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Hyponatraemia is the most common electrolyte disorder encountered in clinical practice. Symptomatic hyponatraemia reflects brain damage because of cerebral swelling. Some coexisting factors such as extreme ages, hypoxia and female sex are associated with poor prognosis. In this report, we describe the case of a 75-year-old patient who suffered from hyponatraemic encephalopathy after elective vaginal hysterectomy under spinal anaesthesia. After being transferred to the ward, she developed nausea, vomiting, hypertensive crisis and intense anxiety. These symptoms were followed by grand mal seizure. Serum sodium level was 108 mmol/l. She also presented hypoxia, considered an aggravating factor, which was probably caused by the combination of benzodiazepine intake and cerebral oedema. However, fast raise of serum sodium level was achieved by immediate treatment with hypertonic saline, and she was discharged home without any sequelae.

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Objetivo. La punción accidental de duramadre es una complicación potencial durante el bloqueo epidural y se puede relacionar con múltiples factores. Nuestro objetivo fue determinar la prevalencia y factores de riesgo de punción dural accidental en un hospital terciario, evaluando las diferencias que existen en el número de complicaciones durante los distintos horarios de trabajo. Material y métodos. Se realizó un estudio observacional prospectivo de todas las mujeres que solicitaron analgesia regional a la Unidad de Analgesia Epidural y cumplían los criterios de inclusión, entre el 1 de enero de 2009 y el 1 de enero de 2011. La técnica empleada para el control del dolor del trabajo del parto fue la analgesia epidural. Resultados. Se incluyeron 12.480 embarazadas. La prevalencia de punción dural accidental fue de 0,4% (50 pacientes). De ellas, 28% correspondieron a médicos residentes. Se observaron más punciones durales accidentales en septiembre y en el turno de trabajo de tarde. Conclusiones. La prevalencia de PAD es similar a otras series. En nuestra serie, el cansancio o la falta de sueño parecen no influir en la incidencia de complicaciones en la analgesia para el trabajo de parto en una unidad de atención 24 horas, quizás por la distribución de lo turnos en las guardias no trabajando más de 6 horas seguidas(AU)

Objective. Accidental dura mater puncture is a potential complication during epidural block, and may be associated with multiple factors. Our objective was to determine the prevalence and risk factors of accidental dural puncture in a university hospital, evaluating the differences in the number of complications during different working hours. Material and methods. A prospective observational study was conducted on all women who requested regional anaesthesia in the Epidural Analgesia Unit between 1 January 2009 and 1 January 2011, and who fulfilled the inclusion criteria. The technique employed to control labour pains was epidural analgesia. Results. A total of 12,480 pregnant women were included. The prevalence of accidental dura mater puncture was 0.4% (50 patients). Of these, 28% were due to medical residents. More accidental dura mater punctures were observed during September and in the afternoon shift. Conclusions. The prevalence of accidental dura mater puncture is similar to other patient series. In ours, tiredness or lack of sleep did not influence the incidence of complications in analgesia for labour pains in a 24 hour care unit. This may be due to the distribution of on-call shifts not exceeding more than 6hours(AU)

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OBJECTIVE: Accidental dura mater puncture is a potential complication during epidural block, and may be associated with multiple factors. Our objective was to determine the prevalence and risk factors of accidental dural puncture in a university hospital, evaluating the differences in the number of complications during different working hours. MATERIAL AND METHODS: A prospective observational study was conducted on all women who requested regional anaesthesia in the Epidural Analgesia Unit between 1 January 2009 and 1 January 2011, and who fulfilled the inclusion criteria. The technique employed to control labour pains was epidural analgesia. RESULTS: A total of 12,480 pregnant women were included. The prevalence of accidental dura mater puncture was 0.4% (50 patients). Of these, 28% were due to medical residents. More accidental dura mater punctures were observed during September and in the afternoon shift. CONCLUSIONS: The prevalence of accidental dura mater puncture is similar to other patient series. In ours, tiredness or lack of sleep did not influence the incidence of complications in analgesia for labour pains in a 24 hour care unit. This may be due to the distribution of on-call shifts not exceeding more than 6 hours.

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We describe the anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins with a common right atrium and a myocardial tissue bridge containing vascular channels between their ventricles. One of them died during the procedure, the surviving twin is now two years old. The survival of one twin for two years without significant sequelae, after the surgical separation of twins with shared right atrium and fused ventricles, has not previously been reported. Careful preoperative assessment is essential to anticipate potential serious problems during the procedure.

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OBJECTIVES: To compare the postoperative mortality of our hospital to that of others. PATIENTS AND METHOD: Retrospectively, we studied patients who died after surgery in 1994, defining postoperative mortality as death occurring in the hospital after surgery. The variables studied were age, sex, preoperative disease, ASA, type of surgery, anesthetic technique, intraoperative complications and place, cause and time of death. RESULTS: One hundred six (1.63%) of the 6,485 surgical patients died. The highest proportion were cardiovascular surgery patients (3.36%) and the smallest proportion (0%) had undergone eye surgery. Of patients receiving general anesthesia 2.16% died, while 0.59% of those receiving local-regional anesthesia did so. Most of those who died were male (55.66%); were over 55 years of age (87.73%); were ASA IV (67.03%); had associated medical disease (79.24%), mainly arterial hypertension; or had undergone emergency surgery (54.71%). Most who died had received general anesthesia (87.73%). Half of all deaths occurred in patients who presented some type of complication during surgery; this was the case with all who received intradural anesthesia, in 47.89% of those who had received general anesthesia and 20% of those receiving local anesthesia. The most common intraoperative complication in all anesthetic techniques was post-induction arterial hypotension. Over half of deaths occurred on the ward, after the first postoperative week, and the most frequent cause of death was sepsis (19.81%). We considered a death occurring on the hospital ward within the first 24 hours after surgery as possibly being associated with anesthesia (1.54/10,000). CONCLUSIONS: Risk factors for postoperative mortality established in other studies (advanced age, male sex, emergency surgery and ASA IV-V) were relevant in most of the deaths studied. Our mortality rate is similar to that reported by other authors for the first 24 to 48 hours after surgery, but is higher 30 days after surgery and later. Some of the 13 patients who died on the hospital ward in the first 48 hours after surgery probably did not receive the care that would have been provided in the postoperative intensive care unit.

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Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.

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OBJECTIVE: To study the effect of ondansetron administered during cardio-pulmonary bypass surgery, in terms of mean arterial pressure, systemic vascular resistance and venous system capacitance. PATIENTS AND METHOD: Twenty patients scheduled for non coronary cardiac surgery were randomly assigned to 2 groups. The study group received 4 mg ondansetron during the bypass and the control group received the same volume of physiological saline solution. The following parameters were recorded during the 10 minutes following administration of either substance: mean arterial pressure, calculated systemic vascular resistance, and the venous reservoir volume at the beginning and end of the study period. RESULTS: Increased mean arterial pressure and systemic vascular resistance were recorded in both groups from the time of injection, with the highest levels recorded at 10 minutes. There were no statistical differences between the 2 groups. No changes in venous system capacitance were observed in either group, as there were no significant changes in venous reservoir volume of the extracorporeal circulation pump. CONCLUSIONS: Ondansetron at the dose used has no effect on arterial or venous vessels. The increased resistance recorded in both groups can be attributed to the release of catecholamines during non pulsatile extracorporeal circulation with a non pulsatile flow.

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Infants with Beckwith-Wiedemann syndrome usually present different abnormalities which may require surgical correction. Anaesthetic management may be complicated by abnormal airway anatomy, congenital heart disease and severe hypoglycaemia. Careful preoperative evaluation, perioperative monitoring and suitable choice of anaesthetic technique are required for a successful outcome. We report the perioperative management of a patient with Beckwith-Wiedemann syndrome presenting for omphalocoele surgery on his first day of life and for bilateral inguinal hernia repair four months later.

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