Biomedical subjects
A Villalonga
Publications and source records attributed to A Villalonga.
[Miliary pulmonary tuberculosis and massive hemoptysis].
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[Peridural morphine in opiate addicts].
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Carbon dioxide embolism during laparoscopy and hysteroscopy.
Venous carbon dioxide embolism is a rare but potentially lethal complication of laparoscopy. The risk is increased when it is associated with hysteroscopy. A case is presented of a young women undergoing laparoscopy and hysteroscopy for infertility. Cardiovascular collapse and cardiac arrest, associated with a mill-wheel murmur, occurred during hysteroscopy at the time of a change of position. The patient had irreversible brain damage and died a week later. Early diagnosis and prevention of this serious complication are discussed.
Ketamine for treatment of priapism.
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[Ischemia of the hand after radial puncture treated with continuous axillary block].
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[Plexus block by the axillary route].
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[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.
[Morbidity and mortality related to anesthesia and surgery in 60 patients treated with bariatric surgery].
OBJECTIVE: To identify the factors predicting morbidity and mortality in patients undergoing bariatric surgery for morbid obesity in our hospital. METHOD: Sixty bariatric surgery patients whose body mass indexes (BMI) exceeded 35 kg.m-2 were studied retrospectively. We examined the incidence of associated disease, the perioperative period, type of surgery, anesthetic technique, postoperative analgesia and the incidence of major complications. RESULTS: Fifty-one women and 9 men (mean age 43.33 +/- 10.25 years, mean BMI 46.41 +/- 6.04 kg/m-2) were studied. The incidences of high blood pressure (55%) and obstructive sleep apnea syndrome (40%) were high. Nine patients (15%) were physical status (ASA) I, 18 (30%) were ASA II, 27 (45%) were ASA III and 6 (10%) were ASA IV. Major complications developed in 3 cases (5%) in the first 24 h and in 8 (13.33%) in the first 7 days. The mortality rate was 0% among ASA I and II patients, 3.7% (1 death) among ASA III patients, and 33.33% (2 deaths) among ASA IV patients. All who died were men. The only factor that predicted morbidity in the first week after surgery was BMI. Both morbidity in the first 24 h and mortality were associated with greater underlying disease in our patients undergoing bariatric surgery. CONCLUSION: Major complications of bariatric surgery occurred in 18.3% of our patients and mortality was 5%. Physical status was a prognostic factor for both early (24 h) postoperative morbidity and mortality in our morbidly obese patients, whereas BMI was related to morbidity during the first week after surgery.
Prevention of post dural puncture headache with epidural-administered dextran 40.
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[Postoperative patient-controlled analgesia is more effective with epidural methadone than with intravenous methadone in thoracic surgery].
OBJECTIVE: To compare the efficacy and side effects of epidural and intravenous methadone for postoperative patient-controlled analgesia (PCA) after thoracic surgery. PATIENTS AND METHODS: A randomized, single-blind trial enrolling 30 patients distributed in 2 groups to receive intravenous methadone (ivPCA group) or epidural methadone (epPCA group). Patients in both groups were administered a loading dose of 0.05 mg.kg-1 followed by infusion of 0.5 mg.h-1. The patients could self-dose 0.5 mg with a lock-out interval of 10 minutes and a maximum of 4 doses per hour. Patient characteristics, type and duration of surgery and fentanyl dose were recorded. Pain was assessed on a visual analog scale (VAS). Level of sedation, respiratory rate and occurrence of nausea, vomiting and pruritus were also recorded over the first 24 hours. RESULTS: The 2 groups were comparable. Pain was greater in the ivPCA group than in the epPCA group in the second hour (VAS 3.93 +/- 1.9 and 2.4 +/- 1.65, respectively; P < .05) and the third hour (VAS 3.57 +/- 1.65 and 1.5 +/- 1.16, respectively; P < .05). The total dose of methadone administered was 25.34 +/- 5.65 mg in the ivPCA group and 18.82 +/- 3.52 mg in the epPCA group (P < .002). There were no significant differences in side effects. CONCLUSIONS: The results suggest that epidural methadone has an intrinsic spinal effect regardless of whether or not there is extra-spinal action arising from syste mic absorption. Epidural methadone provides a more adequate analgesic effect in less time and at a lower dose. Both approaches provide good postoperative analgesia with few side effects.
[Anesthesia with sevoflurane for tonsillectomy in a boy with Duchenne muscular dystrophy].
A 6-year-old boy with Duchenne muscular dystrophy (DMD) and foreseen difficult tracheal intubation underwent tonsillectomy under general inhaled anesthesia with sevoflurane. No neuromuscular blockers were administered and no perioperative complications emerged. In spite of advances in genetic diagnosis there continue to be patients with DMD because of spontaneous mutation of the dystrophin gene. Late detection leaves them vulnerable to administration of drugs like succinylcholine that can trigger fatal reactions involving hyperpotassemia, rhabdomyolysis, and malignant hyperthermia. Total intravenous anesthesia seems the best way to provide general anesthesia for a patient with DMD. Inhaled anesthesia is an alternative. Although halogenated agents can lead to rhabdomyolysis and malignant hyperthermia, the frequency seems low if we bear in mind that the use of sevoflurane is widespread in pediatrics. In this case sevoflurane induction facilitated safe tracheal intubation.
[Comparative study of radial and cubital arterial catheterization].
In this prospective study we evaluated catheterization of the cubital artery as an alternative to cannulation of the radial artery. Seventy six surgical patients were randomly allocated into two groups of 38 patients according to the intention to catheterize the cubital or the radial artery. The incidence of failure and the technical difficulties were significantly higher in cubital than in radial arterial catheterization (p less than 0.001 and p less than 0.05, respectively) and they were related to the cubital pulse palpation. There were no significant differences in the time elapsed to achieve the catheterization, time of stability of the catheter, nor in the incidence of complications. The qualification of the technician, the arterial blood pressure and the anatomic characteristics of the forearm did not influence the results. We conclude that whenever the cubital arterial pulse is appropriately perceived, catheterization of this artery is a good alternative to radial catheterization.
[Comparative study of propofol and sodium thiopental in short-duration anesthesia].
We have compared propofol and sodium thiopental in two groups of 20 women undergoing curettage. Patients received premedication with diazepam and were randomly allotted to propofol group (2 mg/kg, intravenously) or sodium thiopental group (5 mg/kg, intravenously). Anesthesia maintenance was carried out with spontaneous ventilation with 0(2)-N2O. When complementary doses were required, 20% of the initial dose was administered. There were no significant differences with respect to base arterial blood pressure and heart rate on induction, 2 minutes after induction and at the end of the operation. The time from the end of the operation to the patient began to respond to the order of open eyes and to the patient was aware enough to establish a coherent talk and to seat without help was similar in both groups. Adverse effects were minor in bith groups and significantly more frequent in propofol group. We conclude that propofol is a particularly interesting new anesthetic agent for short duration anesthesia.
[Glucose-6-phosphate dehydrogenase deficiency: anesthetic implications].
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[Nitroglycerin spray in the prevention of hypertension induced by electroconvulsive therapy].
The aim of this study was to determine if 0.4 mg of nitroglycerin (NTGs) administered by sublingual route in spray before the electroconvulsive therapy (ECT), attenuated the associated hypertensive response. In 21 patients who were between 17 and 77 years old, 81 sessions of ECT were performed. NTGs was administered in 38 sessions. The rest 43 sessions was considered control group. In the control group ECT caused a significant increase of systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p less than 0.05) when compared with basal values. In NTGs group the increase of SBP and DBP was not significant when compared with basal values. Those changes were mainly observed in patients over 45 years old. In conclusion, 0.4 mg of NTGs significantly attenuate the hypertensive response that is caused by ECT in patients over 45 years old.
[Effect of the peridural methadone concentration in postoperative analgesia].
The analgesic characteristics of 3 to 6 mg epidural methadone administered in two different concentrations for postoperative analgesia have been compared in two homogeneous groups of patients submitted to surgical procedures on trunk or legs. Methadone was given at a concentration of 0.1% in group I (70 patients) and diluted in 10 ml saline in group II (35 patients). Methadone doses were calculated on the basis of age and weight of the patient and the performed surgical procedure. Mean latency for analgesia was 25 +/- 11 min in group I and 28 +/- 13 min in group II. The duration of the analgesia was significantly longer (p less than 0.01) in group I (9.7 +/- 5.6 h) than in group II (5.7 +/- 2.4 h). Side effects were not frequent and without clinical significance in both groups. Epidural methadone is an effective method for postoperative pain relief. Drug concentration modifies the duration of the analgesia and concentration of 0.1% gives better results than more diluted preparations.