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Biomedical subjects

R García-Aguado

Publications and source records attributed to R García-Aguado.

At least 19 recordsLinked to original sources
PubMed2001

Giant inguino-scrotal bladder hernia. Report of a case.

Bladder hernia is very uncommon. It tends to affect patients over the age of 50 and is predisposed by cervico-urethral obstruction. The condition is often diagnosed during inguinal hernia surgery. The authors report a case of massive inguino-scrotal bladder herniation. The different types of bladder hernia are described, and the clinical-radiological findings and surgical management are discussed.

Journal Article↗
PubMed2000

Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine.

UNLABELLED: We explored the effect of fibrin glue injection at the site of dural puncture on cerebrospinal fluid (CSF) leakage in a swine model. Pigs were subjected to a lumbar dural CSF puncture in the sitting position with a 17-gauge Tuohy needle. Fibrin glue 1.4 mL was injected through the same needle into the epidural space. Evans blue dye was infused through the cisterna magna 15 min later, and the appearance of dyed CSF through the skin puncture and along the needle trajectory to the dura was inspected and categorized. In seven of eight animals, the CSF leak was sealed with fibrin glue. Control animals were injected with 1.4 mL saline. A sham operation group of animals underwent cisternal dye infusion without a lumbar puncture. CSF pressure at the cisterna magna was recorded throughout the procedure. No significant differences in the leakage indicators were found between the fibrin glue-injected and sham-operated group, whereas both groups showed significant differences with respect to the control group. The fibrin glue seal was effective against CSF pressures of 24.5 [17-31] cm H(2)O. We conclude that percutaneously injected fibrin glue is effective in stopping CSF leaks after dural puncture in this animal model. IMPLICATIONS: In this swine study, we repaired a cerebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue seems promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.

Animals↗
PubMed2000

[Systematic recording of perioperative events associated with anesthesia as quality indicator in ambulatory anesthesia].

OBJECTIVES: To analyze the quality of several anesthetic techniques used for major outpatient surgery in our hospital, by quantifying for each the relative risk (RR) of adverse events during anesthesia and in the postoperative period. PATIENTS AND METHODS: One thousand seventeen patients who underwent surgery between 18 May 1998 and 23 October 1998 were studied retrospectively. RESULTS: The mean age of the patients was 52.27 +/- 24.65 yr; 44.18% were ASA I, 40.56% were ASA II, 14.56% ASA III and 0.67% ASA IV. Mean time of surgery was 33 +/- 16.49 min and mean recovery time until discharge was 77.3 +/- 93.4 min. Admission was necessary for 0.6% of the patients and re-admission for 0.3%. General anesthesia was used with 19%, anesthetic monitoring with 17%, regional anesthesia (including peribulbar) with 46% and local anesthesia plus sedation with 16.6%. In 95% of the cases, no adverse events occurred during anesthesia; in 94.8% no such events occurred during the early recovery period. During surgery and postoperative recovery, intradural anesthesia was associated with significantly greater RR of adverse events in comparison with general anesthesia (6.6 and 2.2 respectively) and in comparison with monitored anesthesia (7.2 and 3.3). No differences in RR were found between general anesthesia and monitored anesthesia. Problems were slight to moderate in severity and mainly related to nausea and vomiting (2%). CONCLUSIONS: Recording perioperative events permits evaluation of the quality of anesthesic procedures. Intradural anesthesia is associated with more complications.

Adolescent↗
PubMed1998

The effect of fibrin glue patch in an in vitro model of postdural puncture leakage.

UNLABELLED: We studied the possibility of stopping a continuing transdural leakage with fibrin glue, a biologic adhesive, in an in vitro model. The model was made by sealing the bottom of a tube filled with saline to a height of 50 cm with a human lyophilized dural specimen. Dural punctures were performed with a 17-gauge Tuohy needle. The needle was then withdrawn, and 0.8 mL of fibrin glue was injected through the same needle to seal the defect. The column was refilled 3 min after sealing. The pressure in the intrathecal chamber was measured during the procedure. Macroscopic and microscopic histological studies of the dura and the fibrin plug were performed. In the five cases studied, the leak was sealed by the fibrin plug at closing pressures of 25-35 cm H2O, and no further leakage was detected after refilling. The dural specimens showed a fibrin glue plug stuck at the edges of the hole. We conclude that fibrin glue stops leakage of fluid from dural holes created by a 17-gauge Tuohy needle in an in vitro pressurized model. IMPLICATIONS: We explored the possibility of repairing a cerebrospinal fluid leak produced by an accidental dural puncture during epidural anesthesia by percutaneously injecting tissue adhesive in vitro. This technique seems promising for the prophylaxis and treatment of the headache associated with this leakage but requires further study in vivo.

Dura Mater↗
PubMed1996

[The so-called malignant pleural effusion: a new review of direct data obtained with diagnostic pleuroscopy].

We analyze a series of 896 thoracoscopies for pleural effusion, of which 78% (662/896) were due to pleural carcinomatosis, primary or metastatic. Pleural malignancy was observed mainly, in the right hemithorax (65%), arising from tumors within the diaphragm. The likelihood of finding pleural metastasis in lung cancer was 77%. When the pleural effusion is slight (less than 500 ml) the likelihood falls to 22%. We therefore advise thoracoscopy in the former and thoracotomy in the latter. Blood-stained effusion continues to have the worst prognosis (84% stemming from metastasis) and signifies an advanced stage of pleural metastasis. The pleura parietal is involved in 69% of pleural carcinomatosis cases, and in 80% when the lower hemithorax or the area around breast or lung tumors are involved. The cytology yield was 45.9%, though always depending on extent of metastasis. When metastasis was slight, the likelihood of positive cytology was less (19%) and when metastasis was generalized throughout the entire pleura the likelihood increased to 73%. We found no reason to think that the cells in most pleural liquids are able to nest and form tumoral niches. The origin of such cell nests was rather found to be in shedding from the metastases themselves, from lung tumors or from carcinomatous lymphangitis by lymphatic obstruction. The diagnostic yield of thoracoscopy once again proved to be superior to that of pleural biopsy.

Adult↗
PubMed1996

Use of the Univent System tube for difficult intubation and for achieving one-lung anaesthesia.

BACKGROUND: One-lung ventilation in major thoracic surgery is the most commonly accepted technique, not only for surgery on the lung but also in procedures involving the oesophagus, mediastinum and thoracic aorta. Conventional double-lumen tubes may sometimes be difficult to place correctly in patients in whom intubation is difficult. In such cases, the Univent System tube may be of help. It has a curved movable blocker of small calibre, and is designed to slide inside the bronchial tree and occlude all or part of the target lung. CASE REPORT: We describe a new application of the Univent System tube in three cases where intubation was presumed to be difficult, and in another with unexpected difficult intubation. The laryngeal approach was carried out with the distally displaced blocker, inserting it through the sub-epiglottis or the posterior commissure visible orifice. The tube was firmly held and slid through the length of the blocker, rotating slowly until fully introduced. The advantages and criteria for its use are discussed. CONCLUSION: Although the double-lumen tube is the first choice for one-lung ventilation, the Univent tube is a good option for selective bronchial intubation and in patients in whom difficult intubation is predicted.

Adult↗
PubMedDate not supplied

[National survey of preoperative management and patient selection in ambulatory surgery centers].

BACKGROUND: The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated). MATERIAL AND METHODS: We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%. RESULTS: The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9%) and to a lesser extent chest X-ray (33.3%) and electrocardiogram (35.4%). The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%). Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%). Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003), mean stay (240 min vs 367 min, p = 0.002), and recovery time (150 min vs 212 min, p = 0.001) than integrated units. No statistically significant differences were found in the remaining parameters. CONCLUSIONS: Scientifically based protocols for patient selection, preoperative assessment and perioperative management of distinct processes and for the rational use of laboratory tests should be more widely used. The need for an outpatient anesthesia clinic for preoperative assessment was notable. The results of our survey indicate that better results in performance indexes are achieved in autonomous ambulatory surgery units than in integrated units. Given the possibility of defining and validating quality standards, further multicenter studies should be performed.

Ambulatory Surgical Procedures↗
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↗