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Conducción anestésica de un paciente pediátrico con micro esferocitosis hereditaria / Anesthetic approach on a pediatric patient with hereditary microspherocytosis
Sánchez Tamayo, Marcelino; Cruz Crespo, Mariela; Azcuy Barrueto, Anayaris; Díaz Fonseca, Lisbet; Garcés Tamayo, Milagro de la Caridad.
  • Sánchez Tamayo, Marcelino; Hospital General Docente "Comandante Pinares". Artemisa. CU
  • Cruz Crespo, Mariela; Hospital General Docente "Comandante Pinares". Artemisa. CU
  • Azcuy Barrueto, Anayaris; Hospital General Docente "Comandante Pinares". Artemisa. CU
  • Díaz Fonseca, Lisbet; Hospital General Docente "Comandante Pinares". Artemisa. CU
  • Garcés Tamayo, Milagro de la Caridad; Hospital General Docente "Comandante Pinares". Artemisa. CU
Rev. cuba. anestesiol. reanim ; 19(1): e539, ene.-abr. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093131
RESUMEN

Introducción:

La esferocitosis hereditaria (ESH) es una anemia hemolítica de observación frecuente, en la cual existen defectos cualitativos o cuantitativos de algunas proteínas de la membrana eritrocitaria que llevan a la formación de hematíes de forma esférica, osmóticamente frágiles, que son atrapados de formas selectiva y destruidos en el bazo, con incidencia variable y más frecuente en pacientes con descendencia europea.

Objetivo:

Describir la conducta clínica y anestesiológica de un paciente pediátrico con diagnóstico de micro esferocitosis hereditaria programado de forma electiva para procedimiento quirúrgico. Desarrollo Se presenta un caso clínico de un paciente escolar con diagnóstico de micro esferocitosis hereditaria al cual se le realizó esplenectomía total electiva convencional. Con principal signo dolor a la palpación en hipocondrio izquierdo. Se condujo con anestesia total intravenosa con buenos resultados clínicos quirúrgicos, utilizando propofol a razón de 3 mcg/mL y ketamina a 0,2 mg/mL. La estrategia estuvo basada en cinco aspectos claves evitar la hipoxia, la hipotermia, la acidosis, reducir la pérdida de sangre, así como un correcto control del dolor postoperatorio. Asociado a lo anterior es indispensable una estrecha vigilancia ya que estos pacientes pueden manifestar crisis hemolítica y aplásica.

Conclusiones:

El manejo perioperatorio del paciente con esferocitosis hereditaria depende de la severidad del cuadro clínico, de la anemia y su repercusión y del grado de hemólisis. La anestesia total intravenosa es una técnica segura para el tratamiento de pacientes con esferocitosis hereditaria(AU)
ABSTRACT

Introduction:

Hereditary spherocytosis (HS) is a hemolytic anemia of frequent occurrence, in which there are qualitative or quantitative defects of some erythrocyte membrane proteins that lead to the formation of sphere-shaped red blood cells, which are osmotically fragile, and that are selectively trapped and destroyed in the spleen, with variable and more frequent incidence in patients with European descent.

Objective:

To describe the clinical and anesthesiological behavior of a pediatric patient with a diagnosis of hereditary microspherocytosis electively programmed for a surgical procedure. Development A clinical case of a school-age patient with a diagnosis of hereditary microspherocytosis was presented. The patient underwent conventional elective total splenectomy. Pain was as the main sign on palpation to the left hypochondrium. The case was conducted with total intravenous anesthesia, with good surgical clinical results, using propofol at a rate of 3 mcg/mL and ketamine at 0.2 mg/mL. The strategy was based on five key aspects avoid hypoxia, hypothermia, acidosis, reduce blood loss, as well as proper control of postoperative pain. Associated with the above-mentioned, close monitoring is essential, as these patients may manifest hemolytic and aplastic crisis.

Conclusions:

The perioperative management of the patient with hereditary spherocytosis depends on the severity of the clinical status, the anemia and its repercussion, and the degree of hemolysis. Total intravenous anesthesia is a safe technique for the treatment of patients with hereditary spherocytosis(AU)
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Spherocytosis, Hereditary / Splenectomy / Anesthesia, Intravenous Type of study: Qualitative research Limits: Child / Humans / Male Language: Spanish Journal: Rev. cuba. anestesiol. reanim Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Cuba Institution/Affiliation country: Hospital General Docente "Comandante Pinares"/CU

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Full text: Available Index: LILACS (Americas) Main subject: Spherocytosis, Hereditary / Splenectomy / Anesthesia, Intravenous Type of study: Qualitative research Limits: Child / Humans / Male Language: Spanish Journal: Rev. cuba. anestesiol. reanim Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Cuba Institution/Affiliation country: Hospital General Docente "Comandante Pinares"/CU