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Biomedical subjects

X Sala-Blanch

Publications and source records attributed to X Sala-Blanch.

10 recordsLinked to original sources
PubMed2004

[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa].

The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. When the point of the needle was near the nerve, the nerve stimulator was switched on to 0.5 mA, and when no response was obtained the current was increased to 1.5 mA. The needle was moved slightly (1-2 mm) to produce a plantar flexion (tibial component) that persisted until stimulation had been reduced to 0.4 mA, at which time 30 mL of 1.5% mepivacaine was injected. The sonographic image during injection showed that the anesthetic had surrounded the nerve (donut sign). The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.

Adult↗
PubMed1998

Effects of carbon dioxide vs helium pneumoperitoneum on hepatic blood flow.

BACKGROUND: Elevated intraabdominal pressure due to gas insufflation for laparoscopic surgery may result in regional blood flow changes. Impairments of hepatic, splanchnic, and renal blood flow during peritoneal insufflation have been reported. Therefore we set out to investigate the effects of peritoneal insufflation with helium (He) and carbon dioxide (CO2) on hepatic blood flow in a porcine model. METHODS: Twelve pigs were anesthetized and mechanically ventilated with a fixed tidal volume after the stabilization period. Peritoneal cavity was insufflated with CO2 (n = 6) or He (n = 6) to a maximum intraabdominal pressure of 15 mmHg. Hemodynamic parameters, gas exchange, and oxygen content were studied at baseline, 90 mm and 150 min after pneumoperitoneum, and 30 min after desufflation. Determination of hepatic blood flow with indocyanine green was made at all measured points by a one-compartment method using hepatic vein catheterization. RESULTS: A similar decrease in cardiac output was observed during insufflation with both gases. Hepatic vein oxygen content decreased with respect to the baseline during He pneumoperitoneum (p < 0.05), but it did not change during CO2 insufflation. Hepatic blood flow was significantly reduced in both the He and CO2 pneumoperitoneums at 90 min following insufflation (63% and 24% decrease with respect to the baseline; p < 0.001 and p < 0.05, respectively) being this decrease marker in the He group (p = 0.02). CONCLUSIONS: These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than CO2 insufflation.

Animals↗
PubMed1995

Maintained unilateral analgesia.

We describe a case of a patient subjected to what proved to be an epidural puncture with catheter placement resulting in persistent unilateral analgesia. The epidurographic study by contrast medium injection through the catheter showed unilateral distribution of the contrast following the cranio-caudal axis in the anterior epidural space.

Adult↗
PubMedDate not supplied

Phrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic.

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block (ISB) is associated with phrenic block and diaphragmatic paralysis when high volumes (40-50 mL) of local anesthetic are injected. The goal of our study was to test if a low volume of local anesthetic administered while maintaining proximal digital pressure might more selectively block the brachial plexus and decrease the frequency of phrenic nerve block. METHODS: Twenty healthy patients undergoing ISB for orthopedic surgery of the upper extremity were randomly allocated to receive either 20 mL 1.5% mepivacaine while proximal digital pressure to the site of puncture was performed, or 40 mL 1.5% mepivacaine without digital pressure. Spirometry and clinical data were evaluated at baseline, 10, and 90 minutes after accomplishing the block and after the motor and sensory block resolved. Diaphragmatic excursion during deep inspiration was also evaluated 90 minutes after the block was performed, with the patient in the sitting position. RESULTS: Interscalene brachial plexus block produced diaphragmatic paralysis in all patients included in the study, as demonstrated by the pulmonary function testing and the chest radiograph. No significant differences were found in any of the parameters studied. At 10 minutes, baseline functional residual capacity had diminished by 34 +/- 10% in the 40 mL group and 37 +/- 13% in the 20 mL group. Maximum cephalad sensory dermatome level was also similar in both groups, being C 3 or above in all patients. Ipsilateral hemidiaphragmatic motion was similar in both groups (3.2 +/- 2.3 cm in the 40 mL group and 2.6 +/- 1.7 cm in the 20 mL group). However, in no case was dyspnea manifested. CONCLUSIONS: Decreasing the volume of local anesthetic and applying proximal digital pressure to the site of injection is not effective in reducing the cervical block spread and the frequency or intensity of diaphragmatic paralysis during interscalene ISB.

Adult↗
PubMedDate not supplied

Epidural anesthesia in a patient with single ventricle.

BACKGROUND AND OBJECTIVES: Single ventricle is a complex congenital cardiopathy characterized by a unit ventricular chamber. Changes of the cardiovascular system in response to epidural anesthesia in these patients have yet to be clearly elucidated. METHODS: A 26-year-old man with single ventricle underwent an orchiopexy under lumbar epidural anesthesia with intravenous sedation. RESULTS: Orchiopexy was successfully performed and the patient was discharged from hospital 4 days later. CONCLUSION: This case report emphasizes the issues of importance to anesthesiologists in regard to this cardiopathy and describes a successful technique of caring for a patient with a complex problem in an emergency situation.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Epidural hematoma after epidural anesthesia in a patient with peripheral vascular disease. Case report.

BACKGROUND AND OBJECTIVES: Epidural hematoma is a severe, uncommon complication associated with epidural anesthesia in patients with peripheral vascular disease who require anticoagulant therapy. METHODS: An 84-year-old woman with acute left leg arterial ischemia underwent revascularization surgery under lumbar epidural anesthesia. Pre- and postoperative heparin was administered as an anticoagulant. RESULTS: Reperfusion of the leg was successful, however, 3 days later clinical signs of spinal cord compression appeared and epidural hematoma was diagnosed. Neurologic recovery was poor. CONCLUSIONS: This case highlights the need for careful individual preoperative analysis and postoperative observation to make anesthetic practice safe in patients receiving perioperative anticoagulant therapy.

Aged↗
PubMedDate not supplied

[Effect of a 3-in-1 block in arthroscopic knee surgery. Comparative study with subarachnoid block].

HYPOTHESIS AND OBJECTIVES: Trunk blockades in arthroscopic knee surgery are rarely performed because combined blockade of the sciatic and lumbar plexus nerves are required, particularly if ischemia is required. We aimed to assess the efficacy of the "3-in-1 block" combined with intraarticular infiltration of local anesthetic for arthroscopic meniscectomy. The results were compared with our standard technique, subarachnoid anesthesia. PATIENTS AND METHODS: Forty ASA I-II patients undergoing arthroscopic meniscectomy without ischemia. The patients were randomly assigned to receive "3-in-1 block" with 40 mL of 1.5% mepivacaine (T group, n = 20), or the standard technique of subarachnoid puncture with 3 mL of 2% lidocaine (S group, n = 20). Twenty minutes after puncture patients in both groups received intraarticular injections of 20 ml of bupivacaine 0.25% with 1:200,000 adrenaline in the knee. Surgery began 10 minutes later. We assessed requirements for sedation during surgery, degree of satisfaction during surgery according to the surgeon and the patient, hemodynamic variables at predetermined times, postoperative pain (on a verbal scale and related to consumption of analgesics in the first 48 hours after surgery), and the appearance of side effects attributable to anesthetic technique. RESULTS: Demographic variables were comparable in the two groups and no surgical events were recorded. Eighteen patients in the T group and one in the S group required sedation during surgery (p < 0.05). Blood pressure was significantly lower in the S group than in the T group (p < 0.05). No patient in the T group required atropine and/or ephedrine during surgery, whereas 5 patients in the S group did (p < 0.05). Postoperative evolution was similar in the two groups. No postoperative complications attributable to the techniques were recorded. CONCLUSIONS: The "3-in-1 block" combined with joint infiltration of local anesthetics may be an effective alternative when subarachnoid anesthesia is contraindicated in patients undergoing arthroscopic meniscectomy.

Anesthesia, Local↗