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Biomedical subjects

F Vidal

Publications and source records attributed to F Vidal.

314 records · Page 18Linked to original sources
PubMedDate not supplied

[Thoracic epidural anesthesia by the caudal route in pediatric anesthesia: age is a limiting factor].

OBJECTIVES: To evaluate the success and degree of difficulty of inserting an epidural catheter into the caudal space in order to place its distal end at T10 in young patients. PATIENTS AND METHODS: Forty-seven children up to 97 months old were studied. With the patients under general anesthesia with an orotracheal tube, a predetermined length of 18-G epidural catheter (Minipack: SYSTEM 2-Portex) was inserted to T10. X-rays were taken after surgery with 0.3 ml of iodine contrast. The catheter was considered well-placed if the distal end was between T10-T12; the approach was classified as easy, difficult or impossible. RESULTS: The catheter was placed at T12-T10 on 16 occasions: 6 in L1, 3 in L2, 4 in L3, 17 in L4-L5, and 1 in S1. T10-T12 was reached in 52% of patients under 1 year of age, but in only 17% of children older than 1 year. The L4-L5 epidural space was reached with 46 of 47 catheters. Advance was easy in 41 cases, with only 16 reaching the objective. Advance was difficult in 6 cases, with only 1 reaching L1 and none reaching T10-T12. All catheters were easily removed. CONCLUSIONS: It is not possible to guarantee the arrival of an 18-G epidural catheter to the thoracic epidural space by entering through the caudal route. In children over 1 year of age, the level of success decreases significantly. Easy advance of the catheter cannot be taken to be a sign of success.

Age Factors↗
PubMedDate not supplied

[Propofol: ED50 and ED90 induction doses in pediatric anesthesia].

OBJECTIVE: To study ED50 and ED90 induction doses of propofol in children. PATIENTS AND METHODS: Seventy-two children from 1 to 110 months of age and premedicated with pentobarbital 4 mg/kg participated in the study. Seven different doses of propofol (1.5, 2, 2.5, 3, 3.5, 4 and 4.5 mg/kg) were injected into the dorsal hand or foot vein in 30 seconds. We measured the response to application of the mask, corneal reflex and response to trapezius muscle compression 30 and 60 s after administration. A log-probit statistical analysis was used and complications were noted. RESULTS: The doses that produced 50% elimination of reflexes (ED50) or 90% elimination (ED90) in our patients were 1.74 and 3.95 mg/kg for response to mask; 2.47 and 4.26 mg/kg for elimination of corneal reflex; and 3.27 and 4.79 mg/kg for compression of trapezius. Frequency of pain upon injection was 74% and that of spontaneous movement was 12%. Apnea (breathing halted for longer than 20 s) occurred in 7% of our patients. We recorded no cases of broncho or laryngeal spasm, or skin rash. CONCLUSIONS: Induction with propofol is appropriate given the rarity of stimulant effects, but there is a high frequency of pain upon injection, limiting the usefulness of this drug for anesthetic induction in pediatrics. ED50 and ED90 varies depending on the stimulus assessed.

Age Factors↗
PubMedDate not supplied

[Anesthesia recovery, gas exchange and postoperative hepatic and renal function in patients with morbid obesity undergoing bariatric surgery: comparison of the effects of halothane, isoflurane and fentanyl].

OBJECTIVES: To compare the postoperative effects of three anesthetic agents, fentanyl, halothane and isoflurane, on recovery from anesthesia, changes in arterial blood gases, and tests of liver and kidney function in morbidly obese patients recovering from vertical ring gastroplasty. MATERIAL AND METHODS: Thirty-three patients were studied, randomly distributed into three groups of 11. Induction for all was with atracurium (5 mg), 2.5% thiopentone sodium (5-6 mg.kg-1), succinylcholine (1.5 mg.kg-1) and orotracheal intubation. Anesthesia was maintained with intermittent doses of fentanyl (group F), 2% halothane (group H) or 2.5% isoflurane (group I). All patients received a 50% O2/N2O mixture at a minute volume calculated on ideal weight. Muscle relaxation was achieved by continuous perfusion of atracurium. Postoperative analgesia was by morphine chloride through a lumbar epidural catheter. Time of eye opening and time of extubation were recorded. Arterial blood gas measurements were taken and the results of liver and kidney function tests were recorded until the 7th day after surgery. RESULTS: Eye opening after awakening was earlier in the fentanyl group (6 +/- 5 min), but no differences were found for time of extubation. Blood gas measurements for the 33 patients revealed a significant decrease in PaO2 (58 +/- 14 mmHg), a slight increase of PaCO2 (40 +/- 6 mmHg) and a lower pH (7.32 +/- 0.04) immediately after surgery. On day seven, PaO2 had not yet reached preoperative levels (p < 0.01). These results were independent of anesthetic agent used. Kidney function tests showed significant rises in SGOT (81 +/- 36 U/l), SGPT (150 +/- 110 U/l) and bilirubin (Bil: 15 +/- 5 mmol/l) and decreases in prothrombin activity (PT: 73 +/- 11%) 24 hours after surgery, with later normalization. Urea fell significantly throughout the seven-day period (3.2 +/- 1.3 mmol/l). These results were also independent of the anesthetic agent used. CONCLUSIONS: Morbidly obese patients undergoing gastroplasty recover from anesthesia in the same way regardless of the agent used. The early postoperative period is characterized by severe hypoxemia and transitory changes in kidney function tests. Neither of these findings is dependent on the agent used.

Adult↗
PubMedDate not supplied

[Anesthesia in surgery for epilepsy].

OBJECTIVES: To evaluate the efficacy of general anesthesia during epileptic surgery. MATERIAL AND METHODS: A retrospective study of 64 patients who received general anesthesia during epileptic surgery. In the preoperative period, anticonvulsive medication was adjusted in accordance with plasma levels and withdrawn entirely 8 hours before surgery. After premedication with droperidol and fentanyl, a balanced anesthetic technique was applied, based on pentothal, pancuronium (or vecuronium), fentanyl, N2O and isoflurane. Continuous monitoring of ECG, arterial blood pressure, pulse oximetry, ET CO2 and neuromuscular function. Isoflurane was stopped for 10 min after the opening of the duramadre so that ECoG could be recorded and methohexital or propofol was given in some cases in order to activate the epileptogenic focus. Muscular relaxation was restored intraoperatively following the study of somatosensory evoked potentials. Immediate and later complications related to anesthesia or surgery were recorded. RESULTS: The surgical procedure performed in most cases was temporal or frontal resection, with a mean duration for anesthesia of 377 +/- 50 min and for surgery of 318 +/- 50 min. Only one patient received local anesthesia and no hemodynamic changes were observed. Perioperative complications were cerebral edema (4 cases), arrhythmia (2 cases) and bronchospasm (1 case). Postoperative complications were as follows: 3 of 9 patients undergoing callosotomy required mechanical ventilation for 24 hours, 4 patients experienced language alterations, 3 wounds were infected, 2 cases of hemiplegia were observed, 1 status epilepticus occurred after administration of propofol and there was 1 case of respiratory distress. Anticonvulsive medication was given parenterally after surgery. CONCLUSIONS: General anesthesia is a safe and effective method for epileptic surgery, with local anesthesia providing additional sedation for isolated cases. Appropriate treatment requires an understanding of the pharmacokinetics and pharmacodynamics of the drugs used, as well as knowledge of the condition and the anticonvulsive medications used.

Adolescent↗
PubMedDate not supplied

[Economic analysis of an anesthesiology, resuscitation, and pain therapy service].

In this study we analyzed costs and income recorded in 1992 for an anesthesia department at a university hospital in Catalonia. We have broken down overall expenses into subcategories for each service provided by the department: anesthesia, intensive care, and pain (acute and chronic) therapy. We have also analyzed the department's income for these services, with particular attention to the acute pain clinic.

Acute Disease↗
PubMedDate not supplied

[Structure and function of an outpatient surgery unit].

In order for a surgical intervention to be performed in an outpatient regime three basic requisites must be met: adequate patient selection, appropriate type of surgery and adequate unit. These factors are important for the surgical procedure to be carried out with identical safety and success as that undertaken in an admitted patient. In out patient surgery, early psychomotor recovery and slight or lack of secondary effects are fundamental; thus, anesthetic technique is selected keeping these two points in mind as they determine the criteria for the release of the patients from hospital.

Adolescent↗
PubMedDate not supplied

Spread of local anesthetic into the epidural caudal space for two rates of injection in children.

BACKGROUND AND OBJECTIVES: The optimal rate of injection of local anesthetic in pediatric caudal blocks has not been determined. The purpose of this study was to determine the influence of two rates of injection on the level of analgesia in children. METHODS: The patients, 79 children, American Society of Anesthesiologists class 1, who were scheduled for minor surgery, were allocated to three groups according to age: group 1, 0-12 months; group 2, 13-36 months; and group 3, 37-72 months. Each age group was further divided randomly into two subgroups according to rate of injection: subgroup A received 1 mL/kg of 0.25% bupivacaine with 1:200,000 epinephrine at a rate of 1 mL/s, and subgroup B received the same dose at a slower rate of 1 mL per 10 s. Level of analgesia was assessed by loss of sensation to skin pinching. Age, weight, height, time of surgery, onset, and level of analgesia and complications were recorded. RESULTS: For the faster rate, significant differences in level of analgesia were found between groups 1 and 2; the groups were not significantly different for the slower rate, however. The median level in patients 12 months and under was two dermatomes above that of patients older than 12 months at both rates. The levels for each rate (subgroups A and B) were not significantly different in any age group. The time needed to reach the highest level became progressively longer with age (from group 1 to 3), and differences were significant at both rates. CONCLUSIONS: Level of analgesia is not affected by the rate injection of 0.25% bupivacaine into the epidural caudal space in children. The time needed to reach the highest level increases as the child ages.

Anesthesia, Epidural↗