ABSTRACT
Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.
Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.
Subject(s)
Humans , Male , Aged , Penile Neoplasms , Penile Neoplasms/surgery , Catheters , Anesthetics , Pain, Postoperative , Psychiatry , Quality of Life , Blood Transfusion , Bupivacaine , Coronary Disease , Depressive Disorder , Pain Management , Analgesia , Anesthesia , Magnesium SulfateABSTRACT
Opioid free anesthesia (OFA) is defined as an anesthesiologic technique where opioids are not used in the intraoperative and postoperative period. Although the mainstay of intra-operative analgesia may be opioids, current challenges are focus on reducing them and preventing the adverse effects of opioids, by rationalizing and even suspending their perioperative use, specifically at risk populations such as Obstructive Sleep Apnea Syndrome (OSAHS), obesity, Chronic Obstructive Pulmonary Disease (COPD) and cancer surgery. We present this case of OFA in a susceptible patient with complications from the use of opioids undergoing an extended right hemicolectomy. Multimodal analgesia was performed with a thoracic peridural and subanesthetic doses of intravenous agents including dexmedetomidine, ketamine and propofol, accompanied by short and long-lasting local periglotic anesthetics. The patient had given an intraand postoperative analgesia without presenting any adverse events, good recovery, early deambulation and extubation.
La anestesia libre de opioides (OFA) es una técnica anestésica donde no hay administración de opioides, tanto en el intraoperatorio como en el postoperatorio. Aunque una de las bases de la analgesia intraoperatoria podrían ser los opioides, los desafíos actuales están enfocados en reducir su uso perioperatorio, previniendo sus efectos adversos, racionalizando y limitando su empleo específicamente en poblaciones de riesgo como síndrome de apnea obstructiva del sueño (SAHOS), obesidad, enfermedad pulmonar obstructiva crónica (EPOC) y cirugía oncológica. Presentamos este caso de OFA en un paciente susceptible de complicaciones por uso de opioides sometido a una hemicolectomía derecha extendida. Se realizó analgesia multimodal con peridural torácica y dosis subanestésicas de agentes endovenosos como dexmedetomidina, ketamina y propofol, acompañado de anestésicos locales periglóticos de corta y larga duración. Se otorgó una adecuada analgesia intra y postoperatoria, el paciente no tuvo eventos adversos, presentando una buena recuperación, deambulación y extubación precoz.
Subject(s)
Humans , Aged, 80 and over , Colectomy/methods , Colonic Neoplasms/surgery , Anesthesia/methods , Anesthetics/administration & dosage , Sleep Apnea, Obstructive , Analgesics, Opioid/adverse effects , Intraoperative Complications/prevention & control , ObesityABSTRACT
Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8 percent. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86 percent) had non-Hodgkin lymphoma (NHI) and two (14 percent) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50 percent). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86 percent) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29 percent) received chemotherapy with or without radiotherapy, onepatient (7 percent) received radiotherapy alone and two patients (14 percent) received palliative symptomatic treatment. Six cases (43 percent) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57 percent (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed.