Revista Mexicana de Anestesiologia

Print ISSN: 0185-1012
Objetives: To evaluate the effectiveness of the postoperative analgesia with buprenorphine for elective Caesarean section. Material and methods: We carried out a traverse prospective and comparative study in 40 patients with pregnancy to term, with unique product, cephalic presenration, ASA I-II, with diagnosis of cefalo-pelvic disproportion, programmed for Caesarean section, with 20-35 year-old, weight of 60 to 80 kg. The blockade level was L2-L3 for postoperative analgesia. 2 groups of 20 patients were studied; the group I received bupivacalne to 0.125% to 0.15 ml/kg in physiologic solution for a total of 12 ml. dose average of 10 mg. Group II received buprenorphine 3 mcg/kg more bupivacaíne 0.125% to 0.15 ml/kg dose average 10 mg., in physiologic solution for a total volume of 12 ml. The pain was valued with the similar visual scale (EVA), meansurement of pain before and after. The EVA was interpreted as follows: 0-3 no pain or light pain 4-6 moderate pain. 7-10 severe pain After buprenorphine administration FC, FR,T/A, analgesia and secondary effects as drowsiness, vomit, sedation. Results: We evaluated bupivacaine combination with buprenorphine and obtained a better pain control in the postoperative period (p. < 0.05) with duration of the analgesic effect of 6 to 7 hrs. without significant changes in blood pressure (p. = 0.08), and obtaining significance for respiratoty rate (p. < 0.05).
The main target for this study was to compare transanesthetic and postoperatory effects of the ropivacain 0.75% intratecal only one dose in relation to the bupivacaine 0.5% on operated patients of lower extremities orthopedic surgery. Material and Methods: With a previous authorization of the Hospital Ethic Committee, 128 patient of different adults ages. ASA I-IV, were studied and divided randomized into two groups: Group I ropivacaine 0.75% (3ml) and Group II bupivacaine 0.5% (3ml)subjected to regional intratecal anesthesia. It was compared the quality of the sensitive block and the motor block as we as the time of recovery of the motor block. We also calculated the value of the residual analgesic in each group of patients. An statistic analysis of the variable was made taking as a base:average and Standard desviation to compare the analysis a "T" test Student (p < 0.05) was realized. Results: It was calculated the value of the sensitive block reporting in Group I 10.46 ± 1.46 metameras and in Group II 13.51 ± 2.65 metameras with one p < 0.0001. The motor block reported a quicker recovery in Group I with 229.29 ± 21.94 minutes in relation to 266.09±21.42 minutes of Group II with p < 0.0001. Postoperatory analgesic of Group I was 9.48 ± 1.82 hours and of 5.65 ± 1.05 hours in the Group II (p < 0.0001). Conclusions: In our study ropivacaine 0.75% showed more effectiveness as local anesthetic intrathecal compared to bupivacaína al 0.5% as it showed a more lasting residual analgesic as well as motor block recovery an a less time and without big hemodynamic effects.
The present project is a longitudinal type study, it is prospective, comparative and open, done within a population of 50 pregnant patients who were programmed for a caesarean operation, between 18 and 45 years of age, without any suffering of acute fetal syndrome, classifi ed with ASA I-II, weighting no more than 90 kg, high school as minimum study level completed and completing a fast of at least 8 hours. The separation into two groups in the study was determined randomly. The patients who received 0.75% ropivacaine plus 13 mL more of fentanyl (2 mL) peridural were labeled as group (A), and patients who received only 0.75% ropivacaine to 0.75% (15 mL) were determined to be group (B). Fifty patients of an average age of 28.5 were studied, their average weight was 75.5 kg. The latency period was evaluated in both groups. A shorter latency period was found in group A in relation to group B with p =.000 with U of Mann-Whitney. In relation to the quality of anesthesia, it was good in both groups. In relation to post-operation pain, it presented itself later in group A p =.000 measured with U of Mann-Whitney. The heart rate and the arterial pressure went down in both groups p =.000. Conclusion: The combination of ropivacaine 0.75% plus peridural fentanyl during the caesarean operation lowers the latency period, gives good anesthesia quality and prolongs the post-operation analgesic time.
Radiografía portátil anteroposterior de tórax, en la cual se observan consolidaciones bilaterales e imagen en vidrio despulido.
Tomografía axial computarizada pulmonar. En ella, se observan los infiltrados parenquimatosos bilaterales en lóbulos superiores y medios, así como también las zonas de ocupación alveolar de lado derecho.
At the end of 2019, the virus causing the coronavirus disease (COVID-19) was identified in Wuhan, China, wich has affected more than 1.5 million people worldwide. The easy transmission by aerosols and direct contact, represents a challenge for personnel who manipulate the airway of these patients. We present the case of a 33-year-old woman diagnosed with COVID-19 pneumonia, under prolonged intubation scheduled for tracheostomy. The aim of this report is to review the anesthetic considerations during this procedure in this group of patients, in order to reduce the risk of contagion in health personnel.
The disease made by the COVID-19 virus causes the infectious respiratory acute severe syndrome known as SARS-2, this virus can penetrate the central nervous system affecting neurons and glial cells, is clinically manifested as encephalitis, ischemic stroke, and even polyneuropathy. When we confront a neuroquirurgic patient with positive COVID-19 we require a fast but detailed evaluation of the general and neurological status of the sick. Every surgery in presence of a positive COVID-19 patient, must be realized with high-level protection measures while the surgery happens. The use of craniotomes and electrocautery should be minimized in order to reduce aerosol production. Transsphenoidal endonasal procedures should be avoided during the period of the pandemic. We’re based in the concense of experts made by the SNACC (Society for Neuroscience in Anesthesiology and Critical Care) to emit recommendations adapted to our environment. Endovascular therapy is a viable alternative to the intravenous trombolisis for the reestablishment of circulation. It has been observed better reperfusion in those patients who didn’t received sedation, or this was light compared with the ones who did received general anesthesia. In some cases it’s indispensable the post-surgical extubation (specially in those patients who’re infected with COVID-19), so it should be kept as deep sedation and should traslade the patient to UCI. Is important the remember that infection by COVID-19 has been shown in the principal systems, causing multi-organ damage in susceptible patients, reason of why we’ll have to look tightly after every data that takes us to think in dysfunction in small and medium term. Ethical decision making regarding which patient is a candidate to a urgent decompressive craniectomy or endovascular treatment, if more than a vase is occluded, this will have to be discussed with the treating team to not fall in therapeutic cruelty or well in the omission of a opportune treatment.
Currently, the SARS-CoV-2 pandemic has put health systems to the test throughout their world. The impact of surgical stress and anesthesia on predisposition to a new COVID-19 infection or exacerbation of the infection in a COVID-19 infected patient to be operated on is unknown. Although COVID-19 mortality is between 1-5%, most deaths have occurred in elderly patients with underlying cardiopulmonary conditions, most of them hypertensive, diabetic and obese, therefore, it should be specially attention in its handling. Carefull perioperative preparation and planning is key in successfully achieving adequate clinical care and maintaining the safety of the health team in a difficult and high risk moment. An additional role for the anesthesiologist, considering that he has the most experience in the management of the airway, is to support the emergency services for endotracheal intubation of patients who require ventilatory support, being a procedure with very specific protection recommendations. Therefore, there is a commitment as specialists, to know the subject thoroughly and protect ourselves along with the health team involved in saving lives during this contingency.
Sala de endoscopía.
Clasificación y reconversión de los hospitales.
The high demand about anesthesiologist support out of the «security» operating rooms areas have increased exponentially, due to every day complex new practice in diagnoses, therapeutics and palliative technics. This proceedings, every day more complex have given rise to another chapter from the anesthesia, called anesthesia in non operating room area (NORA). In face the COVID-19 pandemic, there are a lot of papers about the restructuring of the operating rooms even the hospitals, but there is not enough information about NORA supports.
Infection with SARS-CoV-2 virus has a different behavior in pediatric patients, so the anesthetic approach may differ from that performed in adults. The present work touches on some generalities of anesthetic management of the pediatric patient that should be considered.
Gráfica de casos COVID-19 en la institución del 30-03-2020 al 30-05-2020. Fuente: los autores.
Palliative care becomes the tool during this pandemic to provide care and support to patients, family members and health personnel, controlling symptoms, promoting quality of life, helping in making difficult decisions and providing comprehensive health care, physical, psychological, social and spiritual. Our objective is to present our institutional model. A systematic narrative review of the literature available so far was performed.
Simulation-based learning has been widely used to improve response to crisis situations. It has played an important role in preparing care teams for patients with infections such as Ebola, influenza, severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). The recent pandemic caused by the coronavirus (SARS CoV-2) declared by the World Health Organization (WHO) in March of this year 2020, requires special attention in these moments, where the disease has exceeded the response of the health systems in several countries, so it is necessary training of response teams to reduce risks. The objectives proposed in this review through deliberate practice, the clinical scenario and simulation in situ, in the patient with suspected or infected by COVID-19, try to systematize the placement and removal of personal protective equipment (PPE), the management of the airway and the approach of the patient in cardiac arrest, in order to improve technical skills and strengthen non-technical skills. Furthermore, during the development of these strategies, unexpected situations can be identified and addressed, some compromise in patient and/or staff safety can be detected, which allows these deficiencies to be rectified and response capacity to be optimized. Likewise, it allows to reflect and analyze the emotions of the staff to prevent adverse situations regarding the performance of health workers. With this, it seeks to strengthen the safety and quality of patient care during the course of this pandemic.
The hospital transformation is well recognized as one of the paramount strategic points through history in order to prepare for the pandemic appearance. In 2020, the WHO declared COVID-19 a pandemic on March 11. As a result in the world and in our country, measures were taken in accordance to the individual capacity of each region. The speed of reaction for the completion of the transformation adds an extra element that burdens even more, this huge task. This process starts with the conjointly work of the hospital authorities and involves as well all the medical staff and health personnel trained in the diagnostic and treatment of the infected patients, which can reach a critical point in the developing of the disease. The launching of this process begins with the recount of the available resources, continuing with de transformation of hospital beds that were intended for other purposes to function as Intensive Therapy beds along with ventilatory support, besides making sure the participation of prepared health staff and enough medical supplies. In the pandemic development nowadays in our country the detection of the issues and the decision making should be made accordingly to the constant changes of this huge threat.
The appearance of the SARS-CoV-2 coronavirus disease, in China late 2019, has spread rapidly to become a pandemic, the clinical characteristics which range from being asymptomatic to having the severe form, where patients present abnormalities of the Coagulation, generally a hypercoagulable state, may evolve to disseminated intravascular coagulation, multiple organ failure, and / or death. It is important to investigate comorbidities; verify the coagulation status from the first contact, analyzing the routes: endogenous, exogenous, common, fibrinolytic system and platelet count, using technology like thromboelastography and sonoclot. The use of anticoagulants is indicated, it can be used unfractionated or low molecular weight heparin, with laboratory tests to adjust the dose, in order to avoid states of hypocoagulability, use blood products when necessary. Remember that antiviral treatment can have interactions with anticoagulants, especially oral ones, bleeding is not common. There are occlusion problems of installed catheters, one must avoid frequent of these washing with heparin. If the patient requires an emergency surgical or invasive procedure, it must verify the evolution of the coagulation, if it cannot be postponed, use treatment with blood products according to the alteration detected. Follow the management algorithm in the operating room to avoid infections from health personnel.
Código PO COVID-19. Elaborada por: Jiménez-Dávila O y Lorenzo-Betancourt A, 2020.
Pasos previos a la colocación de equipos de protección personal. Elaborada por: Jiménez-Dávila O y Lorenzo-Betancourt A, 2020.
Secuencia de colocación de los equipos de protección personal. Elaborada por: Jiménez-Dávila O y Lorenzo-Betancourt A, 2020.
Inducción anestésica paciente COVID-19. Elaborada por: Jiménez-Dávila O y Lorenzo-Betancourt A, 2020.
Secuencia de retirada de los equipos de protección personal. Elaborada por: Jiménez-Dávila O y Lorenzo-Betancourt A, 2020.
Currently, there is an undetermined number of surgical patients infected with coronavirus 2019 (COVID-19) due to the fact that its spread has been carried out at an unprecedented speed, for which reason the surgical areas have had to be reinforced. In the context of viral transmission risk procedures, the surgical team does not escape the high risk of contagion due to infection with the SARS-CoV-2 virus. The epidemiology of surgical pathologies will always have their prevalence, even in times of pandemic. A non-systematic review of the recommendations for the perioperative management of the COVID-19 patient published to date was carried out in order to organize and integrate the information regarding the perioperative management of the COVID-19 surgical patient in order to systematize the same language. adapted to the individual needs of each institution with the particularity of basing the management of this type of patients in 10 steps and thus safeguarding the integrity and protection of both health personnel and the patient himself.
En este artículo de revisión clínico epidemiológico se realizaron búsquedas en CENTRAL, MEDLINE, Oxford y CINAHL, ScienceDirect hasta el 8 de mayo de 2020. Se describe de forma puntual las medidas de prevención y control que el personal de salud debe aplicar a nivel hospitalario. Es muy importante que en los hospitales cuenten con protocolos de prevención y control ante la pandemia de COVID-19, la unidad debe contar con los recursos y el personal para atender a la población infectada, todo trabajador debe tener el entrenamiento del uso del equipo de protección personal (EPP), así como las medidas de higiene. Lo anterior debe aplicarse en todas las áreas del centro hospitalario, desde la recepción hasta en la UCI (Unidad de Cuidados Intensivos), en procedimientos médicos, desinfección y desechos.
The objective of these recommendations is that they are within the reach of any anesthesiologist, in order to carry out protective ventilation in the patient during the COVID-19 pandemic, in which a patient with unique characteristics is confronted, with difficult ventilatory management in a setting crisis of scarcity of resources, lack and fatigue of health personnel. We do not recommend using these guides in a different setting. © 2020, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.
Coronavirus disease 2019 (COVID-19) is highly contagious. Transmission is predominantly by droplet spread. Procedures during the initial handling of the airway and critical areas can generate drops and aerosols that increase the risk of transmission. The aim of this paper is to review the recommendations and guidelines related to airway management in patient infected by SARS-Cov-2.
Introducción: Los ventiladores de las MA constituyen un respaldo obvio de primera línea durante la pandemia COVID-19 cuando no hay suficientes ventiladores en las UCI para satisfacer las necesidades de atención del paciente. Objetivo: Actualizar a los médicos, que no son anestesiólogos, sobre las diferencias entre los ventiladores mecánicos y los de la máquina de anestesia, de manera que puedan ayudar a ventilar a los pacientes que sufren COVID-19. Desarrollo: Se revisaron los protocolos de actuación de varias Sociedades de Anestesiología y Reanimación, así como de Medicina Intensiva, de varios países, fundamentalmente de España, Chile, México y el Protocolo emitido por la CLASA sobre las consideraciones de cada uno de ellos para enfrentar, en caso de ser necesario, la ventilación mecánica con máquinas de anestesia en pacientes con COVID-19. Conclusiones: Las máquinas de anestesia modernas y los ventiladores mecánicos tienen similitudes y diferencias; pero ante esta situación, constituye un verdadero apoyo para que en lugares donde no existen suficientes ventiladores o no alcancen, la máquina de anestesia sea la sustituta de elección para ventilar a los pacientes con COVID-19.
The COVID-19 pandemic has forced us to rethink the way we practice some aspects of medicine. Cardiopulmonary resuscitation is a practice that generates aerosol particles from the airway, which increases the risk of SARS-CoV-2 infection. In this review, the international recommendations on the subject are consulted, high-risk moments are defined and recommendations are established on compressions, ventilation, electrical therapy and even pharmacology in patients with cardiac arrest and with a diagnosis of COVID-19, seeking not only the well-being of the patient, but also the safety of health personnel.
In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. We conducted the review to evaluate the latest evidence on the association between cerebrovascular, cardiovascular and kidney disease, and poor outcome in patients with coronavirus disease 2019 (COVID-19) pneumonia. Cardiovascular, cerebrovascular and kidney disease was associated with increased mortality and borderline increase in severity of COVID-19. Gender, age, hypertension, diabetes, and respiratory comorbidities did not influence the association.
An in situ simulation was performed of a patient with COVID-19 diagnosis that is schedule for emergency surgery. From the arrival to the Emergency Department to the exit from the operating theatre. Previously stablished protocols were performed, and areas of improvement were looked for.
Everything in medicine must be based and balanced on three pillars, the first is: a strong physiological principle; an explanation of what causes the pathological phenomenon that we are facing with which we find how this pathology can be reversed, the second pillar is an adequate statistical corroboration; a physiological principle may be true, but this does not imply that the outcome we seek (decrease in mortality) is the result of our interventions. The third pillar is a clinical protocol, which implies the most important part of all, working together. It is useless to believe that you know the truth, if that is the case, if you do not have the same goals in every shift, we run the risk of falling into the fallacy that «what I do is right and others are wrong», if we are not united in each shift of patient care we will never know what is best for the patient, we will only have a good pretext to affirm that the fault is never ours. During emerging crises you can work without statistics while it is being built, but never without physiology and unity (protocols), the physiological explanation given here is as accurate as possible, the protocol is an induction derived from said physiology, waiting to have Soon a statistic will tell us if what we do is useful or not. In conclusion, what the reader has in his hands are conjectures in search of refutations. At the time of writing this article the only correct answer is «We don’t know yet».
While the world is facing a pandemic caused by the virus 2019-nCoV, critical hospital areas like the surgical unit must be ready to prevent contamination of the environment and the healthcare provider. The main purpose of this article is to review the current recommendations for using personal protection equipment, introduce devices that can prove useful for the practice of anesthesia and to explain the modifications and adaptations that must be made to both human and material resources in the surgical unit.
In the current SARS-CoV-2 pandemic, little attention has been paid to the pediatric population due to its low morbidity and mortality. Due to the wide spectrum of presentation of this disease, in pediatric patients, it is necessary to recognize its different clinical presentations and the importance of pre-anesthetic evaluation in elective and emergency procedures in order to avoid the exposure of health personnel with infected patients and to reduce the perioperative morbidity in the pediatric patient with COVID-19.
In recent days, various protocols have been published for the prevention of transmission of the COVID-19 virus during manipulation of the airway. The article describes a form for airway management that is used in some hospitals in the Boyacá Colombia and Mexico City. This consists of nine phases that describe from the preparation of the medical equipment to be used, as well as the medical personnel that will perform the procedure, to the removal of the endotracheal tube. These phases are: placement of personal protective equipment, preparation, pre-oxygenation, induction, intubation, confirmation, aspiration tube, extubation and removal and disposal of material.
Introduction: Nitrous oxide (N2O) was used for over 150 years for its analgesic, ansiolytic and anesthetic. This study seeks to demonstrate that the use of N2O lower the dose of propofol during induction of anesthesia, at the height of Mexico City. Methods: A randomized, prospective and comparative study. We studied patients undergoing general were divided into groups: group A received 6 liters of oxygen, group B 4 liters of N2O and 2 liters of Oxygen per minute, reaching a concentration of exhaled N 2O 65%. We applied propofol at 20 mg per minute and assesses the loss of reflexes: verbal, handles and lid in seconds and the dose of propofol. Results: Demographic variables were not differences. Group A patients required a dose greater than 65% of propofol and the time was 54% higher for the loss of reflexes in relation to the group which use N2O - propofol. Conclusions: Nitrous oxide is useful as an anesthetic at the height of 2,240 meters above sea level. Significantly reduces the dose of propofol during induction of anesthesia.
Introduction: Multimodal analgesia associated to adjuvants like intravenous lidocaine is the current recommendation for postoperative pain in burned patients. The aim was to compare the intensity of postoperative pain in burned patients treated with multimodal analgesia with and without intravenouslidocaine. Material and methods: An observational study was performed in postoperative pain through the Visual Analogic Scale registered in records of burned patients to compare three schemes of multimodal analgesia: Non-lidocaine group, Intraoperative lidocaine group and Postoperative lidocaine group. Results: When comparing Intraoperative lidocaine group versus the Postoperative lidocaine group, the first one found lower pain intensity at all times of the records, but the difference was statistically significant in background pain (p = 0.01), at 24 hours (p = 0.002), 32 hours (p = 0.03), 40 hours (p = 0.002), 48 hours (p = 0.003), 56 hours (p = 0.002), 72 hours (p = 0.03), at the first (p = 0.02), second (p = 0.002) and the third postoperative day (p = 0.01). Conclusions: Burned patients treated with intravenous lidocaine infusion during surgery at dose of 2 mg/kg ideal body weight/hour as a component of a multimodal analgesia scheme presented lower intensity of postoperative pain. © 2018, Colegio Mexicano de Anestesiologia A.C. All rights reserved.
The history of regional anesthesia goes back to the discovery of cocaine in 1884 by Koeller. Since then its development has been accelerated achieving a preponderant place in the daily practice of anesthesia. Its range of benefits is very wide, but as any other technique, requires experience and expertise. Its use in neonates, infants and children, either as a sole anesthetic or combined with inhaled anesthesia, provides anesthesia and analgesia during and postoperatively. Local anesthetics block propagation of nerve impulses along the nerve fibers by inactivation of voltage-gated sodium channels; its action is not limited only to the sodium channels involved in nerve transmission, but also in those of other tissues like the central nervous and cardiovascular systems, as occurs in cases of overdose or massive absorption during inadvertent intravascular injection, which can lead to serious complications with life risk. Local anesthetic systemic toxicity (LAST) has to be recognized and treated immediately; new guidelines have been issued and clinicians have to be aware of them. The introduction of ultrasound guided blocks has revolutionized the practice of regional anesthesia particularly in small children where anatomy can be easily identified. This technique shows a clear advantage over the use of a neurostimulator or those based on anatomical landmarks, by allowing a clear visualization of neuraxial structures, shorter time to perform the block, reduced time to block onset and use of a smaller volume of local anesthetic. Regional anesthesia continuous to evolve towards improvement and safety. © 2018, Colegio Mexicano de Anestesiologia A.C. All Rights Reserved.
According to what was published by the WHO (World Health Organization), a first case of acute respiratory infection, of unknown origin, appeared in the province of HUBEI, CHINA, in the city of WUHAN, (December 2019). After having ruled out other etiological agents, the isolation of a new coronavirus (7-01-2020) was achieved, which was called new coronavirus (nCOV, COVID-19), currently named SARS-CoV-2. Coronaviruses, being important pathogens, can infect the respiratory, gastrointestinal, hepatic, and nervous systems of humans and birds, livestock, bats, mice, and other wild animals. Since the outbreaks of SARS (Severe Acute Respiratory Syndrome) in 2002 and MERS (Middle East Respiratory Syndrome) in 2012, the transmission of these viruses between humans and animals has been demonstrated.
Throughout the history of humanity, each time a pandemic occurs, a climate of uncertainty is generated, due to fear of the unpredictability of the situation, the possibilities of affecting it, the control it may have over it, and the how this pandemic will affect the socioeconomic conditions of a country. An adequate form of response by health authorities in situations like this is establishing an effective communication policy to allow a flow of confidence in the population. The goals of this communication before or during an outbreak are: educate, inform, recommend, prepare, and prevent. Faced with a situation like the current one, we face ethical problems, and a conflict is created between the individual good and the common good. In the face of a pandemic, the effectiveness necessary to combat it raises the need to prioritize certain groups, such as health professionals and workers, who will need to be more protected and cared for, precisely so that they can respond to the demand for care.
Introduction: In recent years there have been articles that have been proposed to prevent and/or reduce maternal and perinatal mortality, leading to establish hospital strategies to implement an immediate response team (ERI), through three actions: A) identify, B) treating and C) move. Objective: Present the case of a 39 year old woman in whom a pregnancy of 34-35 weeks was diagnosed with obstetric hemorrhage abruptio placenta abruption (abruptio placenta), in which the ERI HGO IMSS No. 221 was successfully active. Presentation of the case: We report the case of a patient of 39 years with 34-35 weeks gestation pregnancy, obstetric hemorrhage secondary to abruptio placenta abruption, underwent surgery for termination of pregnancy as emergency obstetric. Taking as fi ndings: multiple adhesions, placenta 100% detached, amniotic fl uid hematico 100%, umbilical cord with dark coloration blood count, multiple fi broids in anterior and posterior intramural and multiple fibroids in uterine serous with severe endometriosis, uresis 200 mL and 3,000 cm3 bleeding. Getting a newborn at 16:40 hrs woman weighing 2,250 grams, Apgar 6-7 size 47 cm and a Capurro of 36 weeks of gestation. Patient is transferred to the Intensive Care Unit (ICU) and the newborn Neonatal Intensive Care Unit (NICU). After a year of monitoring the patient and her daughter are healthy. Conclusions: Timely and effective activation of the ERI to emergency obstetric (Mater Code) saves lives, preserving the integrity of the maternal-fetal binomial. © 2017, Colegio Mexicano de Anestesiologia A.C. All rights reserved.
Introduction: The most common complications of peridural blockade are hypotension, high spinal anesthesia, backache, dural puncture, urinary retention, vascular or nervous injury, meningitis, cerebral abscess and toxicity due to absorption of the anesthetic. This study was carried out to identify the complications in 300 peridural blockades. Material and methods: Three-hundred anesthetic records of peridural blockades were randomly analyzed to identify all recorded complications and the percentage of each one in relation to the sample. Results: In this study, the only complication was dural puncture in 10 cases, representing 3.3% of the sample. Conclusions: Although other studies report more numerous complications of peridural blockade, in our hospital, where a large number of these blockades are performed, only one complication was seen. This shows that peridural regional anesthesia continues to be a safe and suitable technique for many types of surgeries and patients.
Diffuse hemangiomatosis is a condition of benign behavior that is associated with embryonic development abnormal congenital generally related to the Nocht cells (perivascular cells, non-endothelial origin) associated with HYS genes. The evolution of these lesions is not the usual as injuries go through three stages: proliferative phase in the first year of life, in the second one remission and the third postremision with an apparently healthy behavior, this makes their prognosis variable; when injuries are perpetuated in obstetric patients may have special consideration especially when lesions invade hemangiomatous structures of the upper airways and neuraxial region from the skin to the invasion of medullary vessels. The invasion of the digestive tract is usually associated with frequent bleeding endangering the fetal maternal wellbeing, hemodynamically are classified as low-flow conditions. We report a case of diffuse hemangiomatosis and 34 weeks of pregnancy. It was performed a pre-anesthetic assessment, toracocervical and abdominal ultrasound and NMR, determining the anesthetic technique, opting for general anesthesia with endotracheal intubation without complications. The prognosis is poor by frequent gastrointestinal bleeding and the possibility of it happening neuraxial and/or upper airways. © 2017, Colegio Mexicano de Anestesiologia A.C. All rights reserved.
Objetives: Determine the handling of the postoperative pain in the General Hospital number. 36 of Cd. Cardel Ver. Material and methods: We was carried out a descriptive investigation in patient postoperative, selecting the sample in the operating-theatre area, demographic data of the patient one, vital signs, analgesic and dose administered in the recovery room were captured, measuring the pain with the Visual Analogue Scale (VAS), You continuous determining these parameters for shift during the first 24 hrs. Results: 92 patients were studied, with an age of 44 ± 15 years, with prevalence of the feminine sex (70.6%) intervened surgically by cholecystectomy 33% and caesarean 13%, the anesthetic technique in 53.3% with general anesthesia, during the first 24 hours, the analgesic handling, employment single metamizol in 85%, with a dose average of 22 mg/kg, single Ketorolaco in 8% with a dose of 0.4 mg/Kg and single nalbufina in 1% with a dose of 0.1 mg/kg. The intensity of the pain measure by of VAS of 0-2 reports in the 28.%, of 3-5 the 50% and of 6-10 the 22%. Conclusions: one VAS of 3 at 5 indicate moderate pain which see predominant and a VAS from 6 to 10 indicates intense pain that which is observed in the 22-% the patients; the used doses are below the recommended in the literature, what indicates that the analgesic handling should improve.
Intensidad del dolor (en media).  
Introduction: Most postoperative patients do not receive adequate relief. In this area is where analgesic combinations may have advantages. Therefore, we decided to evaluate what the best dose of the combination of tramadol + ketorolac to control postoperative pain secondary to open cholecystectomy. Material and methods: 258 patients randomized into 3 groups were studied. Group 1 received 50 mg tramadol plus 20 mg ketorolac, Group 2 received 100 mg and 40 mg respectively, Group 3 placebo. Group 1 received 50 mg tramadol plus 20 mg ketorolac; Group 2 received 100 mg tramadol plus 40 mg ketorolac, and Group 3 received placebo. Intensity and pain quality were assessed using a visual analogue scale and the simplified version of the McGill questionnaire, respectively, every 4 hours for 24 hours. The adverse effects also were assessed. Statistical analysis, mean, standard deviation, chi-square test and student's t-test. Results: Pain intensity in the Group 1 was 4.62 ± 0.67, Group 2 was 2.97 ± 0.91, and Group 3 was 8.36 ± 0.80, value ≤ 0.0001. The qualities of the pain were Group 1: 5.08 ± 1.44, Group 2: 4.17 ± 1.13, and Group 3: 8.14 ± 0.83., P ≤ 0.001. Pain-free time was Group 1: 15.20 ± 3.29 hrs; Group 2: 20.00 ± 4.38, and Group 3: 4.70 ± 1.40 hours, P ≤ 0.0003. Side effects were Group 1: vomiting (9.3%), nausea (19.77%), drowsiness (20.93%); Group 2 vomiting (13.95%), nausea (25.58%), drowsiness (43.02%); and Group 3 vomiting (8.14%), and nausea (13.95%). Conclusion: The dose of 100 mg tramadol/40 mg ketorolac every 8 hours during the first 24 postoperative hours is safe and effective for pain control after open cholecystectomy.
Objetive: To evaluate the analgesic effect, as well as the colateral effects of the administration of single dose of 2 mg of morphine against a single dose of 1 mg morphine + 150 mcg clonidine. Material and methods: 60 patients of the feminine sex were studied, ASA I and II, which were divided in 2 groups: (30 patients) administered 1 mg morphine + 150 mcg clonidine and group B (30 patients) administered 2mg morphine; in both groups the drug was administered during the transoperative using a catheter epidural placed previously in T11-T12. The following variables were determined: pain, nausea, vomit, pruritus, heart frequency, arterial pressure, SpO2, and sedation degree when arriving to recovery room (time 0), at the 30′, 60′, 2, 4, 8, 12 and 24 hours. Results: The following variables were smaller in the group A: pain at 0′,30′,2,4,8, 12 and 24 hours, as well as nausea at the 0′,30′,60′,2,4 and 8 hours; the vomit at 0′ and 30′; the pruritus at the 8 hours; the heart frequency at 30′ and 60′; the arterial pressure at 30′, 60′, 2,4 and 8 hours. Finally the degree of the patients' sedation in the group A it was 2 and the patients of the group B it was I. Discusion: In surgery of low abdomen (hysterectomy) the administration of a single dose of 1 mg morphine + 150 mcg clonidine has the same analgesic effect in the postoperative than 2 mg morphine, but with smaller colateral effects.
Computerized axial tomography of abdomen requires the administration of contrast by mouth to hight volumes one hour before the study, leading to consider the patient pediatric with stomach full and at risk of breathing into the lungs when it undergoes sedation anesthesia. Material and methods: We Included patients scheduled to Computerized axial tomography of abdomen that covered the inclusion criteria in the time spanning study (one year). They were divided into two groups: group I received intravenous thiopental and group II sevoflurano inhalated. To decide the anesthetic technique patients were randomized. Results: We included 122 patients, 61 in each group. Hemodinamic stability was observed in both groups. Vomiting two patients presented in group I (3.27%) and group II a patient presenting vomiting (1.6%) without evidence of breathing into the lungs between groups. Efficiency in the group I was good in a 75.4% and regulate in a 24.6%. In the group II was good at 100%. Conclusions: In this investigation the group with Intravenous sedation with thiopental for management of computerized axial tomography of abdomen have double risk of vomiting with your respective risk of breathing into the lungs. The quality of the studies is best when inhalated.
Epidural blockade is one of the most commonly used anesthetic techniques because of its many advantages. Epidural administration of alpha-2-agonists produces analgesia by acting on alpha-2 receptors in the dorsal horn of the spinal cord, which inhibit the release of noradrenaline from adrenergic and central nervous endings. Objective: Comparing the use of epidural lidocaine plus clonidine vs lidocaine plus epinephrine to improve the quality and duration of anesthesia in patients undergoing surgery of the lower abdomen and lower limbs, and recording hemodynamic changes. Materials and methods: Prospective, transversal, descriptive, randomized, comparative, parallel groups clinical study, with 90 patients randomized into two groups, 45 patients each. Group I received 5 mg/kg lidocaine 2% with epinephrine 1:20,000; Group II received 5 mg/kg lidocaine 2% plus 3μg/kg clonidine. Results: Hemodynamic parameters showed no significant difference among the two groups. Average anesthetic time was 86.8 minutes in Group I vs 112.6 minutes in Group II. Quality of anesthesia in both groups was good. Conclusions: Epidural administration of lidocaine plus clonidine achieves a longer anesthetic time with good anesthetic quality, reducing the need for subsequent doses, with minimal hemodynamic effects.
The laparoscopic abdominal surgeries are less painful that the open ones, however the irritation that produces the pneumoperitoneum is cause of important visceral pain in the fi rst postoperative 24 hours, the proper medication decreases the complications, cost and hospital permanence. The treatment of postoperative pain includes anti-infl ammatory non-steroidal analgesics; isomeric forms of drugs provide a more controlled profi le and minimize adverse effects, as dexketoprofen, for quick action, so the control of postoperative pain in these surgeries will have better analgesic effect compared with ketorolac. We included 100 patients, scheduled for laparoscopic surgery, random in group I: supply dexketoprofen 50 mg every 12 hours, group II ketorolac 30 mg every 8 hours, with paracetamol and tramadol rescue if ≥ 4 EVA. The values percent of EVA obtained in I were minor, in them times measured; paracetamol rescue dose in 64% (1 and 2) in II 86% (1 to 4); the rescue application time in I 4.76 hours, II: 3.6 hours; obtaining p < 0.000. The supply of dexketoprofen in laparoscopic surgery, is better option in the postoperative pain control. © 2018, Colegio Mexicano de Anestesiologia A.C. All rights reserved.
Intraoperative awakening with postoperative memories is documented since 1969. Intraoperative awakening incidence is estimated when interviewing patients in the postoperative. Biespectral index (BSI) has been developed for monitoring the anaesthetic effects in the hypnotic state of the brain being a parameter of continual processed electroencephalography that measures the cerebral activity status. Objective: To establish the incidence of intraoperative awakening in patients for abdominal surgery using the combined anaesthetic technique peridural/general, through the biespectral index and intraoperative movements. Material and methods: A clinical, descriptive, prospective, lineal study in 40 patients programmed for gynecological elective surgery under combined anaesthesia was done. A bispectral index sensor was placed and measurements were made when the patient arrived at the operating room, following induction, and sequentially at the began of surgery and at 15, 30 and 45 minutes from the start. At the end of surgery, having recovered from anaesthesia and at 24 hours patients were asked if they kept a memory of the facts occurred during surgery. Results: Basal mean BSI was 97.5, at induction 58.05, BSI 0 60.65, BSI 15 mean of 62. I, BSI 30 mean of 62.9 and BSI 45 mean 64. The percentage of patients that moved head and thoracic extremities one or more times during the estimated measuring time was 27.5% (11 patients). There was no patient that showed postoperative memories. Conclusion: In the combined anaesthesia a BSI value compatible with the awakening status is shown, nonetheless patients having no postoperative memory.
Introduction: Postoperative nausea and vomiting present factors inherent to patients, anesthesia and surgery. They may provoke post-surgical pain, hydroelectrolitic alterations and/or surgical wound dehiscence. Vomiting starts by a stimulus that is captured by an integrating center and the motor response that ends with the expulsion of the gastrointestinal content. In order to prevent these disorders, simple or combined schemes are used. Dexamethasone at intestinal level may prevent the release of serotonin and ondansetron directly acts at the level of the receptors. Methodology: One hundred and twenty-four patients were included in this study. The patients were subjected to non-oncologic abdominal surgery, with two or more risk factors. Group A was given 8 mg of dexamethasone, and Group B was administered 4 mg of ondansetron 20 minutes before the anesthetic induction. The anesthetic management was standardized. Results: The emetic risk was classified as slight. Nausea and vomiting were present in the 12.5% of the patients of Group A y Group B, and it was higher in women and non-smoking patients. Ventilation with face mask was suitable. The doses of the opiates used were standard. In surgeries lasting about two hours, there were no statistically significant differences between both groups. Conclusion: Dexamethasone at doses of 8 mg is effective at abdominal surgery, with a slight to moderate risk of presenting the mentioned complication.
Top-cited authors
Alfredo Covarrubias-Gómez
  • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Uría Guevara
  • Universidad Autónoma Benito Juárez de Oaxaca
Guadalupe Zaragoza
  • Instituto Nacional de Rehabilitación
Cristina Alexandra Benavides-Caro
  • Clinica Universitaria Colombia
Diana Moyao-Garcia
  • Hospital Infantil de México Federico Gómez