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Biomedical subjects

A Villalonga

Publications and source records attributed to A Villalonga.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Study of presurgical anxiety in urologic, gynecologic, and ophthalmologic surgery as a function of the administration or non-administration of anxiolytic premedication].

OBJECTIVE: Anxiety commonly appears before surgery, triggering a set of events that can be described as a general stress response. We measured changes in preoperative stress in relation to premedication or not with diazepam in patients undergoing urologic, gynecologic and ophthalmologic surgery. PATIENTS AND METHOD: We enrolled 87 patients undergoing elective surgery in urology (n = 30), gynecology (n = 30) and ophthalmology (n = 27). Randomly, the patients were premedicated with diazepam, placebo or nothing. During the preoperative visit the patient was administered a test to determine the level of anxiety and blood pressure, heart rate and potassium plasma concentration (K+) the night before surgery and moments before entering the operating theater. RESULTS: No significant differences in anxiety between patients undergoing different types of surgery were detected in the operating theater; however, at that time, anxiety was found to be significantly less among patients premedicated with diazepam than among those given placebo. Preoperative anxiety was significantly less in ophthalmology patients and in those premedicated with diazepam. Both systolic and diastolic blood pressure increased significantly among urologic and ophthalmologic surgery patients and in those who were not premedicated with diazepam regardless of type of surgery. Heart rate did not change significantly. Potassemia decreased significantly in all patients. CONCLUSION: The discrepancy between the psychological and somatic response to the stress conditions studied may be the result of the calming effect of the preoperative visit by the anesthesiologist and to premedication with a tranquilizer. However, neither the preoperative visit nor premedication seem to completely block the stress response.

Adolescent↗
PubMed2000

[Comparative study between 5% prilocaine and 2% mepivacaine by the subarachnoid route in transurethral resections].

OBJECTIVE: To compare the duration of spinal block with 5% prilocaine and 2% mepivacaine in short procedures for transurethral resection and to assess possible complications in the immediate postoperative period. MATERIAL AND METHODS: Fifty-seven patients scheduled for transurethral resection of the prostate or a vesical tumor. Patients were ASA I-III, over 55 years of age and randomly assigned to two groups to receive 5% prilocaine (1 mg/kg, n = 27) or 2% mepivacaine (0.8 mg/kg, n = 30). We collected data on anesthetic technique, levels of extension of motor and sensory blockades, duration of blockades and complications within the first 24 hours after surgery. RESULTS: Demographic data, ASA classification and duration of surgery were similar in both groups. We found statistically significant differences (p < 0.05) in duration of sensory blockade (120.92 +/- 36.21 min with prilocaine and 145.83 +/- 35.81 min with mepivacaine) and in motor blockade (106.29 +/- 38.16 min with prilocaine and 133.16 +/- 42.21 min with mepivacaine). Five cases of hypotension and 4 of bradycardia occurred in each group and one patient in the mepivacaine group suffered slight postoperative cephalea. CONCLUSIONS: Both local anesthetics offer good surgical conditions with hemodynamic stability and few complications. The duration of sensory and motor blockade is shorter with prilocaine than with mepivacaine, making prilocaine more appropriate for short interventions.

Aged↗
PubMed2000

[Isobaric 2% lidocaine in continuous subarachnoid anesthesia using microcatheters].

The objective in the study of the clinical effect of isobaric 2% lidocaine for continuous spinal anesthesia with a microcatheter technique. Nine consecutive patients undergoing lower abdominal surgery under spinal anesthesia were enrolled. We inserted 27 G catheters through 22 G Sprotte (Intralong) needles to administer 20 mg of isobaric 2% lidocaine followed by successive doses of 10 mg until the required level of anesthesia was reached. Repeated injections of 10 mg were given during surgery whenever the level of anesthesia fell as much as one metamere, possibly permitting pain to appear. We recorded hemodynamic variables, level of anesthesia and motor block, as well as complications during and after surgery. The technique was used with nine patients, for whom the mean presurgical dose was 32.3 +/- 9.2 mg and the mean total dose was 51.3 +/- 25.3 mg. However, the protocol for administering the local anesthetic was suspended in three patients due to difficulty in maintaining the achieved level of anesthesia, as repeated injections were required, with consequent patient discomfort. In these patients relatively high levels of blockade were required and surgery lasted longer than one hour. The protocol followed with isobaric 2% lidocaine was not effective for continuous spinal anesthesia with microcatheters because of difficulty of maintaining level of anesthesia.

Aged↗
PubMed2000

[Impact factor of the Revista Española de Anestesiología y Reanimación for 1997 and 1998].

OBJECTIVES: Revista Española de Anestesiología y Reanimación (REDAR) is not listed in the Journal Citation Reports (JCR) of the Institute for Scientific Information (ISI) and therefore REDAR's impact factor (IF) is unknown. This study aimed to calculate REDAR's IF and immediacy index for the years 1997 and 1998 as well as the IF that the journal would have had if it were considered an ISI source journal. The study also aimed to analyze self-citations and how they would affect the IF if REDAR were considered a source journal. MATERIAL AND METHODS: We calculated the IF and immediacy indexes using ISI methodology, by manually counting the references to REDAR articles published in 1997 and 1998 and singling out self-citations. RESULTS: The IF was 0.014 for 1997 and 0.054 for 1998. If REDAR had been considered a source journal in 1997 the IFs would have been 0.437 for 1997 and 0.419 for 1998. The immediacy indexes were 0.37 for 1997 and 0.30 for 1998. The mean number of references per article for the two-year period under study was 19.04 with differences depending mainly on type of article. The highest numbers of self-citations and the highest proportions of the same were found in letters to the editor and authors' replies. The 30 author-plus-journal self citations accounted for 9.3% of all self-citations (n = 322). CONCLUSION: The IF of REDAR is far lower than those of other European journals. If REDAR were accepted as a source journal, it would benefit from its self-citations. Improving REDAR's if would result in greater international recognition of our scientific level.

Anesthesiology↗
PubMed1999

[Comparative study of 3 techniques for total intravenous anesthesia: midazolam-ketamine, propofol-ketamine, and propofol-fentanyl].

OBJECTIVE: To compare the characteristics of induction, maintenance and awakening for three techniques of combined total intravenous anesthesia (TIVA): propofol-ketamine, midazolam-ketamine and propofol-fentanyl. PATIENTS AND METHODS: Sixty patients were randomly assigned to three TIVA groups. Group 1 (n = 20) received midazolam, ketamine and vecuronium. Group 2 (n = 20) received propofol, ketamine and vecuronium. Group 3 (n = 20) received propofol, fentanyl and vecuronium. The variables compared were hemodynamic changes during induction and maintenance and upon awakening; time until awakening; and the incidence of postanesthetic complications. We also assessed whether propofol was better than midazolam at preventing the psychomimetic effects of ketamine. RESULTS: The demographic characteristics of the three groups were similar. Hemodynamic variables were most stable in group 2. Perfusion of midazolam-ketamine was accompanied by a significantly higher number of hypertensive peaks. Time to awakening was significantly shorter in Group I (11.8 +/- 5 min) than in group 2 (20.2 +/- 12.5 min); in group 2 time to awakening was 16.6 +/- 5.6 min. Eight patients in group 1, 5 in group 2 and 1 in group 3 reported having bad dreams, the difference between groups 1 and 3 reaching statistical significance. No patient experienced hallucinations and all reported satisfaction with the anesthetic technique used. CONCLUSIONS: TIVA with ketamine and propofol is comparable to the most commonly used combination of propofol and fentanyl and may be an appropriate choice when hemodynamic stability is of great importance; withdrawal 15 min before ending surgery prevents prolonged awakening. Perfusion of midazolam-ketamine is not recommendable for scheduled surgery because it induces too many hypertensive peaks. Although neither midazolam nor propofol completely prevents the psychomimetic effects of ketamine, such effects are not so severe that patients reject the anesthetic technique used.

Adolescent↗
PubMed1998

Postoperative respiratory function in children after abdominal surgery. A comparison of epidural and intramuscular morphine analgesia.

Thirty children undergoing urological and abdominal surgery were entered into a randomised trial comparing the effects of epidural and intramuscular morphine on postoperative respiratory function. The forced vital capacity and the forced expired volume in 1 s were measured before and 6 h after surgery and on each of the following seven days. Significant decreases (p < 0.01) in forced vital capacity and forced expired volume in 1 s were seen after surgery. After the first postoperative day, a gradual recovery in pulmonary function was observed but the measured parameters had not returned to their pre-operative control values by the end of the study. There were no statistically significant differences between the two groups during the study with respect to forced vital capacity and forced expired volume in 1 s. The quality of analgesia was better in the epidural morphine group than in the intramuscular morphine group. The incomplete recovery of pulmonary function suggests that pain is not the only cause of postoperative respiratory changes in these patients.

Abdomen↗
PubMed1998

[Comparison of lidocaine and urapidil for prevention of hemodynamic response to tracheal intubation in patients in general good health].

OBJECTIVE: To compare the efficacy of endovenous administration of 0.5 mg/kg-1 of urapidil to 1 mg/kg-1 of lidocaine for attenuating hemodynamic response to laryngoscopy and tracheal intubation. PATIENTS AND METHODS: Study of 40 ASA I and II patients with normal blood pressure undergoing elective surgery under general anesthesia with orotracheal intubation. The patients were randomly assigned to two groups to receive either 0.5 mg/kg-1 of urapidil or 1 mg/kg-1 five minutes before anesthetic induction. Anesthesia was provided with 0.04 mg/kg-1 of midazolam, 2 micrograms/kg-1 of fentanyl, 2 mg/kg-1 of propofol, 0.1 mg/kg-1 of vecuronium before proceeding to orotracheal intubation, after electromyographic determination of neuromuscular response with T1 less than 5%, and laryngoscopy. Heart rate, systolic, diastolic and mean pressures, and the product of heart rate and mean arterial pressure (HR x MAP) were recorded at the following times: baseline (before administering either lidocaine or urapidil), after induction, after laryngoscopy and intubation, and 3 minutes and 5 minutes after intubation. RESULTS: ASA classification, age, sex and weight were similar in the two groups. Heart rate immediately after intubation, and after 3 and 5 minutes was significantly lower in the lidocaine group. Likewise HR x MAP immediately after intubation and 3 minutes later was significantly lower in the patients who received lidocaine. CONCLUSIONS: In healthy ASA I and II patients with normal blood pressure, a dose of 1 mg/kg-1 of lidocaine provided better protection against the hemodynamic response to laryngoscopy and tracheal intubation than does 0.5 mg/kg-1 of urapidil.

Adult↗
PubMed1998

[Nasal ketamine compared with nasal midazolam in premedication in pediatrics].

OBJECTIVE: To compare the efficacy and side effects of midazolam and ketamine administered nasally for pediatric premedication. PATIENTS AND METHODS: In this double blind trial 60 children scheduled for elective surgery were randomly assigned to two groups to receive 0.25 mg.kg or 5 mg.kg nasal ketamine. We measured level of acceptance of medication, sedation, hemodynamic variables, reaction to separation from parents, side effects and time until recovery from anesthesia. RESULTS: The two groups were homogeneous. Acceptance of medication was good or adequate in all patients. The level of sedation was significant in both groups 10 min after premedication. Systolic arterial pressure was higher in the ketamine group 20 min after administration of the drug and upon arrival in the operating theater. Reaction to separation from parents was good in all groups. Secretions were higher in the ketamine group and hallucinations were experienced by three patients in the ketamine group and by two in the midazolam group. We found no difference in time until spontaneous eye opening after surgery. No complications were observed. CONCLUSIONS: The nasal route is adequately accepted by children. Both drugs are effective by this route and sedation is rapid. Time until postanesthetic recovery is similar with both drugs. The doses used have wide safety margins.

Adjuvants, Anesthesia↗
PubMed1997

[Severe airway obstruction in 4 cases of postoperative obstructive hematoma].

Obstructive hematoma is a rare postoperative complication of surgery on the floor of the mouth or the anterior region of the neck and throat. The insidious development of symptoms, including agitation, which may be attributed to other causes, or their late appearance in hospital wards staffed by personnel unaccustomed to treating airway complications, means that the risk of hypoxia or respiratory failure is high. We describe four patients in whom the clinical picture began with agitation and dyspnea. Once the diagnosis was established, and after decompression of the surgical wound, tracheal intubation proved impossible in two patients, who required emergency tracheostomy. Two patients died from lack oxygen. Our review of the literature and experience have led to the following recommendations that may prevent avoidable deaths: a) the caregivers directly responsible for these patients should receive specific training; b) long-term monitoring and observation should take place in recovery units where early signs and symptoms can be detected and treated immediately; c) tracheostomy or 24-hour intubation should be considered when surgery in this anatomic region is highly invasive; d) consider that postoperative agitation in these patients is a symptom of hypoxia unless another cause is demonstrated; and e) the zone must be decompressed rapidly by opening the surgical wound and safeguarding the airway whenever obstructive hematomas present.

Airway Obstruction↗
PubMed1997

[Gas embolism secondary to intraoperative use of hydrogen peroxide].

Hydrogen peroxide solution (H2O2) is used to irrigate and clean wounds. When applied to tissue hydrogen peroxide decomposes rapidly as a result of the action of catalases, releasing oxygen in the process. High pressure irrigation of the washing of closed cavities can cause serious complications. We report a case of gas embolism arising from the use of hydrogen peroxide during surgery for hydatidosis of the liver. A 64-year-old woman underwent surgery for removal of a hydatid cyst of the liver. When pressurized injection of 10 ml of 3% hydrogen peroxide was applied to the cystic cavity, cardiac arrhythmias were observed, a long with decreased PetCO2, hypotension and a "water mill" heart murmur. Gas embolism was suspected and treatment was instated immediately. Clinical course was good and without complications. We wish to warn against the potential dangers of using peroxide during surgery and of the importance of capnography for early diagnosis of gas embolism.

Embolism, Air↗
PubMed1997

[Compromized postadenoidectomy respiration in a child with obstructive sleep apnea syndrome].

A two-year-old boy with a history of slow growth, snoring during sleep and adenoid hypertrophy underwent adenoidectomy and transtympanic drainage under general anesthesia. Immediately after extubation, severe inspiratory stridor and shallow labored breathing began and persisted over a period of two hours, in spite of corticoid administration and oxygen therapy. The signs receded partially when the patient was seated and with a mandibular traction maneuver. As symptoms persisted, foreign body obstruction was ruled out by examination of the cavum and upper airway under general anesthesia and with orotracheal intubation. The patient was transferred to the pediatric intensive care unit, where he remained intubated for 18 hours. After extubation, stridor and shallow labored breathing reappeared but gradually receded as the residual effects of sedation disappeared. The parents mentioned symptoms suggestive of obstructive sleep apnea syndrome (OSAS) occurring since the boy was 6 months old and that had worsened in recent months. OSAS in children is characterized by intermittent obstruction of the upper airway during sleep, causing snoring and periods of apnea/hypopnea that lead to hypoxemia and hypercapnia. The most frequent cause is hypertrophy of the adenoid and tonsils, and the treatment of choice is adenotonsillectomy, although the risk of postoperative respiratory distress in such children is high. It is important to rule out OSAS in children who are candidates for adenotonsillectomy so that such patients are not scheduled for ambulatory surgery, but rather given adequate postoperative monitoring and treatment.

Adenoidectomy↗
PubMed1996

[Hemodynamic response to intubation with Macintosh and McCoy blades].

INTRODUCTION: The McCoy laryngoscope incorporates a modification of the Macintosh blade designed to facilitate laryngoscopy and difficult intubation. One end is articulated to allow better viewing of the larynx. Use of this blade reduces pressure placed on tissues in the supraglottic area during laryngoscopy. OBJECTIVE: We designed this study to compare the hemodynamic repercussions of laryngoscopy and tracheal intubation (LTI) performed with either a Macintosh or the McCoy blade. PATIENTS AND METHOD: Sixty ASA I-II patients scheduled for elective surgery requiring LTI were randomly assigned to 2 groups of 30 patients each. In both groups anesthetic induction was achieved with 0.04 mg.kg-1 midazolam, 0.002 mg.kg-1 fentanyl, 2 mg.kg-1 propofol and 0.1 mg.kg-1 vecuronium. In group 1 LTI laryngoscopy and intubation were performed using the Macintosh size 3 blade and in group 2 the McCoy size 3 blade was used. Systolic and diastolic arterial pressures and heart rate were recorded in each patient before anesthetic induction (baseline), 1 minute after induction and 5 minutes after start of LTI. RESULTS: We found no significant differences between the 2 groups at any of the recording times. CONCLUSION: The data obtained do not allow us to assert that there is any difference in hemodynamic response to LTI associated to type of blade used.

Adolescent↗
PubMed1995

[Anuria in the third trimester of pregnancy in a patient with renal transplant].

We present a pregnant patient with a transplanted kidney experiencing chronic rejection, with chronic kidney failure and arterial hypertension. During the third trimester the patient's kidney function deteriorated somewhat and hypertension worsened. In the thirty-second week of pregnancy uterine activity increased, fetal movement decreased and oliguria progressed rapidly to anuria, leading to an emergency cesarean section. Surgery was performed under epidural anesthesia; after removal of the fetus diuresis immediately began and was maintained. Both mother and infant recovered, but after three months the patient entered a hemodialysis program due to terminal kidney failure. The risk of acute kidney failure is greater in the parturient who has been the recipient of a transplanted kidney because of the functional overload that pregnancy involves, the possible exacerbation of acute or chronic rejection, and the higher incidence of pyelonephritis and preeclampsia. The extraperitoneal location of the transplanted organ in the iliac fossa may cause obstructive anuria. Our patient's recovery of diuresis immediately after removal of the fetus suggests that the excretory channel coming from the kidney was compressed by the uterus.

Acute Kidney Injury↗
PubMed1990

[Transient block of the brachial plexus after catheterization of the subclavian vein].

Two cases are reported of brachial plexus anaesthesia and palsy after catheterization of the subclavian vein. This very rare complication occurred after several unsuccessful attempts to catheterize one or both subclavian veins. This was due to inexperience, with insufficient knowledge of clinical anatomy, infiltration with unnecessarily high doses of local anaesthetic, and accidental puncture of the brachial plexus by an infraclavicular approach. One of the patients also had iatrogenic pneumothorax.

Aged↗