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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
PubMed1997

[Air-convection heater for abdominal surgery. Study of the relation between surgical time and the efficacy of body temperature maintenance].

OBJECTIVES: 1) To quantify the efficacy of forced air warming for maintaining body temperature during general anesthesia of adults, and 2) to study the relation between the duration of surgery and the level of thermal protection provided by the device used. PATIENTS AND METHODS: We studied 30 adult patients of both sexes who were scheduled for abdominal surgery involving laparotomy. After three patients were excluded because surgery was unfeasible, the remaining 27 were allocated randomly to a control group (n = 14) or a group (n = 13) to be warmed by a Bair Hugger (Augustine Medical Inc.) heater. Esophageal temperature was checked every 30 min by one probe of a modular thermometric channel (Mon-a-therm) 6510 Mallincrodt, while ambient temperature was monitored by the second probe. RESULTS: Significant differences in esophageal temperature were observed between the two groups from the second hour after start of surgery, and the differences increased over time. Differences were observed at the end of surgery (Bair group: 36.4 +/- 0.5 degrees C; control group: 34.7 +/- 1.1 degrees C) and upon admission to the intensive care recovery unit (Biar group: 36.3 +/- 0.6 degrees C; control 34.8 +/- 1.0 degrees C) (p < 0.0001). CONCLUSIONS: The Bair Hugger heater is effective during abdominal operations lasting two or more hours. The device not only prevented hypothermia from deepening during surgery, but also reversed hypothermia in spite of being used after anesthetic induction and in spite of the loss of heat produced by secondary vasodilation.

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↗
PubMed1996

[María Oliveras: pioneer of neuroanesthesia in Catalonia].

María Oliveras Collelmir (1910) was the first woman to practice anesthesiology in Catalonia and one of the first physicians to receive formal training in the specialty at the important Nuffield Department of Anaesthetics in Oxford. She pioneerèd the use of general anesthesia with tracheal intubation for neurosurgery. This article relates how Dr. Oliveras introduced general anesthesia with endotracheal intubation for neurosurgery in Catalonia and pays well-deserved homage to this enterprising woman, who overcame family obstacles and social prejudices of the time to become the first female anesthesiologist in Catalonia.

Anesthesia, General↗
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↗
PubMedDate not supplied

[Selective right bronchial intubation using tracheal tubes under fibroscopic guidance].

We have evaluated the technique of right bronchial intubation for selective right pulmonary ventilation using one lumen tracheal tubes as an alternative to double lumen tubes. We studied 20 patients ASA II-III with a relatively preserved pulmonary function who were programmed for left thoracotomy. We used Shiley nr. 9 or Mallinckrodt nr. 11 tubes. After endotracheal intubation the tube was blindly advanced to the main right bronchus. The position of the tube was assessed by auscultation and it was verified and modified, if necessary, by fibroscopic visualization. The tube was advanced in such a way that Murphy's hole of the endotracheal tube remained in front of the exit of the right superior lobar bronchus. In three patients (15%) blinded placement of the tube was appropriate and in 4 patients (20%) fibroscopic replacement of the tube was required. In the remaining 13 patients (65%) placement of the tracheal tube was considered incorrect: tube rotation in 7 cases, upper placement of the Murphy's hole with respect to the origin of the superior lobar bronchus in 4 cases, and excessive distal placement of Murphy's hole with respect to the superior lobar bronchus in 2 patients. Complications related with the incorrect position of the tube were: leaking of gas into the left bronchium in 5 patients (25%), displacement of the tracheal tube into the main left bronchus requiring withdrawal of the tube to the trachea in one case (5%), hypoxemia (saturation of O2 lower than 90%) in spite of ventilation with FiO2 = 1 in two patients, moderate hypercapnia in three cases, and atelectasis of the right superior lobe during the postoperative phase in three patients (15%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Obstetric analgesia using continuous epidural perfusion of bupivacaine, adrenaline, and fentanyl].

OBJECTIVES: To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth. PATIENTS AND METHODS: Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out. RESULTS: Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable. CONCLUSIONS: Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.

Analgesia, Epidural↗
PubMedDate not supplied

[EMLA. A new topical anesthetic].

The method most widely used at present for cutaneous analgesia is local anesthetic infiltration. Pain occurs when the needle penetrates and when the anesthetic is deposited and diffuses. The procedure is not risk-free. It is therefore not surprising that many attempts have been made to develop an anesthetic formula that is effective when applied topically to intact skin. Early efforts were unsuccessful due to either low analgesic efficacy or side effects. The problem was solved several years ago in the European market by the EMLA (Eutetic Mixture of Local Anesthetics) cream. The EMLA cream has been shown to be useful as a topical anesthetic on either intact or damaged skin. Its clinical profile is safe, with a low incidence of side effects. We feel it is a useful tool for preventing pain in a variety of procedures that call for cutaneous analgesia. It may also be used as premedication for perineural injection of anesthetics, providing greater comfort for the patient. This article describes the main pharmacological principles that make EMLA an effective topical analgesic, as well as indications for its use in the clinical practice of anesthesiology.

Anesthetics, Local↗
PubMedDate not supplied

[Evaluation of tissue perfusion by simultaneous non-invasive monitoring of the hemodynamic profile and capnography].

OBJECTIVES: To assess the simultaneous variations in blood gases and CO2 tele-expiratory pressure (ETCO2) produced by changes in tissue perfusion in anesthetized patients with stable lung perfusion, alveolar ventilation and metabolic states. MATERIAL AND METHODS: Forty patients were divided into two groups. Group 1 included 20 ASA I patients undergoing orthopedic surgery on the lower extremities. Group 2 included 20 ASA I-III patients undergoing peripheral vascular surgery during which myocardial depression developed after isoflurane administration. The decrease in minute volume was measured in the descending aorta by esophageal ultrasound in both groups. Other hemodynamic parameters were measured by digital plethysmography. ETCO2 was measured by lateral aspiration capnography, and central venous pressure was measured in group 2 by subclavian venous catheter. Measurements were taken before and after release of the tourniquet in group 1, and before and after the decrease in minute volume (> 30%) in group 2. RESULTS: Release of the tourniquet after a mean compression time of 51 +/- 07 minutes produced an increase of 52% (p < 0.001) in minute volume in all patients in group 1; an increase of 23% (p < 0.001) in ETCO2; and a decrease of 60% (p < 0.001) in total vascular resistance. In group 2 a 15% decrease in ETCO2 (p < 0.01) was observed, coinciding with a 35% decrease in minute volume (p < 0.01). CONCLUSIONS: An increase in minute volume produces an increase in ETCO2 while a decrease in minute volume results in a decrease in ETCO2. This means that sharp changes in ETCO2 may be useful in judging the degree of change in tissue perfusion when other parameters like alveolar ventilation, lung perfusion and metabolic rate remain constant.

Adult↗
PubMedDate not supplied

[Massive endobronchial hemorrhage due to pulmonary artery rupture caused by a Swan-Ganz catheter].

We present the case of a 69-year-old male bearing a Swan-Ganz catheter while undergoing aortic and mitral valve replacement. Massive hemorrhage through the endotracheal tube began after closure of the sternotomy. Selective endobronchial intubation was performed and the thorax immediately reopened to reveal a tear in the right pulmonary artery at the level of the middle lobar branch. The tear was sutured, and throughout the early postoperative hours the patient presented signs of active bleeding through thoracic drains, with persistent slight hemoptysis in the right branch of the endotracheal tube. Ventilation was controlled artificially with two synchronized respirators and positive end-expiratory pressure (PEEP) up to 10 cm H2O in the right lung. The double-lumen tube was removed after 15 days with no complications and the patient was released two months after surgery. Massive endobronchial hemorrhage resulting from perforation of the pulmonary artery or its tributaries caused by Swan-Ganz catheters requires early diagnosis and treatment based on airway protection and immediate location and control of the point of hemorrhage. Selective endobronchial intubation with double-lumen tubes, direct arterial surgery and use of PEEP may constitute a valid alternative for management of these patients, making resection unnecessary.

Aged↗