RESUMEN
We report two cases of early-onset pressure pneumocephalus, one occurring during supratentorial brain surgery (craniopharyngioma) which was diagnosed at the end of the anesthetic period upon appearance of comatose status leading to the suspicion of surgical complication in the form of a hematoma. The second case of pneumocephalus was detected after posterior fossa surgery performed with the patient in the sitting position. We review the significance of our anesthetic management on the prevention of tension pneumocephalus, and discuss diagnostic and therapeutic measures available for use in the Postoperative Intensive Care Recovery Unit.
Asunto(s)
Anestesia General/efectos adversos , Encéfalo/cirugía , Neumocéfalo/fisiopatología , Encéfalo/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Niño , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/cirugía , Craneofaringioma/diagnóstico por imagen , Craneofaringioma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neumocéfalo/diagnóstico por imagen , Neumocéfalo/etiología , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a 54-year-old woman with cephalea of five months duration caused by a chronic subdural hematoma that appeared after epidural anesthesia and accidental dural puncture for bilateral saphenectomy. Computed tomography of the brain revealed an intracranial hematoma. After surgical evacuation, the patient's headaches resolved and she recovered fully. The appearance of cephalea after dural puncture is a relatively frequent complication of spinal anesthesia, but its persistence over time, as well as changes in its initial characteristics, should lead to a suspicion of life-threatening subdural hematoma.
Asunto(s)
Anestesia Epidural/efectos adversos , Duramadre/lesiones , Cefalea/etiología , Hematoma Subdural/complicaciones , Heridas Penetrantes/complicaciones , Enfermedad Crónica , Femenino , Hematoma Subdural/etiología , Humanos , Persona de Mediana Edad , Heridas Penetrantes/etiologíaRESUMEN
OBJECTIVE: To determine whether provision of an information sheet during the preanesthesia visit to the patient, and general recommendations for anesthesia, can change patients' image of the anesthesiologist. PATIENTS AND METHODS: Two groups of 100 patients each were studied before outpatient surgery. Group 1 (given no information) answered a questionnaire before an interview with the anesthesiologist. Group 2 (who were given information) answered the same questionnaire, which was accompanied by an information sheet explaining the nature of anesthesia, possible risks, operating room and postoperative procedures. RESULTS: In group 1,67% identified the anesthesiologist as a physician. In group 2, 99% (p < 0.05) were able to do so. In group 1, 48% believed that the anesthesiologist works under the surgeon's orders, while only 27% (p < 0.05) thought so in group 2. The chief of the postanesthesia intensive care unit was thought to be a member of the nursing staff by 48% in group 1, whereas 95% (p < 0.05) in group 2 identified the chief as an anesthesiologist. CONCLUSIONS: The image of anesthesiology and the anesthesiologist can be improved by systematically providing an information sheet to patients who are scheduled for presurgical study.
Asunto(s)
Anestesiología , Educación del Paciente como Asunto , Pacientes/psicología , Adolescente , Adulto , Anciano , Actitud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Folletos , Cuidados Preoperatorios , Evaluación de Programas y Proyectos de Salud , Encuestas y CuestionariosRESUMEN
We divided 80 patients undergoing cataract surgery into two groups of 40: one control group and one propofol group to whom 1-1.5 mg/kg of propofol was administered before retrobulbar anesthesia. The following parameters were recorded before and after retrobulbar anesthesia: systolic and diastolic arterial pressure (SAP and DAP), heart rate (HR) and finally arterial oxygen saturation through pulse oximetry. Pain was also measured on the Scott-Huskisson visual analog scale. For patients in the control group a rise in arterial pressure over baseline values after 5 minutes (p < 0.01) was observed, while a decrease was found in the propofol group (p < 0.01). The rise after 5 minutes in the control group was significant when compared with the measurements for the propofol group (p < 0.01). The pain measure for the control group reached 5.53 +/- 1.54 on the Scott-Huskisson scale, but was 0 in the propofol group. Measurements on the pain scale correlated positively with diastolic arterial pressure 5 minutes after blockade in the control group (p < 0.05). The technique studied affords greater comfort for the patient, presents no special difficulties for the anesthesiologist performing the retrobulbar blockade, and causes no complications.
Asunto(s)
Anestesia Local/métodos , Extracción de Catarata , Propofol , Adolescente , Adulto , Anciano , Ojo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane). MATERIAL AND METHODS: We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications. RESULTS: Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane. CONCLUSIONS: Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.
Asunto(s)
Halotano , Isoflurano , Administración por Inhalación , Niño , Preescolar , Femenino , Halotano/administración & dosificación , Halotano/efectos adversos , Humanos , Lactante , Isoflurano/administración & dosificación , Isoflurano/efectos adversos , MasculinoRESUMEN
We compare the degree of nitrous oxide diffusion in three types of endotracheal tubes available in the market, by means of continuous monitoring of the pressure attained at the pneumoballoon. Among the systems designed to impede or to minimize nitrous oxide diffusion, we have used in this study the so called "rediffusion system". When the endotracheal tube possesses this system, the pressure attained at the pneumoballoon remained constant throughout the study period (23.2 +/- 0.53 mmHg at time zero vs 24.2 +/- 0.66 mmHg 50 min after administration of protoxide). In contrast, endotracheal tubes without "rediffusion system" showed a statistically significant increase (p less than 0.05) of pneumoballoon pressure (25.2 +/- 2.43 mmHg and 26.7 +/- 1.01 mmHg at time zero vs 45.2 +/- 3.12 and 44.3 +/- 2.41 mmHg 50 min after protoxide administration in the two other types of endotracheal tubes). We believe that during anesthesia with nitrous oxide the pneumoballoon pressure should be monitored or systems that avoid diffusion of this inhalational agent should be inserted. Our results indicate that endotracheal tubes equiped with "rediffusion system" are effective in impeding diffusion of the inhalational agents.