Revista española de anestesiología y reanimación
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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.
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Oxygenation, or rather denitrogenation, prior to apnea during anesthetic induction attempts to replace alveolar nitrogen with oxygen to achieve an intrapulmonary oxygen reserve that will allow apnea to be as prolonged as possible with the least possible desaturation. During apnea, the rate of arterial desaturation depends mainly on the volume of oxygen stored in the lung, on mixed venous oxygen saturation, and on the presence of intrapulmonary shunt. ⋯ The efficacy of preoxygenation can be assessed by expired oxygen fraction or by pulse oximetry. In a healthy adult, both methods described ensure sufficient oxygenation (pulse oximetry 90% to 95%) after a period of apnea lasting between 6 and 10 minutes.
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Rev Esp Anestesiol Reanim · Apr 2004
Review[A review of clinical evidence supporting techniques to prevent chronic postoperative pain syndromes].
To conduct a systematic review to evaluate the level of evidence for using acute postoperative pain management techniques with a view to pre-empting the later development of chronic pain syndromes. ⋯ Only chronic pain following thoracotomy has been found to be preempted by acute pain management and only by continuous thoracic epidural analgesia started before surgery. There is no solid evidence demonstrating that other techniques used to relieve acute postoperative pain have a beneficial effect in preempting chronic postoperative pain syndromes.
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Rev Esp Anestesiol Reanim · Mar 2004
Review[Ventilatory management of the severely brain-injured patient].
Mechanical ventilation is necessary for treating patients with severe brain injury because it guarantees the airway (through endotracheal intubation), permits sedation (and even curarization), and prevents hypoxemia and/or hypercapnia. Hyperventilation continues to be a focus of debate in the current literature. ⋯ Gas insufflation through the trachea is a promising therapeutic option for correcting hypercapnia secondary to ventilation for lung protection in such patients. Finally, multimodal monitoring (intracranial pressure, central venous pressure, oxygen saturation detected in the jugular bulb, cerebral oxygen pressure) is recommended for adjusting PEEP and controlling hyperventilation.