Background and aimSevere hemodynamic fluctuations during dental treatment can trigger highly unde... more Background and aimSevere hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone.Materials and methodsForty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target‐controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment.ResultsBlood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG.ConclusionsGeneral anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.
Sir: It has been proposed that severely hypoxemic patients be ventilated in the prone position, i... more Sir: It has been proposed that severely hypoxemic patients be ventilated in the prone position, in an attempt to improve gas exchange [1]. Testing this position in patients with the acute respiratory distress syndrome (ARDS) is recommended [21. However, no guidelines are available for cases of life-threatening events occurring with the patient in the prone position especially cardiac arrest. We report a case of successful cardiopulmonary resuscitation of a patient ventilated in the prone position, without changing the patient's position. A 48-year-old man was being ventilated for community-acquired pneumonia. His gas exchange (partial pressure of oxygen in arterial blood 4.3 kPa and of carbon dioxide 16.4 kPa and pH 7.14) deteriorated despite controlmode ventilation with 10 cmH20 positive end-expiratory pressure, 100 p. 100 fractional inspired oxygen, and 20 ppm inhaled nitric oxide. He was then turned to the prone position. A few minutes later, asytole developed and blood pressure became unobtainable. Cardiac massage was begun immediately with the patient in the prone position. One physician placed the flat of one hand under the patient's sternum, while another physician compressed the mid-thoracic spine rhythmically with both hands (Fig. 1). Arterial radial blood pressure was maintained at least at 80/35 mmHg throughout resuscitation. Epinephrine (1 mg i.v.) was injected twice at a 3-min interval. Five minutes after starting cardiac compression, sinus rhythm resumed and blood pressure was maintained at 140/85 mmHg. Gas exchange dramatically improved a few hours later. Seven days after the incident, the patient was awake and well oriented. The conventional approach of closed chest compression is well established with the patient in the supine position [3]. However, cardiac massage might be required for patients in the prone position, e.g., during anesthesia for spinal or posterior fossa surgery. Three cases of successful resuscitation have been reported in these circumstances [4, 5] in which resuming the supine position might have injured the brain or spinal cord. Changing the position has some other drawbacks for ARDS patients ventilated in the prone position: (a) it is time consuming and delays initiation of cardiac massage; (b) moving the patient into the supine position without proper protection may induce certain complications, e.g., accidental extubation, dislodging the venous catheter, or shoulder injury to the patient; (c) turning a patient from one position into another requires at least four members of staff, who are not always immediately available in emergency situations. For these reasons, we suggest trying the
Revista española de anestesiología y reanimación, 1999
OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially infla... more OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially inflated to 75% of the volume, as recommended by manufacturers. PATIENTS AND METHOD We studied 60 ASA I-II patients scheduled for outpatient surgery under general anesthesia with numbers 3 or 4 laryngeal masks, after having obtained informed consent from the patients (or parents in the case of minors). The patients were randomly assigned to two groups. In group A the masks were inserted inflated to 75% of volume as recommended by manufacturers, whereas in group B deflated masks were inserted as described by Brain. Anesthesia was standardized for all patients. One patient was withdrawn from the study when a technical error was detected. We recorded the presence of criteria predictive of difficult airway management, systolic and diastolic blood pressures, heart rate at four times (baseline, before and after induction and after insertion of the mask), number of insertion tries, final mask volume...
Revista espanola de anestesiologia y reanimacion, 1999
The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubat... more The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubation in patients with criteria predictive of difficult airway control. The new device looks like the conventional laryngeal mask but offers a series of design changes that allow orotracheal intubation to be accomplished without visualization of the glottis. The rigid metal tube is bent and incorporates a metal handle; the two fixed bars that prevent the epiglottis from falling and blocking the opening have been replaced by a moveable bar that rises with the passage of the endotracheal tube and the exit of the V-shaped metal tube guides the endotracheal tube that was specially designed for this use. We describe three patients with cervical disease, one with advanced ankylosing spondylitis, one with traumatic luxation of the C6-C7 articulation and one diagnosed of two cervical disk hernias. All their tracheas were intubated without difficulty through the Fastrach mask with the patients'...
Revista espanola de anestesiologia y reanimacion, 1999
OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially infla... more OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially inflated to 75% of the volume, as recommended by manufacturers. PATIENTS AND METHOD We studied 60 ASA I-II patients scheduled for outpatient surgery under general anesthesia with numbers 3 or 4 laryngeal masks, after having obtained informed consent from the patients (or parents in the case of minors). The patients were randomly assigned to two groups. In group A the masks were inserted inflated to 75% of volume as recommended by manufacturers, whereas in group B deflated masks were inserted as described by Brain. Anesthesia was standardized for all patients. One patient was withdrawn from the study when a technical error was detected. We recorded the presence of criteria predictive of difficult airway management, systolic and diastolic blood pressures, heart rate at four times (baseline, before and after induction and after insertion of the mask), number of insertion tries, final mask volume...
Based on experimental and clinical data derived fro m the literature, etiopathogenic factors of l... more Based on experimental and clinical data derived fro m the literature, etiopathogenic factors of lumbar radicular pain are reviewed. The anatomic characteristics of the spinal nerve roots explain their clinical behavior. Compre ssion is neither the only one nor the most important factor. Vascular and neural inflammatory factors have to be consid e red, and the role of the dorsal root ganglion has to be also assessed. The recognition of the multifactorial etiopathogenicity of radicular pain will help to improve the clinical analysis and the selection of the therapeutic indication.
We present two cases of iliac artery damage arising from surgery to correct a lumbar disc hernia ... more We present two cases of iliac artery damage arising from surgery to correct a lumbar disc hernia due to ventral perforation. The first was a pseudoaneurysm of the left iliac artery with a retroperitoneal hematoma diagnosed by ultrasound and TAC on the third day after surgery. The second was a retroperitoneal hematoma diagnosed by intraoperative ultrasound after the patient was shifted to a new position. Emergency laparotomy was performed on both patients to repair the damage. This is an unusual but serious complication, and in most cases requires intuitive diagnosis and lifesaving surgery.
ABSTRACT Background Fibromyalgia (FM) is a musculoskeletal chronic pain condition with low respon... more ABSTRACT Background Fibromyalgia (FM) is a musculoskeletal chronic pain condition with low response to pharmacological conventional treatment (CPhT). Multidisciplinary treatment (MT) has showed efficacy in improving FM symptoms. Nevertheless, MT has not been studied in patients with FM and obesity. Objectives To compare the benefits of the CPhT versus the MT (with pharmacological, cognitive-behavioural, and physiotherapy treatments) in a sample of women with FM and obesity (Body Mass Index ≥30). Methods 44 women with obesity and FM according to the American College of Rheumatology criteria. Mean age 49.9 years (S.D. 6.4). 21 patients attended CPhT and 23 MT. Patients were assessed before treatment, after treatment, and at 3-6-12 month follow-up. Outcomes were: pain intensity (Numeric Rating Scale), functionality (FIQ), psychological distress (HADS), quality of life (COOP-WONCA), and sleep problems (Medical Outcome Study: MOS). Results The interaction group x time with mixed linear model analyses demonstrated that patients of the MT group improved more than patients of the CPhT group in pain intensity (p<.001), functionality (p<.0001), quality of life (p<.05), and sleep index problems (p<.001). Conclusions MT consisting of pharmacological treatment, cognitive-behavioural psychological treatment and physiotherapy improves FM symptoms in women with FM and obesity. Improvements were maintained at follow-up. Supported by the Foundation Maratό Grant Number 070910 Disclosure of Interest None Declared
Limited mouth opening is an important contributing factor to difficult tracheal intubation. Exist... more Limited mouth opening is an important contributing factor to difficult tracheal intubation. Existing guidelines recommend the use of awake techniques but they are often badly tolerated by patients who sometimes refuse consent. We present three patients with limited mouth opening but with no other criteria for difficult airway management and normal upper airway imaging, who refused awake techniques. They were managed with general anaesthesia and nasotracheal intubation using the McGrath series 5 videolaryngoscope.
Background and aimSevere hemodynamic fluctuations during dental treatment can trigger highly unde... more Background and aimSevere hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone.Materials and methodsForty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target‐controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment.ResultsBlood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG.ConclusionsGeneral anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.
Sir: It has been proposed that severely hypoxemic patients be ventilated in the prone position, i... more Sir: It has been proposed that severely hypoxemic patients be ventilated in the prone position, in an attempt to improve gas exchange [1]. Testing this position in patients with the acute respiratory distress syndrome (ARDS) is recommended [21. However, no guidelines are available for cases of life-threatening events occurring with the patient in the prone position especially cardiac arrest. We report a case of successful cardiopulmonary resuscitation of a patient ventilated in the prone position, without changing the patient's position. A 48-year-old man was being ventilated for community-acquired pneumonia. His gas exchange (partial pressure of oxygen in arterial blood 4.3 kPa and of carbon dioxide 16.4 kPa and pH 7.14) deteriorated despite controlmode ventilation with 10 cmH20 positive end-expiratory pressure, 100 p. 100 fractional inspired oxygen, and 20 ppm inhaled nitric oxide. He was then turned to the prone position. A few minutes later, asytole developed and blood pressure became unobtainable. Cardiac massage was begun immediately with the patient in the prone position. One physician placed the flat of one hand under the patient's sternum, while another physician compressed the mid-thoracic spine rhythmically with both hands (Fig. 1). Arterial radial blood pressure was maintained at least at 80/35 mmHg throughout resuscitation. Epinephrine (1 mg i.v.) was injected twice at a 3-min interval. Five minutes after starting cardiac compression, sinus rhythm resumed and blood pressure was maintained at 140/85 mmHg. Gas exchange dramatically improved a few hours later. Seven days after the incident, the patient was awake and well oriented. The conventional approach of closed chest compression is well established with the patient in the supine position [3]. However, cardiac massage might be required for patients in the prone position, e.g., during anesthesia for spinal or posterior fossa surgery. Three cases of successful resuscitation have been reported in these circumstances [4, 5] in which resuming the supine position might have injured the brain or spinal cord. Changing the position has some other drawbacks for ARDS patients ventilated in the prone position: (a) it is time consuming and delays initiation of cardiac massage; (b) moving the patient into the supine position without proper protection may induce certain complications, e.g., accidental extubation, dislodging the venous catheter, or shoulder injury to the patient; (c) turning a patient from one position into another requires at least four members of staff, who are not always immediately available in emergency situations. For these reasons, we suggest trying the
Revista española de anestesiología y reanimación, 1999
OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially infla... more OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially inflated to 75% of the volume, as recommended by manufacturers. PATIENTS AND METHOD We studied 60 ASA I-II patients scheduled for outpatient surgery under general anesthesia with numbers 3 or 4 laryngeal masks, after having obtained informed consent from the patients (or parents in the case of minors). The patients were randomly assigned to two groups. In group A the masks were inserted inflated to 75% of volume as recommended by manufacturers, whereas in group B deflated masks were inserted as described by Brain. Anesthesia was standardized for all patients. One patient was withdrawn from the study when a technical error was detected. We recorded the presence of criteria predictive of difficult airway management, systolic and diastolic blood pressures, heart rate at four times (baseline, before and after induction and after insertion of the mask), number of insertion tries, final mask volume...
Revista espanola de anestesiologia y reanimacion, 1999
The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubat... more The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubation in patients with criteria predictive of difficult airway control. The new device looks like the conventional laryngeal mask but offers a series of design changes that allow orotracheal intubation to be accomplished without visualization of the glottis. The rigid metal tube is bent and incorporates a metal handle; the two fixed bars that prevent the epiglottis from falling and blocking the opening have been replaced by a moveable bar that rises with the passage of the endotracheal tube and the exit of the V-shaped metal tube guides the endotracheal tube that was specially designed for this use. We describe three patients with cervical disease, one with advanced ankylosing spondylitis, one with traumatic luxation of the C6-C7 articulation and one diagnosed of two cervical disk hernias. All their tracheas were intubated without difficulty through the Fastrach mask with the patients'...
Revista espanola de anestesiologia y reanimacion, 1999
OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially infla... more OBJECTIVE To compare two ways of inserting laryngeal airway masks: uninflated and partially inflated to 75% of the volume, as recommended by manufacturers. PATIENTS AND METHOD We studied 60 ASA I-II patients scheduled for outpatient surgery under general anesthesia with numbers 3 or 4 laryngeal masks, after having obtained informed consent from the patients (or parents in the case of minors). The patients were randomly assigned to two groups. In group A the masks were inserted inflated to 75% of volume as recommended by manufacturers, whereas in group B deflated masks were inserted as described by Brain. Anesthesia was standardized for all patients. One patient was withdrawn from the study when a technical error was detected. We recorded the presence of criteria predictive of difficult airway management, systolic and diastolic blood pressures, heart rate at four times (baseline, before and after induction and after insertion of the mask), number of insertion tries, final mask volume...
Based on experimental and clinical data derived fro m the literature, etiopathogenic factors of l... more Based on experimental and clinical data derived fro m the literature, etiopathogenic factors of lumbar radicular pain are reviewed. The anatomic characteristics of the spinal nerve roots explain their clinical behavior. Compre ssion is neither the only one nor the most important factor. Vascular and neural inflammatory factors have to be consid e red, and the role of the dorsal root ganglion has to be also assessed. The recognition of the multifactorial etiopathogenicity of radicular pain will help to improve the clinical analysis and the selection of the therapeutic indication.
We present two cases of iliac artery damage arising from surgery to correct a lumbar disc hernia ... more We present two cases of iliac artery damage arising from surgery to correct a lumbar disc hernia due to ventral perforation. The first was a pseudoaneurysm of the left iliac artery with a retroperitoneal hematoma diagnosed by ultrasound and TAC on the third day after surgery. The second was a retroperitoneal hematoma diagnosed by intraoperative ultrasound after the patient was shifted to a new position. Emergency laparotomy was performed on both patients to repair the damage. This is an unusual but serious complication, and in most cases requires intuitive diagnosis and lifesaving surgery.
ABSTRACT Background Fibromyalgia (FM) is a musculoskeletal chronic pain condition with low respon... more ABSTRACT Background Fibromyalgia (FM) is a musculoskeletal chronic pain condition with low response to pharmacological conventional treatment (CPhT). Multidisciplinary treatment (MT) has showed efficacy in improving FM symptoms. Nevertheless, MT has not been studied in patients with FM and obesity. Objectives To compare the benefits of the CPhT versus the MT (with pharmacological, cognitive-behavioural, and physiotherapy treatments) in a sample of women with FM and obesity (Body Mass Index ≥30). Methods 44 women with obesity and FM according to the American College of Rheumatology criteria. Mean age 49.9 years (S.D. 6.4). 21 patients attended CPhT and 23 MT. Patients were assessed before treatment, after treatment, and at 3-6-12 month follow-up. Outcomes were: pain intensity (Numeric Rating Scale), functionality (FIQ), psychological distress (HADS), quality of life (COOP-WONCA), and sleep problems (Medical Outcome Study: MOS). Results The interaction group x time with mixed linear model analyses demonstrated that patients of the MT group improved more than patients of the CPhT group in pain intensity (p<.001), functionality (p<.0001), quality of life (p<.05), and sleep index problems (p<.001). Conclusions MT consisting of pharmacological treatment, cognitive-behavioural psychological treatment and physiotherapy improves FM symptoms in women with FM and obesity. Improvements were maintained at follow-up. Supported by the Foundation Maratό Grant Number 070910 Disclosure of Interest None Declared
Limited mouth opening is an important contributing factor to difficult tracheal intubation. Exist... more Limited mouth opening is an important contributing factor to difficult tracheal intubation. Existing guidelines recommend the use of awake techniques but they are often badly tolerated by patients who sometimes refuse consent. We present three patients with limited mouth opening but with no other criteria for difficult airway management and normal upper airway imaging, who refused awake techniques. They were managed with general anaesthesia and nasotracheal intubation using the McGrath series 5 videolaryngoscope.
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