PubMed Health⌕ Search

Biomedical subjects

R Bolinches

Publications and source records attributed to R Bolinches.

At least 19 recordsLinked to original sources
PubMed1995

Continuous spinal anaesthesia versus single dosing. A comparative study.

Continuous and single dose spinal anaesthesia were compared in a prospective randomized fashion in 108 patients undergoing orthopaedic surgery. Continuous spinal anaesthesia was via a 20 gauge polyamide multiperforated catheter introduced through an 18 gauge Tuohy needle. Single-dose spinal anaesthesia was performed with a 24 guage x 103 mm Sprotte spinal needle. The mean local anaesthetic dose for the continuous technique was 38.4 (SD 16.5) mg as hyperbaric lignocaine 5%, and for the single-dose spinal anaesthesia 10.8 (SD 2.2) mg as hyperbaric bupivacaine 0.5%. Segmental levels reached with the initial dose did not differ significantly between the two groups. Mean time required to perform continuous spinal anaesthesia was 6.7 (SD 3.9) min, which was longer than for single dose 4.9 (SD 2.8) min (P < 0.05). The onset time and efficacy of anaesthesia, and the duration of the operation were similar in the two groups. Analgesia was inadequate in six patients who received continuous spinal anaesthesia (11%) and one patient who received single dose (2%) (P = 0.18). Hypotension was more frequent in those receiving single doses (P < 0.05). Caudal rotation of the outlet needle orifice to advance the catheter correlated with inadequate analgesia (P < 0.01, r = 0.38). There were no significant differences in the incidence of post-operative complications.

Aged↗
PubMed1994

Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients.

One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. SDSA was quicker to perform: mean 4.4 (SD 1.6) min compared with 6.2 (2.6) min for CSA (P < 0.01). Times to onset and surgical anaesthesia were also significantly greater in the CSA group (P < 0.01). The quality of the block was better in the SDSA group (P < 0.05), but was associated with greater haemodynamic instability (P < 0.05). The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.

Adult↗
PubMed1987

Dependence of hepatic gluconeogenesis on PO2: inhibitory effects of halothane.

The dependence of gluconeogenesis and O2 uptake on PO2 in isolated rat hepatocytes is presented. Maintenance of steady-state PO2 was achieved with an oxystat system (Biochem. J. 236: 765-769, 1986). O2 uptake showed a half-maximal (K0.5) value of 0.5 Torr PO2, whereas the glucose synthesis rate was half-maximal at 1.2 Torr PO2. Halothane at concentrations greater than 1 mM exerted a parallel inhibition of O2 uptake and glucose synthesis at all PO2 levels studied. In contrast, at halothane concentrations less than 1 mM, inhibition of glucose synthesis occurred only at less than 20 Torr PO2. At these low concentrations, halothane was without significant effects on cellular O2 uptake. In isolated mitochondria, inhibition of O2 uptake was already half-maximal at a halothane concentration of 0.5 mM. In this subcellular system the inhibitory effect of halothane was independent of PO2. These results demonstrate that the critical PO2 at which cellular O2 utilization begins to decrease and the PO2 at which glucose synthesis begins to decrease are comparable; both PO2 levels are approximately 5 Torr. The metabolic zonation of the liver lobule is discussed in view of the results presented.

Animals↗
PubMed1980

[A rare case of silent cholinesterase genetic variant (author's transl)].

Some patients present prolonged apnea following the administration of succinylcholine because of substantial portion of plasma cholinesterase (the enzyme responsible for the hydrolysis of this muscle relaxant) is present as an atypical variant. Up to the present four types of cholinesterase genes are known which combination can cause apnea to a greater or less extent. Silent homozygous EsEs present apnea of greatest duration due to the complete absence of cholinesterase activity. The case reported belongs to a family of four members and is an example of this extremely uncommon genetic variant, with a frequency of 1/170.000. To determine total cholinesterase activity genetic typing of the whole family was carried out utilizing the spectrophotometric technique of Szasz and Knedel with butirylthiocholine iodide as substrate. Inhibition studies were performed using benzoylcholine and dibucaine, sodium fluoride, scholine, and sodium chloride as inhibitors.

Adolescent↗
PubMed1979

[A case of succinylcholine apnea. Identification of genetic variants].

A report of a case of prolonged apnoea after succicurarium in a female patient with abnormal pseudo-cholinesterases is followed by a presentation of a study of pseudo-cholinesterases in 12 members of the family. The value of the use of 4 tests of inhibition of cholinesterase activity in determining the genotype of an individual is emphasised.

Apnea↗
PubMedDate not supplied

[Continuous intradural anesthesia in geriatric patients undergoing orthopedic and traumatologic surgery].

OBJECTIVES: The aim of the study was to prospectively evaluate the results of continuous intradural anesthesia with 18G Tuohy needle and 20G catheter in geriatric patients. MATERIAL AND METHODS: We studied 70 patients with a mean age of 75.9 +/- 10.8 years who were subjected to orthopedic or traumatologic surgery of the lower extremities with a duration of 104.6 +/- 53.6 min. RESULTS: Success index was 95.7%. The initial dose of 1% tetracaine was 10.36 +/- 3.96 mg, the second dose in 29 patients was 7.2 +/- 2.7 mg, the third in 7 cases was 7.40 +/- 2.47 mg, and the total dose was 14.56 +/- 5.6 mg. The metameric level was between T8 and T11 in 80.32% of patients. Peroperative complications were limited to paresthesia in 5 cases (7.14%) during insertion of the catheter, difficulties in catheter placement in one case (1.42%), and accidental catheter extraction during withdrawal of the needle in 2 cases (2.85%). Ten patients (14.28%) presented arterial hypotension (pressure decrease greater than 30% of baseline systolic arterial pressure). During the postoperative phase there were 3 cases of slight headache after dural puncture (4.28%) that recovered with conservative treatment, and one case of lumbalgia at the puncture zone (1.42%). CONCLUSIONS: Continuous intradural anesthesia with the material used in this study is technically easy. It allows to accurately reach the desired metameric level, avoiding massive sympathetic blockade, and providing a steady hemodynamic condition. All these effects are essential for anesthesia in geriatric patients.

Aged↗
PubMedDate not supplied

[Importance of the needle in regional anesthesia].

The safety of regional anesthesia lies on a set of factors, namely, selection of the adequate technique, skill and proper training from the part of anesthesiologists and use of right equipment. The needle, as a prolongation of the hand of the anesthesiologist, must provide references in technique either by itself or joined to an objective method of nerve localization; this will result in a high percentage of success without iatrogenesis. We have reviewed 1,132 cases of regional anesthesia and grouped them into: intradural anesthesia, epidural anesthesia, and plexus anesthesia. We have evaluated the equipment used according to the success and iatrogenesis directly produced by the needle. Results were analyzed by Fisher's exact test and were statistically significant in the three groups, a fact that would indicate some specificity of the characteristics of the needle in each group of techniques. It would seem reasonable to adopt those techniques appearing to be the most efficacious after analysis in order to increase percentage of success and achieve the greatest safety in the clinical practice of anesthesiologists.

Anesthesia, Conduction↗
PubMedDate not supplied

[Continuous block of the brachial plexus with nerve stimulation. Intra and postoperative control in orthopedic surgery of the arm].

A perivascular axillary plexus block was performed to 87 patients scheduled for orthopedic surgery of hand or arm using an electric nerve stimulator. A catheter was inserted for the postoperative pain control. The success rate was of 90.8% (79 cases); 65 patients (74.7%) presented a complete motor block. Complications were: arterial puncture (3), difficulty in inserting catheter (3), injection out of the sheath (1), pain at the electric stimulation (3). No allergic reactions nor neurologic complications were founded during a year of posterior control.

Adolescent↗
PubMedDate not supplied

[Anesthesia with continuous + infusion of propofol for trans-sternal thymectomy in myasthenic patients].

Patients with myasthenia gravis respond unpredictably to muscle relaxants and more often suffer respiratory complications after surgery. We describe the use of total intravenous anesthesia with propofol and alfentanil without muscle relaxants is three myasthenic patients classified as Osserman I-IIB. Mean time since appearance of the disease was 1 year and all were undergoing transsternal thymectomy. Time in surgery ranged from 115 to 170 min and mean total dose of propofol was 1,374 mg. In all cases total intravenous anesthesia afforded good conditions for intubation, maintenance during surgery and rapid recovery from anesthesia, with early extubation.

Adult↗