Intubación selectiva evaluada con ecografía en neonato pretérmino llevado a corrección de atresia esofágica tipo C. Reporte de caso / Ultrasound-guided selective intubation in a preterm neonate undergoing type-C esophageal athresia correction. Case report

Abstract Introduction: Neonatal patients presenting with tracheoesophageal fistula represent a challenge to the anesthesiologist due to the multiple difficulties this pathology involves for airway management. Case discussion: Following is a description of a case of a neonate undergoing tracheoesophageal fistula repair using ultrasound-guided orotracheal intubation as an adjunct to selective intubation. Conclusion: Perioperative ultrasound is a promising tool for airway management of the pediatric patient. Further studies to assess the possibility to position the technique as a standard of care are needed.

Resumen Introducción: Los pacientes neonatales con fístula traqueoesofágica representan un reto para el anestesiólogo dadas las dificultades en el manejo de la vía aérea que esta patología supone. Presentación del caso: A continuación se expone un caso de un neonato llevado a corrección de fístula traqueoesofágica con intubación orotraqueal guiada por ultrasonido como técnica adjuvante a la intubación selectiva. Conclusion: La ultrasonografía perioperatoria en el manejo de la vía aérea del paciente pediático constituye una herramienta prometedora que requiere de estudios adicionales para evaluar la posibilidad de posicionarla como un estándar de cuidado.

The role of microembolic signal monitoring in brainstem infarction and vertebrobasilar artery stenosis / 天津医药

Objective To investigate the relation between microembolic signals (MES) and vertebral basilar artery ste?nosis in patients with brainstem infarction. Methods A total of 156 patients with acute brainstem infarction, who were de?termined the cerebral infarction lesion and vertebral basilar artery stenosis by cranial magnetic resonance imaging and CT an?giography, and were monitored by transcranial Doppler via occipital window of basilar arterial MES monitoring in 7 days of the onset, were divided into microembolus signal negative group (n=136) and positive group (n=20). The clinical data were compared between two groups. The differences of different degrees of stenosis were analyzed in two groups. The differences of different locations of stenosis in patients with vertebral basilar artery stenosis were analyzed in two groups. Logistic regres?sion analysis was used to analyse the factors affecting MES. Results There were no significant differences in age, gender, history of hypertension and diabetes mellitus between the two groups (P<0.05). There were significant differences in the dif?ferent degrees of stenosis between two groups, no or mild stenosis was found in MES-negative group and severe stenosis in MES-positive group (P<0.05). There were 70 cases with no vertebral basilar artery stenosis, 86 cases with mild, moderate and severe stenosis, in which 14 cases were MES-positive and 72 cases were negative. There were significant differences in different locations of stenosis between the two groups. The proportion of multiple infarctions was significantly higher in MES-positive group than that of MES-negative group (P<0.05). The intracranial vertebral basilar artery stenosis and 75%of ver?tebral basilar artery stenosis were the independent risk factors of MES-positive. Conclusion Severe stenosis of the verte?bral basilar artery is more vulnerable to occur MES of posterior circulation, leading to cerebral infarction. Microemboli may be the cause of multiple infarctions in patients with vertebral basilar artery stenosis.