Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 2002
[Indications for thoracic radiography in the preoperative evaluation for elective surgery].
To establish a protocol for ordering chest x-ray films for screening before elective surgery. To study the prevalence of anomalies detected in routinely-ordered chest x-rays, their influence on management of anesthesia and surgery and on the prevention of perioperative complications. ⋯ A preoperative chest x-ray should be ordered only for patients over 60 years of age, smokers of 10 cigarettes/day or more, those with heart or respiratory disease, those who have had contact with tuberculosis and who have not had any other chest x-ray taken within the past year.
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Rev Esp Anestesiol Reanim · Feb 2002
Case Reports[Infraclavicular brachial plexus block using a multiple injection technique and an approach in the cranial direction in a patient with anticipated difficulties in tracheal intubation].
A man with a pathologic diaphysial fracture of the middle third of the left humerus underwent emergency surgery for osteosynthesis of the fracture. Preoperative examination revealed that intubation would be difficult due to a history of radical surgery for epidermoid carcinoma of the oropharynx, and local-regional anesthesia was therefore considered. ⋯ Among the various levels of brachial plexus blockade, the infraclavicular option is little known and the least utilized, considering that one of its advantages is that the upper limb does not need to be moved for referencing (giving it an advantage over the axillary block) and that it has a lower incidence of pneumothorax (in comparison with a supraclavicular approach). Combined with a multiple injection technique and puncture in a cephalad direction, this solution allowed proximal surgery to be performed on the arm of a patient in whom intubation would have been difficult.
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Rev Esp Anestesiol Reanim · Feb 2002
Case Reports[Treatment of post-dural-puncture headache with intravenous cortisone].
Postdural puncture headache (PDPH) is the most frequent complication of procedures involving dural penetration for spinal anesthesia or following unintentional dural puncture during attempted epidural anesthesia or analgesia. PDPH causes serious problems for women who have just given birth, as they are unable to give adequate care to their infants. ⋯ We report three cases of incapacitating PDPH in women after vaginal or caesarian delivery in which symptoms resolved with intravenous hydrocortisone treatment. Hydrocortisone treatment for PDPH has never been reported in the literature, but given our results, we consider that clinical trials are warranted to establish the efficacy of this treatment and to determine if there is a chance that it might offer an alternative to the blood patch.
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Rev Esp Anestesiol Reanim · Feb 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Hyperbaric subarachnoid ropivacaine in ambulatory surgery: comparative study with hyperbaric bupivacaine].
To compare the clinical efficacy of hyperbaric 0.5% ropivacaine and 0.5% bupivacaine in subarachnoid blockade for ambulatory surgery. ⋯ Hyperbaric 0.5% ropivacaine offers certain advantages over hyperbaric 0.5% bupivacaine for subarachnoid block in outpatient surgery. Duration and intensity of the sensory-motor blockade is less with ropivacaine and fewer cardiovascular side effects develop.
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Rev Esp Anestesiol Reanim · Feb 2002
Review[Magnetic resonance in dural post-puncture headache in patient with cerebrospinal fluid hypotension].
Magnetic resonance imaging (MRI) has allowed us to establish a set of radiologic signs associated with intracranial hypotension syndrome. Findings are partly influenced by cerebral displacement. Intracranial hypotension syndrome is characterized by a decrease in cerebrospinal fluid (CSF) pressure to less than 60 mm H2O associated with occipital headache radiating to the frontal and temporal zones. ⋯ Findings gradually disappear as symptoms diminish. The signs and symptoms that might develop during intracranial hypotension syndrome vary according to the brain structure that might be affected during descent, repositioning and the traction of anchoring structures. MRI allows the degree of cerebral and spinal involvement to be ascertained, to predict whether resolution of the clinical picture will be early or late and to visualize the effect of approaches to reducing CSF leakage.