{"id":13986,"date":"2018-03-09T09:00:29","date_gmt":"2018-03-09T09:00:29","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/el-efecto-de-la-anestesia-epidural-sobre-las-anastomosis-colorrectales-valoracion-mediante-tonometria\/"},"modified":"2018-03-09T09:00:29","modified_gmt":"2018-03-09T09:00:29","slug":"el-efecto-de-la-anestesia-epidural-sobre-las-anastomosis-colorrectales-valoracion-mediante-tonometria","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/el-efecto-de-la-anestesia-epidural-sobre-las-anastomosis-colorrectales-valoracion-mediante-tonometria\/","title":{"rendered":"El efecto de la anestesia epidural sobre las anastomosis colorrectales. valoracion mediante tonometria."},"content":{"rendered":"<h2>Tesis doctoral de <strong>  Sala Palau Carlos Enrique <\/strong><\/h2>\n<p>La anestesia epidural es un metodo ampliamente difundido para el control del dolor postoperatorio que produce un bloqueo simp\u00e1tico con el consiguiente predominio parasimpatico vagal, mejorando la perfusion del area esplacnica. la tonometria es un metodo de valoracion de la oxigenacion-perfusion del tubo digestivo que permite medir la presion parcial de co2 de la mucosa y calcular el ph intramucosos a traves de la ecuacion de henderson-hasselbalch.  objetivos: estudiar la evoluci\u00f3n del estado de oxigenacion-perfusion de las anastomosis colorrectales en comparacion con el estomago y el colon transverso durante el postoperatorio precoz, y analizar el efecto de la anestesia epidural sobre la anastomosis en comparacion con las otras areas.  hemos intervenido 24 pacientes en la serie preliminar para caracterizar las variacones de phi en el postoperatorio y 15 en la definitiva con anestesia epidural. A todos los pacientes se les realiz\u00f3 una reserci\u00f3n anterior de rectosigma. Colocamos sondas de tonometria en el estomago, colon transverso y anastomosis.  hemos registrado un valor significativamente inferior en la anastomosis durante el primer dia, igualandose posteriormente. Asimismo, el phi gastrico y del colon transverso mejora con la epidural, empeorando en la anastomosis y volviendo a los valores basales tras el cese del efecto.  postulamos que los valroes de phi registrados en la anastomosis durante el primer dia pueden deberse a la devacularizacion y denervaci\u00f3n autonoma producida por la reseccion del meso en los bordes anastomoticos. La mejoria fisiologica del phi en el estomago y colon transverso con la epidural contrasta con el empeoramiento simultaneo y reversible del phi en la anastomosis, que puede deberse a un efecto de robo de flujo desde las areas criticas (anastomosis) hacia las sanas(estomago y colon transverso) y a la ausencia de respuesta parasimpatica sacra a nivel de la anastomosis, afectada por el bloqueo epidural.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>El efecto de la anestesia epidural sobre las anastomosis colorrectales. valoracion mediante tonometria.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 El efecto de la anestesia epidural sobre las anastomosis colorrectales. valoracion mediante tonometria. <\/li>\n<li><strong>Autor:<\/strong>\u00a0  Sala Palau Carlos Enrique <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Universitat de val\u00e9ncia (estudi general)<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 23\/11\/2001<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Salvador Lledo Matoses<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Carlos Carbonell antoli <\/li>\n<li>damian Garc\u00eda olmo (vocal)<\/li>\n<li>Jos\u00e9 Luis Balibrea  cantero (vocal)<\/li>\n<li>Francisco Sanchez bueno (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Sala Palau Carlos Enrique La anestesia epidural es un metodo ampliamente difundido para el control del dolor [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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