2276 / 2894
2276
Anestesia por subespecialidades en el adulto
IV
oxigenación. La atención cuidadosa de los detalles maximizará la
seguridad del paciente en este entorno. A partir de estudios adicio-
nales sobre su mecanismo de acción surgirá la optimización de las
pautas terapéuticas. Los avances en la prevención y el tratamiento
de la toxicidad del O
2
quizá permitan un tratamiento más prolon-
gado del que puede administrarse en la actualidad de forma segura
y así posibiliten una actitud más enérgica frente a los síndromes
isquémicos e infecciosos.
La reducción de la presión ambiental y la hipoxia consi-
guiente asociadas con la exposición aguda a una elevada altitud
provocan cambios fisiológicos bien definidos que suelen asociarse
a síntomas clínicos. Se han descrito métodos profilácticos y tera-
péuticos. La anestesia segura a elevada altitud requiere ciertas
modificaciones de las técnicas a nivel del mar, no sólo por la hipoxia
y por la reducción de la presión ambiental, sino también porque
puede disponerse de equipos subóptimos en condiciones de
montaña.
La anestesia en el espacio plantea dificultades excepciona-
les que pueden prolongarse incluso más allá del regreso a la
Tierra.
Bibliografía
1. Fontaine J-A: Emploi chirurgical de l air comprimé.
Un Méd Paris 28(Sér 3)445–448, 1879.
2. Zuntz N: Zur Pathogenese und Therapie der durch
rasche Luftdruckänderungen erzeugten Krankhei-
ten. Fortschr Med 15:632–639, 1897.
3. Yarbrough OD, Behnke AR: The treatment of com-
pressed air illness using oxygen. J Ind Hyg Toxicol
21:213–218, 1939.
4. Cochran WD, Levison H, Muirhead DM Jr, et al: A
clinical trial of high oxygen pressure for the
respiratory-distress syndrome. N Engl J Med 272:
347, 1965.
5. Boerema I, Meijne NG, Vermeulen-Cranch DME:
Observations during operation on deeply cyanotic
young children breathing oxygen at three atmos-
pheres absolute. Surgery 52:796–799, 1962.
6. Bernhard WF, Frittelli G, Tank ES, Carr JG: Surgery
under hyperbaric oxygenation in infants with congeni-
tal cardiac disease. Circulation 29(Suppl)91–94, 1964.
7. Gesell LB (ed): Hyperbaric Oxygen Therapy: Indi-
cations. Durham, NC, Undersea and Hyperbaric
Medical Society, 2008.
8. Bert P: Barometric Pressure (La Pression Barométri-
que). Bethesda, MD, Undersea Medical Society, 1978.
9. Gilbert R, Keighley JF: The arterial-alveolar oxygen
tension ratio: An index of gas exchange applicable
to varying inspired oxygen concentrations. Am Rev
Respir Dis 109:142–145, 1974.
10. Mathieu D, Neviere R, Pellerin P, et al: Pedicle mus-
culocutaneous flap transplantation: Prediction of
final outcome by transcutaneous oxygen measure-
ments in hyperbaric oxygen. Plast Reconstr Surg
91:329–334, 1993.
11. Fife CE, Buyukcakir C, Otto GH, et al: The predic-
tive value of transcutaneous oxygen tension measu-
rement in diabetic lower extremity ulcers treated
with hyperbaric oxygen therapy: A retrospective
analysis of 1,144 patients. Wound Repair Regen
10:198–207, 2002.
12. Demchenko IT, Oury TD, Crapo JD, Piantadosi CA:
Regulation of the brain’s vascular responses to
oxygen. Circ Res 91:1031–1037, 2002.
13. Stamler JS, Jia L, Eu JP, et al: Blood flow regulation
by S-nitrosohemoglobin in the physiological oxygen
gradient. Science 276:2034–2037, 1997.
14. McMahon TJ, Moon RE, Luschinger BP, et al: Nitric
oxide in the human respiratory cycle. Nature Med
8:711–717, 2002.
15. Whalen R, Saltzman H, Holloway D, et al: Cardio-
vascular and blood gas responses to hyperbaric
oxygenation. Am J Cardiol 15:638–646, 1965.
16. Ishikawa K, Kanamasa K, Yamakado T, et al: The
failure of oxygen breathing to decrease the myocar-
dial contractile force in denervated dogs. Jpn Circ J
47:824–829, 1983.
17. Savitt MA, Rankin JS, Elberry JR, et al: Influence of
hyperbaric oxygen on left ventricular contractility,
total coronary blood flow, and myocardial oxygen
consumption in the conscious dog. Undersea
Hyperb Med 21:169–183, 1994.
18. Berry JM, Doursout MF, Butler BD: Effects of
hyperbaric hyperoxia on cardiac and regional
hemodynamics in conscious dogs. Aviat Space
Environ Med 69:761–765, 1998.
19. Abel FL, McNamee JE, Cone DL, et al: Effects of
hyperbaric oxygen on ventricular performance,
pulmonary blood volume, and systemic and pulmo-
nary vascular resistance. Undersea Hyperb Med
27:67–73, 2000.
20. Lavoute C, Weiss M, Rostain JC: The role of NMDA
and GABA(A) receptors in the inhibiting effect of
3 MPa nitrogen on striatal dopamine level. Brain
Res 1176:37–44, 2007.
21. Bennett PB, Towse EJ: The high pressure nervous
syndrome during a simulated oxygen-helium dive
to 1500 ft. Electroencephalogr Clin Neurophysiol
31:383–393, 1971.
22. Bennett PB, Coggin R, Roby J: Control of HPNS in
humans during rapid compression with trimix to 650
m (2132 ft). Undersea Biomed Res 8:85–100, 1981.
23. Rostain JC, Balon N: Recent neurochemical basis of
inert gas narcosis and pressure effects. Undersea
Hyperb Med 33:197–204, 2006.
24. Winter PM, Smith RA, Smith M, Eger EIII: Pressure
antagonism of barbiturate anesthesia. Anesthesio-
logy 44:416–419, 1976.
25. Gran L, Coggin R, Bennett PB: Diazepam under
hyperbaric conditions in rats. Acta Anaesth Scand
24:407–411, 1980.
26. Tonner PH, Poppers DM, Miller KW: The general
anesthetic potency of propofol and its dependence
on hydrostatic pressure. Anesthesiology 77:926–
931, 1992.
27. Tonner PH, Scholz J, Koch C, Schulte am Esch J: The
anesthetic effect of dexmedetomidine does not adhere
to the Meyer-Overton rule but is reversed by hydros-
tatic pressure. Anesth Analg 84:618–622, 1997.
28. Koblin DD, Fang Z, Eger EI 2nd, et al: Minimum
alveolar concentrations of noble gases, nitrogen,
and sulfur hexafluoride in rats: Helium and neon as
nonimmobilizers (nonanesthetics). Anesth Analg
87:419–424, 1998.
29. Heimburg T, Jackson AD: The thermodynamics of
general anesthesia. Biophys J 92:3159–3165, 2007.
30. Gross DR, Kramer WG, Gentile BJ, et al: Plasma
volume and estimated liver plasma flow during
hyperbaric and hyperoxic exposures in awake dogs.
Aviat Space Environ Med 56:1203–1208, 1985.
31. Kramer WG, Gross DR, Moreau PM, Fife WP: Drug
disposition under hyperbaric and hyperbaric-hype-
roxic conditions: Meperidine in the dog. Aviat Space
Environ Med 54:410–412, 1983.
32. Kramer WG, Welch DW, Fife WP, et al: Pharmaco-
kinetics of pentobarbital under hyperbaric and
hyperbaric hyperoxic conditions in the dog. Aviat
Space Environ Med 54:1005–1008, 1983.
33. Kramer WG, Gross DR, Fife WP, Chaikin BN:
Theophylline pharmacokinetics during hyperbaria
and hyperbaric hyperoxia in the dog. Res Commun
Chem Pathol Pharmacol 34:381–388, 1981.
34. Kramer WG, Welch DW, Fife WP, et al: Salicylate
pharmacokinetics in the dog at 6 ATA in air and at
2.8 ATA in 100% oxygen. Aviat Space Environ Med
54:682–684, 1983.
35. Stoudemire A, Miller J, Schmitt F, et al: Develop-
ment of an organic affective syndrome during a
hyperbaric diving experiment. Am J Psychiatry
141:1251–1254, 1984.
36. Piantadosi CA, Lee PA, Sylvia AL: Direct effects of
CO on cerebral energy metabolism in bloodless
rats. J Appl Physiol 65:878–887, 1988.
37. Thom S: Antagonism of carbon monoxide-media-
ted brain lipid peroxidation by hyperbaric oxygen.
Toxicol Appl Pharmacol 105:340–344, 1990.
38. Thom SR: Dehydrogenase conversion to oxidase
and lipid peroxidation in brain after carbon
monoxide poisoning. J Appl Physiol 73:1584–1589,
1992.
39. Thom SR: Functional inhibition of leukocyte b2
integrinsbyhyperbaricoxygenincarbonmonoxide-
mediated brain injury in rats. Toxicol Appl Pharma-
col 123:248–256, 1993.
40. Thom SR: Leukocytes in carbon monoxide-media-
ted brain oxidative injury. Toxicol Appl Pharmacol
123:234–247, 1993.
41. Piantadosi CA: Diagnosis and treatment of carbon
monoxide poisoning. Respir Care Clin North Am
5:183–202, 1999.
42. Thom SR, Fisher D, Manevich Y: Roles for platelet-
activating factor and *NO-derived oxidants causing
neutrophil adherence after CO poisoning. Am
J Physiol Heart Circ Physiol 281:H923–H930, 2001.
43. Thom SR, Bhopale VM, Fisher D: Hyperbaric
oxygen reduces delayed immune-mediated neuro-
pathology in experimental carbon monoxide toxi-
city. Toxicol Appl Pharmacol 213:152–159, 2006.
44. Thom SR, Bhopale VM, Han ST, et al: Intravascular
neutrophil activation due to carbon monoxide poi-
soning. Am J Respir Crit Care Med 174:1239–1248,
2006.
45. Kao LW, Nanagas KA: Toxicity associated with
carbon monoxide. Clin Lab Med 26:99–125, 2006.
46. Thom SR, Bhopale VM, Fisher D, et al: Delayed
neuropathology after carbon monoxide poisoning
is immune-mediated. Proc Natl Acad Sci USA
101:13660–13665, 2004.
47. Shillito FH, Drinker CK, Shaughnessy TJ: The
problem of nervous and mental sequelae in carbon
monoxide poisoning. JAMA 106:669–674, 1936.
48. Thom S, Taber R, Mendiguren I, et al: Delayed neu-
ropsychologic sequelae after carbon monoxide poi-
soning: Prevention by treatment with hyperbaric
oxygen. Ann Emerg Med 25:474–480, 1995.
49. Weaver LK, Hopkins RO, Chan KJ, et al: Hyperbaric
oxygen for acute carbon monoxide poisoning. N
Engl J Med 347:1057–1067, 2002.
50. Weaver LK, Valentine KJ, Hopkins RO: Carbon
monoxide poisoning: Risk factors for cognitive
sequelae and the role of hyperbaric oxygen. Am
J Respir Crit Care Med 176:491–497, 2007.