Browsing by Author "Echevarria, Ghislaine C."

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    Comparison of Plasma Concentrations of Levobupivacaine With and Without Epinephrine for Transversus Abdominis Plane Block
    (2012) Corvetto Aqueveque, Marcia Antonia; Echevarria, Ghislaine C.; Fuente Lopez , Natalia Francisca de la; Mosqueira Podesta, Loreto Alejandra; Solari Gajardo, Sandra; Altermatt Couratier, Fernando René
    "Background and Objectives: The pharmacokinetics for levobupivacaine in transversus abdominis plane (TAP) blocks has not been previously reported. We aimed to determine the extent of the block and the effect on plasma concentrations of levobupivacaine with the addition of epinephrine.", "Methods: We enrolled 11 healthy volunteers in this double-blind, 2-intervention, 2-period crossover study. The intervention periods were defined as a unilateral left TAP block with 20 mL of 0.25% levobupivacaine with (E) or without (no E) 5 mu g/mL epinephrine. Subjects were randomized to E, followed by no E or no E followed by E, with 2-week washout period. Sensory dermatomal anesthesia was recorded. Blood samples were obtained for the measurement of plasma levobupivacaine levels.", "Results: The median cranial-to-caudal spread of sensory blockade for sharp touch was T9 (interquartile range [IQR], T7-T10) to L1 (IQR, T12-L1) with epinephrine and T9 (IQR, T8-T10) to T12 (IQR, T11-L1) without epinephrine (P > 0.05). The mean maximum arterial levobupivacaine concentrations with epinephrine were 0.36 (95% bootstrap confidence interval [95% CI], 0.30-0.42) mu g/mL and 0.63 (95% CI, 0.49-0.85) mu g/mL without epinephrine (P = 0.014, difference in means of 0.27 [95% CI, 0.12-0.46]). The mean maximal venous levobupivacaine concentration was 0.32 (95% CI, 0.28-0.39) mu g/mL and 0.49 (95% CI, 0.37-0.68) mu g/mL, with and without epinephrine, respectively (P = 0.006, difference in means of 0.17 [95% CI, 0.08-0.33]). The mean duration of the blockade was 10.2 hours (95% CI, 8.5-12.5 hours) with epinephrine and 10.3 hours (95% CI, 8.7-12.4 hours) without epinephrine (P = 1.000).", "Conclusions: Adding epinephrine to levobupivacaine reduces its peak plasma concentration after unilateral TAP blocks, with no remarkable effects on block characteristics or duration."]
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    Intraoperative Fascial Plane Blocks Facilitate Earlier Tracheal Extubation and Intensive Care Unit Discharge After Cardiac Surgery: A Retrospective Cohort Analysis
    (2023) Revollo, Shirley O.; Echevarria, Ghislaine C.; Fullerton, Demian; Ramirez, Ignacio; Farias, Jorge; Lagos, Rodrigo; Lacassie, Hector J.
    Objectives: Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extu-bation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intrave-nous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay.Design: Retrospective observational study.Setting: Single-center study.Participants: Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtain-ing ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous anal-gesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differen-ces in the baseline characteristics. Adjusted p < 0.05 was considered statistically significant.Measurements and Main Results: Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI:-11.98,-6.60; p = 0.022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI:-11.89,-3.75; p < 0.001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI:-1.43,-0.79; p = 0.0001) in the block group. No complications were reported.Conclusions: Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time.(c) 2022 Elsevier Inc. All rights reserved.
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    The Effective Effect-Site Propofol Concentration for Induction and Intubation with Two Pharmacokinetic Models in Morbidly Obese Patients Using Total Body Weight
    (LIPPINCOTT WILLIAMS & WILKINS, 2012) Echevarria, Ghislaine C.; Elgueta, Maria F.; Donoso, Maria T.; Bugedo, Diego A.; Cortinez, Luis I.; Munoz, Hernan R.
    BACKGROUND: Most pharmacokinetic (PK) models used for propofol administration are based on studies in normal-weight patients. Extrapolation of these models for morbidly obese patients is controversial. Using 2 PK models and a target-controlled infusion system, we determined the predicted propofol effect-site concentration (Ce) needed for induction of anesthesia in morbidly obese subjects using total body weight.