Efecto de la hidratación endovenosa con Hidroxietil almidón 6% (Voluven®) versus Ringer Lactato previa a la analgesia epidural en la incidencia de hipotensión durante el trabajo de parto

En pacientes gestantes durante trabajo de parto, la fluidoterapia endovenosa es fundamental en la prevención de la hipotensión tras la analgesia epidural y mantener el bienestar materno-fetal. El tipo de fluidoterapia administrada (coloides o cristaloides) puede influir en la incidencia y grado de dicha hipotensión. El objetivo de nuestro estudio fue evaluar la incidencia de hipotensión tras la administración de un coloide (Hidroxietil almidón 6%, 250 ml) o un cristaloide (Ringer Lactato 750 ml), evaluando también la posible repercusión fetal. Hasta la fecha hemos incluido 60 gestantes, mostrando una tendencia a una mejor hemodinámica en el grupo coloides

Bloqueig paravertebral toràcic ecoguiat per a cirurgia oncològica de mama. Experiència en 43 casos.

Encara que habitualment es realitza sota anestèsia general, la cirurgia de la mama es pot dur a terme mitjançant un bloqueig paravertebral toràcic (BPVT). Amb les avantatges conegudes de l’anestèsia regional i les que ens aporta l’ecografia per aconseguir millor eficàcia i seguretat del bloqueig, presentem una sèrie de 43 casos emmarcats en una nova guia clínica del servei d’anestesiologia. Els resultats indiquen que el BPVT ecoguiat és altament segur i aconsegueix un molt bon control del dolor postoperatori, amb requeriments mínims de rescat analgèsic, i amb nul•la incidència de nàusees i vòmits postoperatoris.

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient"s QoL during the first postoperative week, especially due to local pain and eating discomfort.

Monitorización del niño bajo sedación consciente

La sedación consciente es una ayuda muy importante para el odontopediatra en casos de niños sin capacidad para cooperar. El paciente sedado ha de estar monitorizado adecuadamente para que los tratamientos sean seguros y podamos obtener el máximo rendimiento de los fármacos utilizados. Recomendamos el uso de un estetoscopio, un monitor de signos vitales y un oxímetro de pulso.

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine

Anestesia local en podología

La primera referencia histórica sobre anestesia, la encontramos en el Génesis cuando Yavé, sumió a Adán en un profundo sueño para formar, con una de sus costillas a su compañera Eva.