Manejo de Vía Aérea Difícil en Paciente con Espondilitis Anquilosante. Reporte de caso

Introducción: La espondilitis anquilosante es una artropatía que se encuentra dentro del grupo de artropatías seronegativas, siendo la entidad más común y representativa de ellas. Se caracteriza por inflamación crónica del esqueleto axial, con dolor de espalda de tipo inflamatorio y rigidez progresiva. Típicamente se manifiesta en pacientes jóvenes que inician su sintomatología entre los 20 y 30 años. La osificación progresiva en la espondilitis anquilosante envuelve los cartílagos articulares y discos de la columna vertebral, con el desarrollo de puentes óseos entre las vértebras. Esta fusión hace difícil, sino imposible, el abordaje axial para lograr una anestesia epidural o espinal, e incluso una dificultad aumentada del manejo de la vía aérea por la fusión de las vértebras cervicales. Caso clínico: En este reporte de caso se presenta una paciente femenina de 40 años, ya con diagnóstico de espondilitis anquilosante, que acude para una histerectomía total abdominal, que en primera instancia se intenta un abordaje neuro axial fallido y posteriormente se procede al uso de anestesia general con manejo de la vía aérea. Conclusión: La intubación en pacientes despiertos, es un tema ampliamente descrito en la literatura el cual se puede realizar de distintas maneras, en nuestro caso optamos por el uso de bloqueos de la vía aérea superior con posterior uso de fibroscopio para asegurar la intubación endotraqueal. (provisto por Infomedic International)

Introduction: Ankylosing spondylitis is an arthropathy that falls within the group of seronegative arthropathies, being the most common and representative entity of them. It is characterized by chronic inflammation of the axial skeleton, with inflammatory back pain and progressive stiffness. It typically manifests in young patients who begin to show symptoms between 20 and 30 years of age. Progressive ossification in ankylosing spondylitis involves the articular cartilage and discs of the spine, with the development of bony bridges between the vertebrae. This fusion makes the axial approach difficult, if not impossible, to achieve epidural or spinal anesthesia, and even increases the difficulty of airway management due to the fusion of the cervical vertebrae. Case report: This case report presents a 40-year-old female patient, already diagnosed with ankylosing spondylitis, who underwent a total abdominal hysterectomy, where a failed neuraxial approach was first attempted and then general anesthesia with airway management was used. Conclusion: Intubation in awake patients is a subject widely described in the literature which can be performed in different ways, in our case we opted for the use of upper airway blocks with subsequent use of fiberscope to ensure endotracheal intubation. (provided by Infomedic International)

Ayuno preoperatorio: diferencias ultrasonográficas en periodos de ayuno diferentes en pacientes hospitalizados en el Hospital Santo Tomás

Introducción: La principal razón, por la que surge el concepto de ayuno prolongado, en pacientes que serán sometidos a procedimientos quirúrgicos, es para disminuir el contenido estomacal, y así el riesgo o la incidencia de vómitos y broncoaspiración durante la inducción de la anestesia. Volúmenes grandes a nivel del antro gástrico, están asociados a riesgo de vómito perioperatorio. Objetivo: Comparar mediante ultrasonido la apariencia cualitativa gástrica, luego de diferentes periodos de ayuno. Metodología: Estudio prospectivo, transversal, cualitativo realizado en pacientes hospitalizados en el Hospital Santo Tomás durante los meses de julio a octubre 2020. A cada paciente se le indicó realizar un ayuno completo de 8 horas y posterior, un ayuno de 2 horas luego de una bebida con carbohidratos. Se analizaron datos demográficos (edad, sexo, peso, talla), índice de masa corporal, clasificación ASA, y la apariencia cualitativa del estómago en el ultrasonido en cada ayuno. Resultados: 92 pacientes, con predominio del sexo masculino y una media de edad de 37 años, fueron evaluados mediante ultrasonido: se observó que a las 8 horas de ayuno el 100% de los pacientes presentaban un estómago vacío (grado 0), mientras que a las 2 horas de ayuno a liquido el 67% presentó un grado 0, el 26% presentó grado 1 y el 4% presentó grado 0. Conclusiones: los periodos de más de 8 horas tienen características ultrasonográficas muy similares a los periodos de ayuno de 2 horas a líquidos, en la población de adultos jóvenes sin patologías que alteren el estómago. (provisto por Infomedic International)

Introduction: The main reason, for which the concept of prolonged fasting arises, in patients who will undergo surgical procedures, is to decrease stomach contents, and thus the risk or incidence of vomiting and bronchoaspiration during induction of anesthesia. Large volumes at the level of the gastric antrum are associated with risk of perioperative vomiting. Objective: To compare by ultrasound the qualitative gastric appearance after different fasting periods. Methodology: Prospective, cross-sectional, qualitative study performed in patients hospitalized at Hospital Santo Tomás during the months of July to October 2020. Each patient was instructed to perform a complete 8-hour fast and then a 2-hour fast after a carbohydrate drink. Demographic data (age, sex, weight, height), body mass index, ASA classification, and the qualitative appearance of the stomach on ultrasound at each fast were analyzed. Results: 92 patients, predominantly male and with a mean age of 37 years, were evaluated by ultrasound: it was observed that at 8 hours of fasting 100% of the patients presented an empty stomach (grade 0), while at 2 hours of fasting to liquid 67% presented grade 0, 26% presented grade 1 and 4% presented grade 0. Conclusions: the periods of more than 8 hours have ultrasonographic characteristics very similar to the periods of 2 hours of fasting to liquids, in the population of young adults without pathologies that alter the stomach. (provided by Infomedic International)

Elective laparoscopic sigmoidectomy with preservation of the superior rectal artery prior to endoscopic decompression in sigmoid volvulus

Sigmoid volvulus is a frequent cause of intestinal obstruction. Its management has evolved with the use of laparoscopic surgery, achieving an elective sigmoid resection with anastomosis after a flexible endoscopic detorsion. A female patient was admitted to the emergency room with abdominal pain, distention, and constipation. The abdominal computed tomography showed a whirled sigmoid mesentery in addition to dilated sigmoid loops, and coffee bean sign. The patient successfully underwent a flexible endoscopic detorsion and was scheduled for elective sigmoid colectomy with rectal superior artery preservation and primary anastomosis. During the sigmoid resection, the superior rectal artery preservation is related to a better prognostic, with less bleeding, anastomotic leakage, and hospital stay. Currently, there are few reports of the laparoscopic preservation of the superior rectal artery in patients with sigmoid volvulus. (AU)

Potential drug delivery system: study of the association of a model nitroimidazole drug with aggregates of amphiphilic polymers on aqueous solution

This study evaluated the association of N-hexyl-2-methyl-4-nitroimidazol, a model drug, to aggregates formed by anionic polyelectrolytes on aqueous solution. The alternating copolymers of maleic anhydride and N-vinyl-2-pyrrolidone were synthesized and then modified by reaction of the anhydride groups with aliphatic amines and alcohols of varying length of the alkyl chain. The partition of the model drug between water and the hydrophobic microdomains provided by the copolymers was studied using the pseudo-phase model to determinate the distribution coefficient K S, and the standard free energy of transfer ∆µ°t. The results indicate that all copolymers assessed are potential pharmaceutical reservoirs of the model drug. Nevertheless, the solubility of N-hexyl-2-methyl-4-nitroimidazol on the polymeric solutions is independent from the length of the alkyl chain of the copolymer.

Realizou-se estudo sobre a associação da N-hexil-2-metil-4-nitroimidazol, fármaco modelo, aos agregados formados por polieletrólitos aniônicos em solução aquosa. Os copolímeros alternados de anidrido maléico e N-vinil-2-pirrolidona foram sintetizados e, em seguida, modificados pela reação dos grupos de anidrido com aminas e álcoois alifáticos de duração variável da cadeia alquílica. A partição do fármaco modelo entre a água e os microdomínios hidrofóbicos fornecido pelos copolímeros foi estudada usando o modelo de pseudo-fase, a fim de determinar a distribuição do coeficiente K S e a energia livre padrão de transferência ∆µ°t. Os resultados indicam que todos os copolímeros avaliados são potenciais reservatórios farmacêuticos do fármaco. No entanto, a solubilidade do N-hexil-2-metil-4-nitroimidazol sobre as soluções poliméricas é independente do comprimento da cadeia alquílica do copolímero.