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V Mayoral

Publications and source records attributed to V Mayoral.

5 recordsLinked to original sources
PubMed1998

[The incidence of intraoperative conciousness in emergency surgery and its possible relation to the post-traumatic stress syndrome. Presentation of three cases].

Intraoperative awakening and recall of specific events is a rare complication (0.2 to 1.3%) of surgery. The possibility of developing serious psychiatric complications, such as posttraumatic stress disorder (PTSD) makes the prevention and detection of intraoperative awareness a subject of special interest. We describe our experience with three patients in whom awareness was detected during emergency surgery under general anesthesia. We conducted two structured interviews with the patients three months after surgery in order to detect the possible development of psychiatric complications. One patient suffered insomnia and reexperience of the event during the first two weeks after surgery. Improvement was spontaneous. None of the patients suffered PTSD. Efforts to decrease the incidence of episodes of intraoperative awakening with specific recall must be based on clinical observation and exhaustive monitoring of the patient, including anesthetic gases, given that no ideal method of monitoring depth of anesthesia exists. Cases should be detected in the first few days after surgery by means of a specific test. Likewise, possible causes for the episode should be explained to the patient, who should be followed for six months so that early diagnosis of PTSD or other psychiatric complications can be made.

Adult↗
PubMed1996

[Percutaneous femoro-porto-jugular venovenous shunt in orthotopic liver transplantation].

Veno-venous bypass (VVB) by the percutaneous introduction of cannulas in the right internal jugular vein during liver transplantation may reduce the complications derived from the classical method of axillary vein dissection. The results and complications observed over a two and a half year period in 126 consecutive patients submitted to liver transplantation in whom preparation for femoral-portal-jugular veno-venous bypass was carried out are reported. Twelve complications (9.5%) were observed in the 126 patients. All the complications were due to jugular cannulation and were divided as follows: in 7 patients (5.5%) some of the guide introductions were unsuccessful following multiple punctures; in 2 patients (1.6%) the right carotid artery was punctured; 2 hemothorax (1.6%) were observed and one pneumothorax (0.8%). Forty patients required veno-venous bypass. The blood flows obtained during VVB were suffice in all the cases with a mean +/- standard deviation of 2.21 +/- 0.44 l/min-1. The technique of femoral-portal-jugular veno-venous bypass is a good alternative to the classical method of the axillary approach. It has advantages such as in the speed of installation of VVB and the utility of the large jugular vein during the remainder of the surgery for rapid fluid transfusions. Although the number of complications is low, they may be important thereby hindering intra management and post operative of the patients.

Adult↗
PubMed1995

Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome.

The hypoxaemia of hepatopulmonary syndrome, seen in severe chronic liver dysfunction, occurs as a result of precapillary pulmonary arterial dilatation and arteriovenous communications. These abnormalities contribute to the mismatch between ventilation and perfusion, and the right to left blood flow shunting. Nitric oxide (NO) is a powerful vasodilator concerned with the regulation of pulmonary vascular tone in man. Using a chemiluminescence analyser, we have measured endogenously produced NO in the exhaled air of three patients with the hepatopulmonary syndrome, six normoxaemic cirrhotic patients and six healthy volunteers. The subjects breathed NO-free air throughout the measurements. The molar rate of production of exhaled NO was raised almost threefold in the patients with hepatopulmonary syndrome compared with normal volunteers and with normoxaemic cirrhotic patients. Hypoxia per se, achieved in the normal volunteers by breathing a hypoxic gas mixture, reduced rather than increased the exhaled NO. One hepatopulmonary syndrome patient received an orthotopic liver transplant and achieved normoxaemia after 3 months. The exhaled NO also returned to normal. Increased pulmonary production of NO could contribute to the development of the hepatopulmonary syndrome.

Blood Gas Analysis↗
PubMed1995

[Hepato-pulmonary syndrome: meta-analysis].

INTRODUCTION AND OBJECTIVES: The clinical introduction of multiple elimination of inert gases (MEIG) has meant a qualitative advance in our understanding of the physiopathology of a wide range of pulmonary diseases. This meta-analysis aims to bring together data on patients with cirrhosis of the liver from 3 similar studies in which MEIG was used. PATIENTS AND METHODS: The results from 30 patients in 3 studies, divided into 2 groups based on baseline partial arterial O2 pressure (hypoxemic: PaO2 < 80 mmHg, n = 17; normal: PaO2 > or = 80 mmHg, n = 13) were subjected to statistical analysis. RESULTS: The hypoxemic group experienced an increase in the percentage of cardiac output perfusing regions of shunting (10.1 +/- 10 vs. 1.08 +/- 1.6%; p < 0.01) and low ventilation/perfusion relationships (16.3 +/- 10.3 vs. 3.5 +/- 5.8%; p < 0.01). We also observed greater dispersion in the distribution of perfusion (1.09 +/- 0.43 vs. 0.67 +/- 0.34; p < 0.01) and ventilation (0.62 +/- 0.14 vs. 0.49 +/- 0.13; p < 0.05), with the ventilation mean located in regions with higher ventilation/perfusion relationships (1.3 +/- 0.5 vs. 0.85 +/- 0.15; p < 0.01). The difference between observed and calculated PaO2 was significant in the hypoxemic group (7.3 +/- 5.5 vs. 1.2 +/- 1.3 mmHg; p < 0.01). CONCLUSIONS: Hypoxemia in patients with cirrhosis of the liver is mainly due to changes in ventilation/perfusion relationships and shunting. In the most hypoxemic patients, however, we cannot rule out a role for the causes of hypoxemia, such as diffusion changes.

Adult↗