Especializaciones

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Browsing Especializaciones by Subject "Abdomen"

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    Analgesia del bloqueo ecoguiado del plano transverso del abdomen como coadyuvante en anestesia general para apendicectomía laparoscópica. Hospital “José Carrasco Arteaga”. Cuenca - Ecuador, 2020– 2021
    (Universidad de Cuenca, 2022-09-06) Valdivieso Díaz, Angie Cecibel; Espinoza León, Juan Carlos
    Background: the transversus abdominis plane (TAP) block is a multimodal analgesia technique, with proven efficacy in abdominal surgery; the ultrasound-guided technique in real time allows to reduce complications. General objective: to determine the analgesic degree of ultrasound-guided TAP in laparoscopic appendectomy. Methods: observational, descriptive, cross-sectional. 118 patients who underwent laparoscopic appendectomy and TAP block participated. A survey was applied in which postoperative pain was assessed at 5 and 120 minutes using the Visual Analog Scale for pain (VAS) and the need for rescue analgesia. Descriptive statistics and personalized tables were extracted to record the information. Results: according to the VAS at 5 min at rest, 50% of patients were categorized with a grade 0, followed by 36.4% in level 2; at 2 hours, 69%, 18.6%, and 15.3% are classified as grade 0, 4, and 2, respectively. It was reduced that 13.6% and the participants required rescue analgesia upon postoperative awakening and 33.9% in the Post Anesthesia Care Unit (PACU). In PACU, opioids were the drugs most used in rescue analgesia, since 3 out of 10 patients were managed with these drugs. The prevalence of complications of the transversus abdominis block was only 0.8%, detailing that there was intoxication by local anesthetic. Conclusions: The TAP block contributed to the fact that patients undergoing laparoscopic appendectomy presented postoperative pain intensity values between mild and moderate according to VAS, in addition, a low prevalence of rescue analgesia with minimal complications was evidenced.
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    Anestesia total intravenosa con propofol vs anestesis balanceada con sevoflurano, para la cirugía abdominal, Hospital Vicente Corral Moscoso, Hospital José Carrasco Arteaga, 2009-2010
    (2010) Ordóñez Ugalde, Xavier Eduardo; Barzallo Sacoto, Jorge Eduardo; Orellana Cabrera, Iván Eladio
    With the last inovations in surgery, we required a better anaesthesic control and minimal side effects in the post operatives rooms. Right know we have the balanced general anaesthesia and lately with the new intravenous agents like propofol, we can do a maintenance during anaetshesia with endovenous drogs, avoid from this way the toxicity of the fluorathes componenets. Total intravenous anaesthesia (TIVA) is increasingly used in surgery. TIVA may provide fast recovery of psychomotor function, less nausea, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol as the hypnotic component and balanced anaesthesia with sevoflurane. Objetive: This study was designed to investigate the differences between TIVA with propofol and remifentanil, and balanced anaesthesia with sevoflurane and remifentanil in abdominal surgery. Emphasis was put on hemodynamic reaction, recovery profile, and postoperative side effects. Methods: One hundred eighty six patients were randomly assigned to receive either total intravenous anaesthesia with propofol and remifentanil (ninety three patients) or anaesthesia with sevoflurane and remifentanil (ninety three patients). After induction of anesthesia (propofol, rocuronium, remifentanil) in both groups, anaesthesia was maintained with 0.5 microgram/kg/min remifentanil (reduced to 50% after 5 min) and 4 mg/kg/h propofol or 1.8 vol % sevoflurane. Both groups were mechanically ventilated. The administration of sevoflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. At the end of surgery the anaesthetics were discontinued and hemodynamic, early emergence from anaesthesia, quality of awake, incidence of PONV, awareness, shivering and patient satisfaction were assessed. Parameters were recorded each 15 minutes postoperatively. Results: Recovery time after propofol-remifentanil anaesthesia was significantly shorter than after administration of sevoflurane remifentanil (traqueal extubation 4.96 vs. 7.34 min, eye opening 5.3 vs. 8 min, orientation in time, space and person 15 min vs. 30 min. There were no significant differences between the groups in blood pression and hemodynamic stability. Side effects like PONV (RR 4 (IC95%: 1.4 - 11.5) P = 0,009)., headache (RR 3.25 (IC95%: 1.1 - 9.6) P = 0,041) were significantly less in the propofol Group. Awareness were presented in two patients in propofol group, but there were no significant differences between the two groups. Conclusion: TIVA with propofol and remifentanil proved to be particularly suited for abdominal surgery. It´s major advantages are significantly shorter times of emergence, and the exceptional acceptance by the patients. Key words: TIVA, balanced anaesthesia, propofol, sevoflurane, awareness, recovery profile.
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    Caso clínico 1: absceso cervical profundo secundario a celulitis por síndrome de Ramsay Hunt. Caso clínico 2: hernia diafragmática traumática multivisceral, causa inusual de hemotorax: reporte de caso
    (Universidad de Cuenca, 2023-06-13) Ochoa Crespo, Julio Hernán; Ordoñez Cumbe, Julio Cesar
    Introduction: Ramsay Hunt syndrome represents an unusual complication of the reactivation of the varicella zoster virus, which if perpetuated can give a localized infection and this in turn an abscess, no clinical cases have been described at the moment that present as an additional complication a cervical abscess, by analyzing this case we can guide the clinical and diagnostic suspicion in cases that present clinical characteristics similar to this one.Clinical case: We present the case of a patient with a history of type II diabetes mellitus and arterial hypertension under treatment, with pain and a mass in the cervical region of 12 days of evolution, plus paralysis of the left side of the face due to said findings and history. Ramsay Hunt with secondary complication; deep cervical abscess, administering medical treatment without finding improvement, so exploration plus surgical washing is performed in the affected area after treatment evolves favorably.Conclusion: Deep cervical abscess is an unusual form of complication due to superinfection of a tissue, its association with Ramsay Hunt syndrome is not frequent, and it should be suspected in cases of elderly patients, immunodeficiency with impaired motor function. in face. Introduction: Traumatic diaphragmatic hernia is defined as the passage of organs from the abdominal cavity to the thoracic cavity due to discontinuity at the level of the diaphragm. It is a rare lesion, most of the time not suspected and for this reason not diagnosed, this being a condition by itself with high morbidity and mortality. Constituting a diagnostic challenge for the personal physician. In this case report, one of the most striking findings was the presence of a grade II-III hemotórax as a result of a grade IV splenic lesion due to its protrusion into the thorax.Clinical case: the case of a patient with polytrauma due to high-speed traffic accident due to impact on a rigid surface, on admission diffuse chest and abdominal pain, on physical examination dullness to percussion in the left lung base resolved with insertion of a tube of chest with initial blood flow 1000 cc. Tomography was performed showing rupture and diaphragmatic hernia made up of stomach, omentum and spleen, laparotomy plus reduction of herniated viscera, splenectomy for grade IV injury and diaphragm raffia was performed, presenting favorable evolution.Expected conclusions: through the following report, it is sought to guide the diagnostic suspicion in all trauma with high energy exchange that compromises the thoracoabdominal area, given the case, a diaphragmatic lesion must be ruled out, for which the current case is made available for evaluation and conduct in similar cases