Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Videolaparoscopic surgery has benefits for patients. Interventions with reduced times involve anesthetic techniques adjusted to them, which determines many difficulties when pain manifests in the care practice. The finding of patients with immediate postoperative pain motivated the study. Objective: To evaluate the effectiveness of a fast-acting opioid as an immediate postoperative analgesic administered by intranasal way. Method: A quasiexperimental study was developed, with two groups of patients (100 each) who underwent laparoscopic cholecystectomy at "Dr. Luis Díaz Soto" Central Military Hospital. The hundred patients under study were administered fentanyl 50 mcg as intranasal drops upon arriving at the postoperative care room. The study variables included pain according to the Visual Analogue Scale (VAS), the onset time of opioid action, and the analgesia achieved, as well as the effects derived from its use. Results: The average age was 51 ± 2, the male sex predominated with 55 % of the cases, an average VAS of all the initial cases was evidenced in three. At discharge, 100 % of the patients in the study group had excellent analgesia (VAS 2), whereas the controls had an average VAS in 5. Pruritus was the most frequent adverse event after the administration of intranasal fentanyl. Conclusions: The use of a fast-acting opioid (fentanyl) is an excellent and safe postoperative pain control measure.

Introduction: Evidence shows that inadequate control of preoperative pain has harmful physiological and psychological consequences in patients, and increases morbidity and mortality.Objective: To evaluate the efficacy of modified femoral block in patients with a diagnosis of hip fracture.Method: A quasi-experimental study was carried out at Manuel Ascunce Domenech University Hospital in Camagüey Province, from January 2016 to January 2018. The study population was made up of 639 emergency and elective surgical patients with the diagnosis of hip fracture of hip, through simple random sampling automatically with the Statistical Package for the Social Sciences (SPSS) Version 21 for Windows, acceptable error and 95% confidence level. The sample was made up of 295 patients.Results: Most of the patients operated on for hip fracture are above their fifth decade of life. Extracapsular fracture was diagnosed in 174 patients. Regarding pain evaluation through McGill’s Pain Questionnaire, terrible pain of 4 was perceived, with confidence interval (2.00912-6.23110) before block; and also analgesia of 1 after blockage, with confidence interval (0.73102-1.48209).Conclusions:The modified femoral block provided analgesia in all cases.Keywords:   hip fracture; femoral block; analgesia; pain.

Introduction:Meperidine (or pethidine) is a synthetic opioid with well-known local anesthetic properties. It has been safely used intrathecally in general, urological and obstetric surgery. This can be used in spinal anesthesia in patients with hypersensitivity to local anesthetics.Objective:To describe anesthetic management of a patient with hypersensitivity to local anesthetics with the use of intrathecal meperidine.Case presentation:The case is presented of a 54-year-old female patient with a previous history of hypersensitivity to local anesthetics, scheduled for anterior colporrhaphy, who is performed regional technique, administering intrathecal meperidine. For post-operative analgesia, diclofenac sodium was administered intravenously in a single dose of 75 mg before the incision.Conclusions:The described technique allowed to achieve adequate sensory and motor block, stability of intraoperative vital signs, and optimal recovery in the immediate postoperative period. It is another alternative in the management of patients with hypersensitivity to local anesthetics.Keywords:   spinal cord anesthesia; meperidine; sensitive block.   

Introduction: Regional anesthesia is the most used in obstetric caesarean section. In particular, the use of intrathecal anesthesia has its advantages. Although the failure rate is low, the onset of this event generates difficulties that deserve attention. Objective: To describe the anesthetic management in an obstetric patient with failure of regional intrathecal anesthesia. Clinical case: Female patient, aged 20 years, who was administered intrathecal anesthesia by the specialist. There were no errors in the lumbar puncture, this was done with a trocar 25 of Whitacre tip. No sensory, motor or sympathetic block was observed, so general endotracheal anesthesia was performed, which went on smoothly. In the immediate postoperative period, joint hypermobility was observed, leading to suspicion of the diagnosis. This was positive in conjunction with the Neurology service, Ehlers-Danlos syndrome type 3 was determined. Conclusions: The failure rate is very low for subarachnoid anesthesia. However, for a patient of this type, it should be completely ruled out. There are few documented cases of resistance to local anesthesia. If it were the case, it should be studied exhaustively to look for strategies that allow an optimal anesthetic management.

Introduction:Anesthesia for juvenile angiofibroma is one of the most complex interventions within otolaryngology, since incoercible bleeding causes acute hypovolemia, which occurs in a short period and leads to hypovolemic shock and death if not treated properly.Objective:To carry out an update about the perioperative period of anesthesia in juvenile angiofibroma.Development:Blood losses must be minimized at all costs. The best association was induced hypotension, hypovolemic hemodilution, and autologous blood predeposit, with angiography and selective arterial embolization of the tumor.Conclusions:Surgical removal of juvenile angiofibroma is a high-risk intervention. The work team is an essential element. The association of induced hypotension, hypovolemic hemodilution, and autologous blood predeposit are the fundamental pillars for the best evolution of these patients.Keywords:  juvenile angiofibroma; anesthesia; blood-saving methods; complications.

Introduction: Difficult airway Intubation is a health problem. To prevent it, different rate values have been used. Objective: To evaluate the usefulness of El-Ganzouri index for predicting the degree of difficulty in tracheal intubation by conventional laryngoscopy. Method: A descriptive, cross-sectional study was carried out with patients who needed tracheal intubation, in Hermanos Ameijeiras Hospital, between February 2014 and 2017. This test combines and stratifies seven variables derived from individually associated observational parameters. Their values were stratified and interpreted (below 4, easy airway; 4 or higher, difficult airway). Results: We studied 94 patients, in which the El-Ganzouri index was evaluated. The age group of 50-59 years (29.8%) and the male sex (52.1%) predominated. ASA II was more frequent, accounting for 66%. The El Ganzouri index prevailed the oral opening over 4 cm, the tiromentonian distance below 6.5 cm, the Mallamapati class was present in 91.5%, neck movements below 90°, body weight over 90 kg, and no antecedent of history of difficult intubation in 67.0%. Upon corroborating the predictive tests with that of Cormack and Lehane, it was observed that 92.6% of the patients had an easy airway and this condition was obtained in 78.7% with the El Ganzouri index. Sensitivity was 71.43% and specificity was 20.69%. The positive predictive value was 6.76, and the negative predictive value was 90.0. Conclusions: The usefulness of the multivariate El-Ganzouri risk index was confirmed for the prediction of the degree of difficulty in tracheal intubation by conventional laryngoscopy. Sensitivity, specificity, positive and negative predictive values were identified, which showed good prediction of anatomically difficult airway.

Introduction: Rapid sequence intubation is a procedure that minimizes the time required to guarantee the respiratory airway in patients with high risk of bronchoaspiration. Objectives: To compare the quality of intubation with three doses of succinylcholine in rapid sequence induction in patients with full stomach, as well as the side effects of such drugs. Methods: An observational, cross-sectional study was carried out to assess the quality of intubation with rapid sequence intubation in emergency patients and with full stomach. The group I was administered 0.4 mg/kg of succinylcholine; the group II, 0.6 mg/kg; and the group III 1 mg/kg. The respiratory airway was assessed in all patients. The study was carried out in Hermanos Ameijeiras Clinical Surgical Hospital, between August 2013 and 2016. Results: The time of visualization of the vocal folds was fast in the three groups. The best results were obtained in the group III, followed by the group II. The intubation conditions were excellent in the group III (90 %), good in the group II (80 %), and fair in the group I (70 %). The hemodynamic variables showed significant differences among the three groups (p= 0.008). Conclusions: The effectiveness was determined of using three doses of succinylcholine in rapid sequence intubation, with optimal and safe intubation when succinylcholine was used at doses of 1 mg/kg, but it had a higher percentage of hemodynamic alterations as adverse effects.