study. Patients received one of four regimens for the prevention of postoperative nausea and vomiting (PONV): ondansetron 4 mg (n = 25), dexamethasone 8 mg (n = 25), ondansetron with dexamethasone (4 mg and 8 mg, respectively, n = 25) or placebo (saline, n = 25) There were no differences in background factors or factors related to operation and anaesthesia, morphine consumption, pain or side effects between groups. The incidence of nausea and emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (P < 0.01), ondansetron (P < 0.05) and dexamethasone (P = 0.057) groups. There were no differences between ondansetron and dexamethasone, and both were more effective than placebo (P < 0.05 and P < 0.01, respectively). Dexamethasone appeared to be preferable in preventing nausea than emetic episodes. Fewer patients in the ondansetron with dexamethasone group needed antimetic rescue (P < 0.01 vs placebo and P < 0.05 vs ondansetron). We conclude that prophylactic administration of combined ondansetron and dexamethasone is effective in preventing PONV.

Adolescent↗
PubMed1995

[Reduction of the need for blood derivatives in liver transplantation using aprotinin].

OBJECTIVES: To evaluate the efficacy of aprotinin in reducing the need for blood products in orthotopic liver transplantation. PATIENTS AND METHODS: Blood product needs and coagulation test results were studied in 42 adults with cirrhosis of the liver who received orthotopic liver transplants. The first 16 liver transplants carried out without aprotinin (control group) were compared with the next 26 consecutive transplant patients who received aprotinin. Each of the first 9 received a loading dose of 2 million units that was followed by the infusion of half a million units per hour until the end of surgery. The next 17 received the same infusion dose at the same rate but no loading dose. RESULTS: Patients who received aprotinin required fewer transfusions of blood products (5.3 units of packed red blood cells as opposed to 13 units; 9 units of fresh frozen plasma versus 14.6 units; 1.7 units of platelets versus 4.2 units; and 3.8 units of cryoprecipitates versus 8.8 units). We observed a marked reduction of fibrinolysis (less increase in D dimers after removal of the liver when aprotinin was used. CONCLUSIONS: Prophylactic use of aprotinin during surgery has a beneficial effect on hemostatic mechanisms, reducing the need for blood products. A reduction in fibrinolysis seems to contribute to this effect.

Adult↗
PubMedDate not supplied

[Depression of the mononuclear phagocyte system caused by high doses of narcotics].

We evaluated in human monocytes the effect of high doses of alfentanyl on the expression of vimentin filaments, the phagocytic activity and the membrane display of HLA-DR molecules in the subjects undergoing surgery. The study was performed on 30 patients, ASAI-II. The patients received 100 mcg/kg i.v. of Alfentanil and the maintenance of anaesthesia was made with Alfentanil (2-3 mcg/kg/min.). The patients were randomized in two groups. The patients were ventilated with N2O:O2 (1:1) (Group I) or air: O2 (1:1) (Group II). After surgery, all patients of the Group II received Naloxone (0.2-0.4 mg). Central venous blood samples were obtained before induction, one and two hours after induction of anaesthesia and at the end of surgery. Separation of monocytes was performed according to Boyum technique. CD35 and HLA-DR molecules and vimentin filaments were studied by indirect immunofluorescence method using monoclonal antibodies. Percentage of positive cells were read with a cytofluorometer. The phagocytic function of monocytes was determined by ingestion of latex particles. Cortisol and ACTH plasma levels were determined by RIA. High doses of Alfentanyl depress phagocytic function and membrane display of CD35 and HLA-DR molecules in monocyte and induce marked changes in the organization of vimentin filaments in these cells in patients undergoing surgery. This monocytic depression was more marked in the patients ventilated with N2O. In our results there was uninhibition of ACTH and cortisol plasma levels responses to surgical stress by Alfentanil administration. Since the effects of Alfentanil were reversed by Naloxone, an opioid receptor mechanism seems to mediate these events.

Adrenocorticotropic Hormone↗