Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Oct 2006
Review[Incident reporting systems and patient safety in anesthesia].
Incident reporting schemes collect information on adverse events, errors, complications, or problems with the aim of analyzing their causes and suggesting changes to prevent recurrence. Such schemes are currently part of clinical safety programs in various countries. ⋯ Therefore, reporting is intended to stimulate a culture of learning rather than assigning blame. The main limitations of such schemes are under reporting, the use of different terms and concepts, the lack of resources for research and development, and the scarcity or lack of legislation to guarantee the proper use of information without legal consequences.
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Few pharmacologically new anesthetics have appeared in recent years, but great progress has been made toward improving some existing ones. Such is the case with propofol. New formulations have been developed to reduce or avoid adverse side effects associated with the original drug produced by Astra-Zeneca. ⋯ Some new formulations contain excipients with bactericidal action, such as propofol with ethylenediaminetetraacetic acid or metabisulfite, and others use lipuro rather than intralipid. Other more advanced products are propofol in cyclodextrin or IDD-D propofol, which makes use of nanoparticle technology. A grasp of the pharmacokinetics and pharmacodynamics of the original formulation must be the basis for understanding the differences between these new products.
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Rev Esp Anestesiol Reanim · Jun 2006
Review Comparative Study[Characteristics and distribution of normal human epidural fat].
Epidural fat provides sufficient cushion for the pulsatile movements of the dural sac, protects nerve structures, facilitates the movement of the dural sac over the periosteum of the spinal column during flexion and extension, and forms a pharmacologic reservoir of lipophilic substances. We review epidural fat and related structures, including their development during the fetal period when the epidural space is filled by undifferentiated loose, areolar mesenchymal tissue that surrounds the dural sac. ⋯ We consider the distribution of epidural fat in the axial and sagittal planes; its presence in the anterior, lateral and posterior epidural space; its presence in the cervical, thoracic and lumbar portions of the spinal column; and its characteristics and variations according to differing body habits and sex. Finally, we speculate on the possible anesthetic implications of epidural fat in terms of the pharmacokinetics of drugs injected into the epidural space and the tasks of locating the epidural space and inserting an epidural catheter during anesthetic procedures.
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Rev Esp Anestesiol Reanim · May 2006
Review[Risk assessment, prophylaxis and treatment for postoperative nausea and vomiting].
The incidence of postoperative nausea and vomiting in the general population has been estimated to have remained constant at around 20% to 30% in recent years, but it can reach 80% in high-risk patients. A wide range of risk factors related to patient variables, anesthetic technique, or surgery have been described. However, risk can be classified by taking only 4 factors into consideration: female gender, nonsmoker, a history of motion sickness or postoperative vomiting, and use of opioids for postoperative analgesia. ⋯ For patients at high risk (3 or 4 risk factors), prophylaxis should be provided with 4 mg of intravenous ondansetron 30 minutes before ending surgery, 4 mg of intravenous dexamethasone at anesthetic induction, or both. Besides medical prophylaxis, strategies for lowering underlying risk are recommended: use regional anesthesia whenever possible, use total intravenous anesthesia with propofol if regional anesthesia is impossible, keep opioid and neostigmine use to a minimum, and try to maintain adequate hydration during surgery. Once preventive measures are taken, therapeutic options are limited and the management of postoperative nausea and vomiting, once established, is difficult.