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Biomedical subjects

V Moral

Publications and source records attributed to V Moral.

14 recordsLinked to original sources
PubMed1998

[Effectiveness of topical anesthesia enhanced by sedation and analgesia for cataract surgery].

OBJECTIVES: To compare the efficacy of topical anesthesia and retrobulbar anesthesia for cataract surgery by lens emulsification. PATIENTS AND METHODS: Two hundred sixty patients were randomized to two groups in this open clinical trial. Patients with cataracts that could not be treated by lens emulsification were excluded. Group I patients (n = 129) received 0.5% tetracaine drops and intravenous fentanyl and propofol, along with continuous sedation. Group II patients (n = 131) received 2% lidocaine in the retrobulbar space and hypnotic doses of intravenous propofol before retrobulbar injection. The anesthesiologist evaluated anesthesia negatively if SpO2 was 90% and either heart rate or blood pressure varied more than 20%. The ophthalmologist evaluated anesthesia negatively if the eye did not remain fixed in the center, if blepharospasm appeared or if the anterior chamber of the eye collapsed. The patient reported the intensity of any discomfort experienced on a six-point scale. Anesthesia was determined to be effective when favorable evaluations were given by both the anesthesiologist and the ophthalmologist and when no significant discomfort (first three points on the scale) was reported by the patient. The two treatment groups were compared using a single and multiple factor analysis. RESULTS: Group II experienced significantly fewer instances of ineffective anesthesia than did group I (8 versus 22) and fewer negative evaluations by the ophthalmologists (7 versus 18). More patients in group I reported discomfort than in group II (46 versus 9), although most complaints were of slight discomfort. Multiple factor analysis showed that a patient in group I had 4.64 more chances of experiencing ineffective anesthesia. CONCLUSIONS: Topical anesthesia is less effective than retrobulbar anesthesia for cataract surgery by lens emulsification.

Aged↗
PubMed1996

Spinal anesthesia with bupivacaine and fentanyl in geriatric patients.

We assessed the risks and benefits of the administration of fentanyl during spinal anesthesia in the elderly. Forty patients (70-83 yr) undergoing knee or hip replacement were studied. Preoperatively, cognitive function (minimental state examination [MMSE]), associated pathology, medications, and treatment were evaluated. Patients had spinal anesthesia with 12.5 mg bupivacaine plus saline (SS; n = 21) or 25 micrograms fentanyl (FN; n = 19). The number of ailments and drugs per patient were 2.5 and 2.3, respectively; 35%-44% of disorders were untreated, 16%-26% were symptomatic, and 33% were adequately treated. Groups were comparable regarding demographic data and characteristics of the spinal block. Group FN had more pruritus (P < 0.02) and lower SaO2 (P < 0.007), but prevalence of side effects was similar. Pain intensity (visual analog scale [VAS], facial expression test [FET] at the time of analgesia request (TAR) was lower in Group FN (P < 0.01). A poor correlation between VAS and FET (range 0.42-0.58) was obtained. MMSE at hospital discharge was no different from preoperative values. Our results show that 25 micrograms of spinal fentanyl do not modify spinal anesthesia in the elderly, but induces pruritus and O2 desaturation. The decrease in postoperative pain intensity and the preservation of cognitive function would justify the use of spinal fentanyl in the elderly.

Aged↗
PubMedDate not supplied

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Anesthesiology↗
PubMedDate not supplied

[Paradoxical bradycardia and hemorrhagic shock].

We report two cases of paradoxical bradycardia associated with acute hemorrhage and hypotension in conscious patients who had no antecedents of myocardial disease. In some cases of massive and rapid hypovolemia the occurrence of bradycardia may constitute a protective reflex directed to improve ventricular filling. This reflex is probably mediated by a vagal mechanism which acts on a previously increased sympathetic nerve tone and tends to maintain systemic vascular resistances and keep a cerebral blood flow high enough to preserve conscience level. We discuss the differential diagnosis with vasovagal syncope which can also occur during the initial phases of acute hemorrhage and during the preterminal bradycardia that develops during the so called "irreversible phase" of shock. Paradoxical bradycardia during hemorrhagic shock is always a sign of important bleeding that requires a rapid reposition of volemia. Administration of vagolytic agents is contraindicated since they can favour the occurrence of severe cardiac arrhythmias.

Aged↗
PubMedDate not supplied

[Late postoperative apnea in a premature newborn infant].

We report the case of a premature newborn child (36 weeks) who was operated on a teratoma of the sacrum when he was 12 days old and weighed 2,950 g. The patient presented a late postoperative apnea 17 hours after anesthesia. The anesthetic technique consisted of lumbar epidural blockade with 0.33% bupivacaine at a dose of 2.25 ml and superficial inhalation anesthesia with 0.5% isoflurane. Relaxing muscular agents used in this case were succinylcholine (3 mg) for orotracheal intubation and pancuronium bromide (0.3 mg) for maintaining the anesthetic level. The immediate postoperative phase was uneventful but 17 hours after surgery the patient presented apnea, bradycardia (40 beats/min), and marked cyanosis requiring assisted ventilation with bag and mask during 3 min and initial cardiac massage. Recovery of heart rate was immediate and recovery of ventilation was progressive. The patient was treated with caffeine during one week and no relapses occurred. Pneumocardiographic recordings obtained later on revealed sporadic short lasting episodes of apnea (shorter than 15 s) sometimes associated with bradycardia (40 beats/min lower than baseline). There were no apparent intercurrent or precipitating factors for this apnea. We believe that the present clinical picture corresponds to a late postoperative apnea of unknown origin which required reanimation measures and that until present, there are no reported complications of the anesthetic technique that can explain this episode.

Anesthesia, Epidural↗
PubMedDate not supplied

[Severe heart arrhythmia secondary to magnesium depletion. Torsade de pointes].

We report a case of torsade de pointe ventricular tachycardia in a patient with chronic magnesium depletion. The etiological aspects implicated this unusual cardiac arrhythmia are: the congenital long QT syndrome; bradycardia, either sinusal or due to atrioventricular block; ionic depletions: hypokalemia, hypocalcemia and hypomagnesemia; treatment with antiarrhythmic class AI drugs (quinidine-like agents), tricyclic antidepressants, phenothiazines and erythromycin; organophosphate poisoning. After ruling out other factors, we concluded that it was caused by hypomagnesemia on the basis of laboratory findings and the good response to replacement therapy. We then discuss the several types of therapy proposed for this arrhythmia; finally, we emphasize the major role of magnesium in myocardial repolarization.

Electrocardiography↗