Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Oct 2004
Review Case Reports[Horner's syndrome following epidural analgesia for labor].
Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. ⋯ The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.
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Rev Esp Anestesiol Reanim · Oct 2004
Review[Anesthesia and postoperative care of 11 patients undergoing peritonectomy and hypothermic intraperitoneal chemotherapy].
Peritoneal carcinomatosis is the final stage of certain malignant tumors located both inside and outside the abdomen. Mortality is high with conventional treatments and the best mean survival rates reported have reached up to 6 months. One technique tried in recent years involves resection of macroscopic parietal and visceral peritoneal lesions (peritonectomy) combined with intra- and postoperative perfusion of the abdominal cavity with hyperthermic chemotherapy to treat residual microscopic lesions. ⋯ The main complications are related to the long duration of surgery, bleeding secondary to the many surgical resections, and hyperthermia caused by the chemical agents. The therapeutic process, therefore, is not risk-free and involves high rates of morbidity and mortality. We describe the anesthetic and postoperative management of the first 11 cases in which this procedure was carried out at our hospital, analyzing the main complications arising.
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Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. ⋯ We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.