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Aguado D.,Complutense University of Madrid | Aguado D.,Hospital Universitario La Paz | Abreu M.,Complutense University of Madrid | Abreu M.,Hospital Universitario La Paz | And 3 more authors.
Anesthesia and Analgesia | Year: 2012

BACKGROUND:: Tolerance to remifentanil during sevoflurane anesthesia may blunt the ability of this drug to reduce anesthetic requirements. Gabapentin has been shown to be effective in reducing postoperative narcotic usage, a reduction that may be associated with a reduction in opioid-induced tolerance and hyperalgesia. We sought to determine whether gabapentin might prevent the observed acute opioid tolerance (AOT) produced by remifentanil in sevoflurane minimum alveolar concentration (MAC). METHODS:: Wistar rats were anesthetized with sevoflurane and the effects of gabapentin alone on sevoflurane MAC were determined at doses of 150 and 300 mg • kg. In a second experiment, gabapentin 300 mg • kg was administered before remifentanil (120 and 240 μg • kg • h). The MAC was determined before gabapentin administration and 3 more times at 1.5-hour intervals after drug administration to assess AOT. MAC was determined from intratracheal gas samples using a sidestream gas analyzer; tail clamping was used as a supramaximal stimulus. Statistical analysis was performed with the 1-way analysis of variance test. RESULTS:: Remifentanil reduced MAC (2.5 ± 0.2%) by 16% ± 5% and 36% ± 6% (120 and 240 μg • kg • h, respectively, P < 0.01) with a further reduction produced by coadministration with gabapentin 300 mg • kg to 39% ± 12% and 62% ± 14%, respectively (P < 0.01 versus remifentanil alone). Gabapentin given alone at 150 and 300 mg • kg reduced MAC by 26% (both doses, P < 0.01). AOT was observed with remifentanil and characterized by a lower degree of MAC reduction, approximately 1.5 hours later (P < 0.05). However, when remifentanil was administered with gabapentin, the AOT to remifentanil was not observed (P > 0.05). CONCLUSIONS:: Gabapentin reduced the sevoflurane MAC and enhanced the MAC reduction produced by remifentanil. This enhancement may limit AOT in rats. Copyright © 2012 International Anesthesia Research Society.

Pereira A.,Gregorio Maranon University General Hospital | Perez-Medina T.,Puerta Of Hierro University Hospital | Rodriguez-Tapia A.,Autonomous University of Madrid | Mendizabal E.,Gregorio Maranon University General Hospital | Ortiz-Quintana L.,Gregorio Maranon University General Hospital
International Journal of Gynecological Cancer | Year: 2015

Objective: The objective of this study was to determine the survival of patients with nodepositive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system. Materials and Methods: We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed. Results: The distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV(hazard ratios, 2.75and 3.16, respectively; P = 0.002).The hazard ratio for patientswith abdominal peritoneal metastaseswas 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001). Conclusions: The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases. Copyright © 2014 by IGCS and ESGO.

Gutierrez-Gonzalez R.,Puerta Of Hierro University Hospital
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2012

Chondromyxoid fibroma (CMF) is a benign tumour of the bone that typically occurs in long bone metaphysis. Spinal involvement is uncommon, but more frequent in the cervical and thoracic segments. Lumbar involvement is extremely rare. We report the ninth case of lumbar CMF and the first one involving the articular process of the vertebra. A review of the literature is also intended making special emphasis on the differential diagnosis with other benign spinal tumours of the bone. A 21-year-old Caucasian male suffering from low back pain that increased with sports and interrupted sleep was diagnosed with a tumoural lesion in the right inferior articular process of L5. Complete surgical excision of the tumour was accomplished. Histological diagnosis confirmed a CMF. The patient remains asymptomatic at 1-year follow-up. Despite the low incidence of CMF in the lumbar spine, differential diagnosis must include this subtype of lesion among other benign tumours of the bone and cartilage. Histological diagnosis is essential in order to provide the patient with an accurate management of the pathology. Recurrence rate is to be considered even in the case of complete surgical excision. Radiotherapy administration is controversial due to suspicion of malignant transformation of the tumour.

Aguado D.,Complutense University of Madrid | Abreu M.,Hospital Universitario La Paz | Benito J.,North Carolina State University | Garcia-Fernandez J.,Puerta Of Hierro University Hospital | De Segura I.A.G.,Complutense University of Madrid
Anesthesiology | Year: 2013

Background: Opioid antagonists at ultra-low doses have been used with opioid agonists to prevent or limit opioid tolerance. The aim of this study was to evaluate whether an ultra-low dose of naloxone combined with remifentanil could block opioid-induced hyperalgesia and tolerance under sevoflurane anesthesia in rats. Methods: Male adult Wistar rats were allocated into one of four treatment groups (n = 7), receiving remifentanil (4 μg·kg· min) combined with naloxone (0.17 ng·kg·min), remifentanil alone, naloxone alone, or saline. Animals were evaluated for mechanical nociceptive thresholds (von Frey) and subsequently anesthetized with sevoflurane to determine the baseline minimum alveolar concentration (MAC). Next, treatments were administered, and the MAC was redetermined twice during the infusion. The experiment was performed three times on nonconsecutive days (0, 2, and 4). Hyperalgesia was considered to be a decrease in mechanical thresholds, whereas opioid tolerance was considered to be a decrease in sevoflurane MAC reduction by remifentanil. Results: Remifentanil produced a significant decrease in mechanical thresholds compared with baseline values at days 2 and 4 (mean ± SD, 30.7 ± 5.5, 22.1 ± 6.4, and 20.7 ± 3.7g at days 0, 2, and 4, respectively) and an increase in MAC baseline values (2.5 ± 0.3, 3.0 ± 0.3, and 3.1 ± 0.3 vol% at days 0, 2, and 4, respectively). Both effects were blocked by naloxone coadministration. However, both remifentanil-treated groups (with or without naloxone) developed opioid tolerance determined by their decrease in MAC reduction. Conclusions: An ultra-low dose of naloxone blocked remifentanil-induced hyperalgesia but did not change opioid tolerance under inhalant anesthesia. Moreover, the MAC increase associated with hyperalgesia was also blocked by naloxone. © 2013 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology.

Gonzalez-Pizarro P.,Akademiska Sjukhuset | Garcia-Fernandez J.,Puerta Of Hierro University Hospital | Canfran S.,Complutense University of Madrid | Gilsanz F.,Hospital Universitario La Paz
Respiratory Care | Year: 2016

Background: Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (<48 h old) with healthy lungs under general anesthesia. Methods: The primary outcome was peak inspiratory pressure (PIP) causing pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. RESULTS: Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). Conclusions: Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of <50 cm H2O. Hemodynamic impairment may occur with high driving pressures. More studies are needed to determine the exact hemodynamic impact of these procedures and pneumothorax PIP in poorly compliant lungs. © 2016 Daedalus Enterprises.

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