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 · Jan 2007
Review Case Reports[Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision].
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. ⋯ This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.
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Rev Esp Anestesiol Reanim · Jan 2007
Review[Multimodal approaches to postoperative pain management and convalescence].
Coping with pain is a complex, multifactorial phenomenon that requires an interdisciplinary approach. Multimodal analgesia involves the association of several analgesics administered by different routes to achieve more effective relief than analgesics administered individually. This approach reduces side effects and increases patient satisfaction. ⋯ The choice of local anesthetic, the route of administration, and the duration of treatment will depend on the type of patient and operation. The combination of an anti-inflammatory drug with an analgesic that works on the central nervous system is recommended, whether the route is oral or parenteral, provided there are no contraindications. Integrating these techniques into a rehabilitation program will facilitate postoperative convalescence.
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Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. ⋯ We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.
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The Proseal laryngeal mask was introduced into clinical practice in 2000. Since then, many publications, most of them case reports, have discussed the use of this mask. ⋯ The Proseal is compared with the conventional laryngeal mask. We reviewed the literature indexed on MEDLINE through October 2005 using the search terms Proseal laryngeal mask, airway, and anesthesia.