Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Feb 2007
Review[Pulmonary hypertension: pathophysiology, diagnosis, treatment and anesthetic considerations].
Pulmonary artery hypertension is a rare entity but one that presents genuine challenges during anesthesia mainly because of the high risk of exacerbation and right heart failure during and after surgery. This review covers currently available treatments, the battery of diagnostic procedures at our disposal, and the basic precepts for the perioperative management of patients with this condition. Adequate hemodynamic control and the early use of selective pulmonary vasodilators are absolutely essential.
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Rev Esp Anestesiol Reanim · Feb 2007
Case Reports[Airway management in a man with ankylosing spondylitis].
We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. ⋯ We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.
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Rev Esp Anestesiol Reanim · Jan 2007
Editorial Comment[Anesthetic procedures during fetal surgery].
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Rev Esp Anestesiol Reanim · Jan 2007
[Patient satisfaction with spinal cord stimulation for failed back surgery syndrome].
The incidence of failed back surgery syndrome is about 40%. We studied the efficacy of and patient satisfaction with use of a spinal cord stimulator to treat this syndrome. ⋯ Spinal cord stimulation improves lumbar back pain in patients with failed back surgery syndrome and reduces the amount of additional medication taken to control pain. It is important for patients to adjust their expectations about the implanted stimulator.
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Rev Esp Anestesiol Reanim · Jan 2007
Case Reports[Two cases of congenital airway obstruction managed with ex utero intrapartum treatment procedures: anesthetic implications].
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. ⋯ In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.