Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Mar 2003
Review[Non-therapeutic intraoperative hypothermia: causes, complications, prevention, and treatment (part I)].
During the first hour of general anesthesia, a patient's body temperature can decrease between 1 and 1.5 degrees C; regional anesthesia also induces central hypothermia. Intraoperative hypothermia interferes with immunological function, particularly with the oxidative capacity of neutrophils. Cutaneous vasoconstriction occurs and blood flow is reduced in tissues subject to surgery. ⋯ Hypothermia increases the likelihood of shivering, and with enhanced central nervous system activation, there is increased cardiovascular morbidity. Currently, these effects can be attenuated or even avoided by applying various warming methods available. The efficacy and mechanisms of action of such methods are described in the second part of this review of the literature.
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Rapid-sequence induction (RSI) techniques are designed to reduce the risk of aspiration in cases where risk is high. ISR is often for surgery, particularly under emergency conditions, but is also found in procedures requiring emergency tracheal intubation inside and outside the hospital. ISR techniques have proven safe for reducing the risk of aspiration and providing good conditions for intubation in such situations. ⋯ Precisely because of this last factor and the good results obtained with short-acting opiates, great interest has developed in recent years in RSI that does not use neuromuscular blocking agents. However, conclusive data are unavailable. Studies are often difficult to compare because of small differences in the combination of drugs, the dosing of one or more of them, the route of administration, or because the criteria used to define ideal intubation conditions are different.
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Rev Esp Anestesiol Reanim · Nov 2002
Review Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of efficacy and complications of 27G and 29G Sprottte needles for subarachnoid anesthesia].
Post-dural puncture headache and lumbar backache are related to needle gauge and type of point used. We aimed to determine whether the incidence of post-dural puncture headache and lumbar backache could be reduced by using fine gauge pencil-point Sprotte 27G and 29G needles. We also studied increases in technical difficulty with these needles and whether or not reducing needle gauge affected anesthetic quality. ⋯ The use of 29G pencil-point needles can be recommended to reduce the incidence of headache and lumbar backache in the postoperative period, in spite of the greater technical difficulty involved, given that quality of anesthesia is maintained.
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Surgical patients and others admitted to recovery and intensive care units require sedation and pain therapy, for which a range of pharmaceuticals is available. Their use is more or less widespread, but other drugs, such as dexmedetomidine, have been and continue to be studied for application in such patients. Dexmedetomidine, a compound derived from imidazole, has a high affinity for the alpha-2 adrenoreceptor, on which it acts as a potent agonist. ⋯ Moreover, its effect on ventilation is scarce. Dexmedetomidine is presently distributed in the United States but not in the European Union. The aim of this review was to outline the main pharmacological properties of dexmedetomidine, including its pharmacokinetics and pharmacodynamics, to give an overall view of this promising drug.