Envíos recientes

Anaesthesia in craniosynostosis

González Cárdenas, Víctor Hugo | 2014-07-14

Craniosynostosis is a congenital disorder requiring extensive reconstructive surgery thatentails a high probability of severe bleeding, massive transfusion and difficult airway man-agement. Considering that the anaesthetic management for this procedure has specialrequirements and priority targets, presenting the experience of the anaesthesiology depart-ment working under the programme for surgery of craniofacial abnormalities is of thegreatest importance. Objective: Describe the behaviour of anaesthetic variables during the perioperative period inpatients taken to craniosynostosis correction at Hospital Infantil Universitario de San José.Methods: Retrospective observational cohort study in patients taken to surgery between Jan-uary 1st 2008 and January 31st 2012. Data were collected from electronic clinical records andanaesthesia records. Results: The most relevant data were haemorrhage and transfusion. Blood loss was 35.6 cc/kg(SD = 17.4), considered as severe haemorrhage. Patients receiving tranexamic acid did notshow lower intra-operative levels of blood loss or packed red blood cell (PRBC) transfusions,shorter mechanical ventilation or ICU (intensive care unit) length of stay. We observed asmaller number of PRBC transfusions in patients in the ICU who received desmopressin. Conclusions: We suggest that neither tranexamic acid (14 mg/kg) nor desmopressin (0.36 mg/kg) in this cohort correlated with reduced haemorrhage or smaller volumes of intra-operative PRBCs. We only describe a smaller volume of transfused PRBCs in the ICU associated with the use of desmopressin.

Postoperative residual paralysis in patients aged over 65 years old at the Post-Anesthesia Care Unit

González Cárdenas, Víctor Hugo | 2016

Abstract Introduction: Few studies have been made on the incidence of residual paralysis from nondepolarizing relaxants in people over 65 years old; however, estimating the number of cases and treatment thereof are both important. Objective: To study the incidence of residual paralysis with non-depolarizing relaxants in patients over 65 years of age and discuss treatment. Methodology: Analytical observational study based on a cohort design. Results: The pre-extubation residual paralysis was estimated at 23.2% and at 9.2% at patient admission to the Recovery Suite. Pharmacological reversal showed 89.4% and 100% success rates with Neostigmine and Sugammadex respectively, with similar times at T4/T1 > 0.9. Conclusions: The incidence of pre-extubation residual paralysis was lower than the figure published worldwide. Pharmacological reversal therapies were typically highly effective.

Pre-anesthesia evaluation in patients with chronic renal disease (emphasis on cardiovascular risk)

González Cárdenas, Víctor Hugo | 2013

Chronic renal disease is a public health problem worldwide. Several times these patients will undergo surgical procedures related to dialysis or surgeries related to their co-morbidities. The purpose of the pre-anesthesia evaluation is to assess the risk of cardiovascular events and initiate interventions that may influence morbidity and mortality. This article describes the relevant epidemiological data of chronic kidney disease and its cardiovascular risk and provides a guide on clinical assessment, diagnostic tools and strategies to reduce surgical risk. This narrative literature review is based on articles written in both English and Spanish limited to the last 10 years, information from basic textbooks and primary databases (i.e., PUBMED - EMBASE - LILACS), supported by articles referenced in the above-mentioned search.

Remifentanil vs. propofol controlled infusion for sedation of patients undergoing gastrointestinal endoscopic procedures: A clinical randomized controlled clinical trial

Muñoz, Luis | 2013

Background: Target controlled infusion (TCI) for the administration of anesthesia may provide a safe alternative for managing the discomfort of patients undergoing gastrointestinal endoscopic procedures. However, the most appropriate drug available for TCI is yet to be established. The objective of this trial was to compare remifentanil vs. propofol in TCI for sedating patients during GI endoscopy. Materials and methods: Sixty-nine patients requiring GI endoscopies were randomly distributed to receive remifentanil (n = 30) or propofol (n = 39) TCI at the effect site (e). The primary outcome was patient's satisfaction. Secondary outcomes included the gastroenterologist satisfaction, comparison of the percentage of adverse events between the two groups (occurrence of arrhythmias, major respiratory depression, bradycardia, hypotension, pain, nausea or vomiting and absence of amnesia), and the level of awareness. Retrospective registration number is NCT01746641 at Clinicaltrias.gov Results: The mean (range) of patient satisfaction with remifentanil vs propofol was 1 (1-2) and 2 (11), respectively (Chi2, p < 0.001). Pain during the procedure was found to differ between remifentanil and propofol (mean 2 vs. 1, Chi2, p = 0.042), nausea or vomiting (4 vs. 0, Chi2, p = 0.01), and absence of amnesia (29 vs. 10, Chi2, p < 0.001), respectively. No statistically significant differences were found between the two groups. Conclusion: Propofol in TCI seems to be an adequate agent for sedation of patients undergoing GI endoscopic procedures, with less adverse effects and higher patient satisfaction. Most likely, the combination of these two drugs may be synergistic and further reduce any adverse effects.

Técnica anestésica para reparo endovascular de aneurisma de aorta abdominal

Muñóz, Luis A. | 2017-09-01