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Biomedical subjects

J M Villar Landeira

Publications and source records attributed to J M Villar Landeira.

At least 19 recordsLinked to original sources
PubMed2002

Comparison of auditory evoked potentials and the A-line ARX Index for monitoring the hypnotic level during sevoflurane and propofol induction.

BACKGROUND: Extraction of the middle latency auditory evoked potentials (AEP) by an auto regressive model with exogenous input (ARX) enables extraction of the AEP within 1.7 s. In this way, the depth of hypnosis can be monitored at almost real-time. However, the identification and the interpretation of the appropriate signals of the AEP could be difficult to perform during the anesthesia procedure. This problem was addressed by defining an index which reflected the peak amplitudes and latencies of the AEP, developed to improve the clinical interpretation of the AEP. This index was defined as the A-line Arx Index (AAI). METHODS: The AEP and AAI were compared with the Modified Observers Assessment of Alertness and Sedation Scale (MOAAS) in 24 patients scheduled for cardiac surgery, anesthetized with propofol or sevoflurane. RESULTS: When comparing the AEP peak latencies and amplitudes and the AAI, measured at MOAAS level 5 and level 1, significant differences were achieved. (mean(SD) Nb latency: MOAAS 5 51.1 (7.3) ms vs. MOAAS 1: 68.6 (8.1) ms; AAI: MOAAS 5 74.9 (13.3) vs. MOAAS 1 20.7 (4.7)). Among the recorded parameters, the AAI was the best predictor of the awake/anesthetized states. CONCLUSION: We conclude that both the AAI values and the AEP peak latencies and amplitudes correlated well with the MOAAS levels 5 (awake) and 1 (anesthetized).

Anesthesia↗
PubMed2002

[The creation of the first anesthesiology service in Spain (Hospital de la Santa Cruz y San Pablo, Barcelona 1941)].

On the sixtieth anniversary of the founding of the first Spanish anesthesia department, we review factors that led to its creation and its early development. Hospital de la Santa Cruz y San Pablo in Barcelona was the place where the service was established for several reasons. The first was the growing need for anesthesia to be administered by specialized physicians able to handle problems developing during and after surgery. The second was the presence of a prestigious surgeon, Dr. Juan Soler Juliá, who perceived the need, alongside the only physician in Spain who was completely dedicated to anesthesiology, Dr. José Miguel Martínez. Finally, the fact that professional anesthesiology allowed a physician to earn a decent income triggered interest in the specialty among physicians.

Anesthesia Department, Hospital↗
PubMed2000

[Comparison of an auditory evoked potentials index and a bispectral index versus clinical signs for determining the depth of anesthesia produced by propofol or sevoflurane].

OBJECTIVES: To evaluate an anesthetic depth index (ADI) obtained from auditory evoked potentials and a bispectral EEG index (BIS) in comparison with clinical assessment of anesthetic depth using the modified observer's assessment of awareness/sedation scale (MOAA/SS), for induction of anesthesia with propofol or sevoflurane as the only agent. PATIENTS AND METHODS: The ADI and BIS were recorded simultaneously in this prospective study and compared to the MOAA/SS during the anesthetic induction of 26 adults undergoing elective heart surgery. Assignment of patients to two groups was random. Group A (n = 13) patients were induced with propofol (target dose 5 micrograms.ml-1 in 5 min). Induction in group B (n = 13) was with sevoflurane (8% tidal volume). A scheme of awake-sleeping-awake-sleeping was followed. The means of the two indexes were compared (Mann-Whitney test) one minute before the patient slept (awake) and one minute later (sleeping), and the evolution of the indexes was compared during awake/sleep and sleep/awake phase changes and while the patients were in a stable sleep phase. The sensitivity and specificity of each index was analyzed in function of the MOAA/SS. We also analyzed the time elapsing from the moment the patient fell asleep (MOAA/SS 2) until the two indexes reached published reference values (ADI = 38, BIS = 60). RESULTS: After induction with propofol (group A) the ADI fell to 29.2 +/- 11.7 and the BIS fell to 63.5 +/- 13.4. After induction with sevoflurane (group B) the ADI fell to 33.8 +/- 14.9 and the BIS to 66.8 +/- 15. The ADI value that best discriminated between arousal and sleeping (sensitivity 100%) was 38; the BIS value that best discriminated was 60. The responses to sound in decibels (dB) during "awake/sleeping" and "sleeping/awake" phases were, respectively, -3.8 dB and -4.5 dB for the ADI and -1.5 dB and -0.8 dB for the BIS. With the patient in stable sleep, response to the two indexes was at -0.79 dB. In group A, the ADI detected MOAA/SS 2 significantly earlier (ADI 13.1 +/- 30 s; BIS 56 +/- 36 s; p < 0.05). No patient reported remembering the study period. CONCLUSIONS: Monitoring anesthetic depth with the ADI or BIS was technically easy and effective for detecting whether patients were awake or sleeping. The ADI response was faster and identified awake/sleeping and sleeping/awake phase changes better than did the BIS.

Adult↗
PubMed1999

[Impossibility of intubation due to angioedema secondary to an angiotensin-converting enzyme inhibitor].

Angioedema secondary to treatment of one year's duration with angiotensin converting enzyme inhibitor (ACEI) (lisinopril) in a 56-year-old man scheduled for elective cardiac surgery led unexpectedly to impossible intubation. Surgical access (tracheostomy) was required when airway control was threatened. We review the clinical course, etiology and treatment of angioedema secondary to ACEI therapy. This is a life threatening complication which, though rare, is becoming increasingly frequent with increased use of such drugs.

Angioedema↗
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↗
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↗
PubMedDate not supplied

[Intracardiac knotting of a Swan-Ganz catheter. Detection using intraoperative trans-esophageal echocardiography].

Transoesophageal echocardiography is a new technique that allows continuous and noninvasive assessment of cardiac function during surgery. More recently this technique is being used to detect the presence of external objects into the cardiac cavities. We report a case of Swan-Ganz catheter knotting confirmed by this echocardiography technique. He was a 57 year old male with previous history of arterial hypertension and ischemic heart disease who was scheduled for surgery because poor response to medical therapy. After anesthetic induction a thermodilution catheter was introduced percutaneously into the right internal jugular vein under continuous pressure monitoring from the distal catheter hole. In view of the difficulties in introducing the catheter into the pulmonary artery an intravascular catheter knotting was suspected and a bidimensional transesophageal echocardiogram confirmed the diagnosis. During extracorporeal circulation the catheter was withdrawn through a right auriculotomy. Monitoring with a Swan-Ganz catheter, as other invasive monitoring techniques, is followed by a certain degree of complications which should be avoided by a careful manipulation. Echocardiography is a valuable diagnostic procedure to identify the position of monitoring catheters into the cardiac cavities.

Catheterization, Swan-Ganz↗