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Biomedical subjects

J I Casas

Publications and source records attributed to J I Casas.

At least 19 recordsLinked to original sources
PubMed2005

[False low oximetry reading caused by patent blue vital dye during breast surgery].

Patent blue vital (patent blue V; Laboratoire Guerbet, France) is used to identify the sentinel node during surgery for invasive breast cancer. Detecting the sentinel node that first drains the primary tumor reduces the need for total breast and wide axillary node removal, with the problems that such radical surgery involves. Like other dyes, patent blue V can interfere with accurate pulse oximeter reading, leading to underestimation of real values. We report the case of a 31-year-old woman who underwent lumpectomy and removal of the sentinel node. After intradermal injection of patent blue V dye into the left breast (100 mg administered because the sentinel node was difficult to locate) a drop in peripheral oxyhemoglobin saturation from 99% to 93% was detected by the pulse oximeter. When arterial blood gas analysis showed normal values and other causes were ruled out, the diagnosis was false low oximetry reading due to patent blue V dye.

Adult↗
PubMed1998

[Obstetrical anesthesia in 15 women with myasthenia gravis].

OBJECTIVES: To report our experience in managing anesthesia during obstetric delivery of women with myasthenia gravis (MG) and to review the anesthetic technique of choice for vaginal or cesarean delivery in such cases. PATIENTS AND METHODS: Fifteen pregnancies in 12 patients were recorded between 1980 and 1996; 14 cases were documented. Disease course during pregnancy, delivery and postpartum, the course of pregnancy, the presence of severe neonatal myasthenia and anesthetic treatment during vaginal or cesarean delivery were analyzed. RESULTS: Improvement in MG was observed in 6 cases. No change was seen in 4 patients and 3 worsened. In one woman generalized MG debuted 15 days after delivery. Two neonates were premature and a third suffered severe neonatal myasthenia. Six vaginal deliveries were aided by forceps; 8 deliveries were by cesarean and 1 fetus was aborted. Lumbar epidural anesthesia was employed in 73.33% (5 vaginal deliveries and 6 cesareans) and general anesthesia in 26.66% (1 abortion, 1 vaginal delivery and 2 cesareans). CONCLUSIONS: Continuous lumbar epidural anesthesia is the technique of choice for vaginal as well as cesarean deliveries. The combination of opioids and local anesthetics is considered particularly beneficial for patients, as it allows the motor blockade to be decreased. General anesthesia is only indicated when there is bulbar involvement. Short-acting non depolarizing agents, among them atracurium Besilate, are the muscle relaxants of choice. Succinylcholine is contraindicated. Thanks to current optimization of anesthetic and recovery techniques and administration of non depolarizing muscle relaxants with neuromuscular monitoring, the prognosis for pregnant MG patients has improved considerably.

Adult↗
PubMed1996

Continuous infusion is superior to bolus doses with thoracic paravertebral blocks after thoracotomies.

OBJECTIVES: This study was designed to determine whether a continuous thoracic paravertebral infusion of bupivacaine (continuous TPVI) offers a higher quality of analgesia than a bolus regimen after thoracotomy. DESIGN: A prospective and randomized study. SETTING: It was conducted by an anesthesiology and pain clinic department in a university hospital. PARTICIPANTS: Thirty patients were included in this study. INTERVENTIONS: As postoperative analgesia, the patients received either 20 mL of 0.375% bupivacaine every 6 hours (n = 15; bolus group), or a loading dose of 15 mL of 0.375% bupivacaine, plus an infusion of 5 mL of 0.25% bupivacaine every hour (n = 15; infusion group). MEASUREMENTS AND MAIN RESULTS: Pain intensity was assessed at rest and on movement (coughing) at 0, 1, 4, 10, 20, and 48 hours by means of the visual analog scale. The need for additional rescue analgesia, bupivacaine plasma concentration in the infusion group, blockade level (pinprick), and vital signs were also recorded. There were no significant differences regarding the additional rescue analgesia, vital signs, and pinprick level. However, the pain scores were significantly higher in the bolus group at rest and on movement (p < 0.01). The bupivacaine plasma concentration was low with a Cmax of 1.841 +/- 0.20 micrograms/mL at 15 hours. No systemic toxicity or other side effects were seen. CONCLUSION: Results suggest that continuous TPVI provides better pain control than the bolus regimen after this kind of surgery.

Adult↗
PubMed1996

[Anesthesia for thoracoscopy].

The thoracoscopy is used both for diagnosis and treatment of pleural and lung diseases. We describe our experience in managing anesthesia for such procedures, the number of which is increasing thanks to technical advances. We review 82 thoracoscopic procedures, 48 of which were video assisted. Sixty-two were performed under balanced general anesthesia (GA) with isoflurane, fentanyl and atracurium. Local anesthesia (LA) with fractionated doses of propofol and fentanyl was used in 20 cases. The mean age of patients receiving LA (63 +/- 17 years) was significantly greater (p < 0.05) than those receiving GA (49 +/- 13 years). ASA IV patients were given LA and sedation. Selective bronchial intubation was performed in 46 cases. Complications during surgery were severe hypoxemia (SpO2 < 85%) requiring suspension of selective lung ventilation in 8 cases, moderate hypoxemia (spO2 < 90% and > 85%) in 1 case, coughing in 3 cases and agitation in 1 case. Video-thoracoscopy is a safe technique that is less invasive than conventional thoracotomy. The number of applications is increasing, although its future place in thoracic surgery must still be determined.

Adult↗
PubMed1995

Heparin-induced thrombocytopenia and heart operation: management with tedelparin.

Anticoagulation for cardiopulmonary bypass in the infrequent clinical setting of thrombocytopenia associated with the use of unfractionated heparin is a very serious problem. We describe a case in which a low-molecular-weight heparin (tedelparin) was selected for this purpose based on a platelet aggregation test, permitting adequate anticoagulation during cardiopulmonary bypass for valve replacement. This case report might help establish an adequate anticoagulation protocol when faced with a patient suffering from this condition.

Cardiopulmonary Bypass↗
PubMed1995

Aprotinin versus desmopressin for patients undergoing operations with cardiopulmonary bypass. A double-blind placebo-controlled study.

BACKGROUND: Aprotinin reduces blood loss in operations done with cardiopulmonary bypass, whereas the use of desmopressin remains controversial. We compared aprotinin, desmopressin, and placebo in a double-blind, randomized trial to evaluate bleeding and transfusion requirements. METHODS AND RESULTS: One hundred forty-nine patients (48 received aprotinin, 50 desmopressin, 51 placebo) were included. Blood loss and transfusion requirements were recorded and levels of Factor VIII coagulant activity, von Willebrand's factor, thrombin-antithrombin complexes, and D-dimer were measured. Overall blood loss was 195 +/- 146 ml/m2 in the aprotinin group, 400 +/- 192 ml/m2 in the desmopressin group, and 489 +/- 361 ml/m2 in the placebo group (95% confidence intervals: difference between desmopressin and aprotinin 98 to 312 ml/m2, p < 0.001; difference between placebo and aprotinin 190 to 398 ml/m2, p < 0.001). Twenty-six percent of patients treated with aprotinin, 66% of those treated with desmopressin, and 56% of those treated with placebo were given transfusion (95% confidence intervals: difference between aprotinin versus placebo plus desmopressin 51% to 71%, p < 0.001). Fibrinolytic activation throughout cardiopulmonary bypass was markedly higher with placebo or desmopressin administration. D-dimer level correlated with overall blood loss in patients receiving desmopressin or placebo, but not in those receiving aprotinin. CONCLUSION: Aprotinin administration reduces blood loss and transfusion requirements in cardiopulmonary bypass. This benefit may be explained by a lower activation of fibrinolysis.

Antithrombin III↗
PubMed1995

[Analgesia of postoperative pain in ambulatory surgery].

Although the role of outpatient surgery has become increasingly important in the campaign to reduce waiting lists and health care costs, careful control and treatment of postoperative pain too often receives slight attention. Pain control after surgery must produce high quality analgesia without lengthening the hospital stay or increasing the risk of complications. The risk of side effects must be low, the safety margin wide and administration simple. Anesthesiologists must therefore take preventive measures as well as apply techniques during and after surgery that diminish the intensity of pain and the incidence of nausea or vomiting. Drugs that act in the short term and have few side effects, regional anesthesia (depending on type of operation), non-opioid analgesics and balanced analgesia seem to give good quality control of pain after outpatient surgery.

Ambulatory Surgical Procedures↗
PubMed1993

[Cardiac tamponade: a fatal complication of parenteral nutrition].

Several complications are associated with the use of central venous catheters for total parenteral nutrition; cardiac tamponade is one of the most severe. The recent use of flexible materials made of silastic polymeric silicone has great decreased the incidence of this complication, but has not eliminated wholly. We report the case of a patient with fatal cardiac tamponade, while receiving parenteral hyperalimentation trough a silicone central venous catheter placed in the right jugular internal vein, secondary to superior vena cava perforation. The physiopathological mechanisms, precautionary measures and treatment are discussed.

Adult↗
PubMed1991

[The long-term results of aortocoronary bypass surgery in patients with a severe preoperative left ventricular dysfunction].

We analyze retrospectively the short- and long-term results of coronary artery bypass surgery in 50 patients with severe left ventricular dysfunction operated in a period of 11 years. Sixty-six percent of patients had unstable angina and 12% of total presented angina post-acute postmyocardial infarction. Thirty-eight percent of patients were in preoperative functional class III-IV of NYHA. Three-vessel disease was present in 70% of the patients, two-vessel in 30%, and the main trunk was affected in 12% of the global. Hospital mortality was 4% (2/50) due to low cardiac output syndrome. Follow-up was available in all the survivors and ranged 6 months-11 years (mean: 4.8 +/- 3.1). During follow-up, 13 patients died, but in only six was due to cardiac cause. The 35 patients followed were in functional class I-II of NYHA. Eighty-eight percent of the patients were angina free at follow-up. Actuarial analysis, after exclusion of 3 patients who died of causes no directly related to the heart, showed an intrahospital survival rates of 96%; at first year was 92, at 3rd was 78%, and 5th year survival rates were 75%. In conclusion, patients with symptomatic angina and preoperative severe left ventricular dysfunction, coronary artery bypass graft has a low hospital mortality, is effective in improving angina and heart failure, and the long-term survival is acceptable.

Actuarial Analysis↗