Manejo de la hipotermia perioperatoria / Management of peri-operative hypothermia

La hipotermia (temperatura corporal central menor de 36°C) es el trastorno de la temperatura más frecuente en pacientes quirúrgicos. En general, debe ser evitada para reducir la morbimortalidad y los costes derivados. La temperatura debe ser considerada como una constante vital más y, todo el personal implicado en el cuidado del paciente quirúrgico debe estar concienciado con el sostenimiento de la misma dentro de la normalidad. El mantenimiento de la temperatura corporal es el resultado del balance entre la producción y la pérdida de calor. La regulación de la temperatura se lleva a cabo mediante un sistema de retroalimentación positiva y negativa en el sistema nervioso central, desarrollándose en 3 fases: aferencia térmica, regulación central y respuesta eferente. El mejor método para asegurar la normotermia es la prevención. Es obligado el calentamiento activo intraoperatorio del paciente. El sistema más eficaz, sencillo y barato para prevenir y tratar la hipotermia es el que emplea aire caliente(AU)

Hypothermia (body temperature under 36°C) is the thermal disorder most frequently found in surgical patients, but should be avoided as a means of reducing morbidity and costs. Temperature should be considered as a vital sign and all staff involved in the care of surgical patients must be aware that it has to be maintained within normal limits. Maintaining body temperature is the result, as in any other system, of the balance between heat production and heat loss. Temperature regulation takes place through a system of positive and negative feedback in the central nervous system, being developed in three phases: thermal afferent, central regulation and efferent response. Prevention is the best way to ensure a normal temperature. The active warming of the patient during surgery is mandatory. Using warm air is the most effective, simple and cheap way to prevent and treat hypothermia(AU)

[Management of peri-operative hypothermia]. / Manejo de la hipotermia perioperatoria.

Hypothermia (body temperature under 36°C) is the thermal disorder most frequently found in surgical patients, but should be avoided as a means of reducing morbidity and costs. Temperature should be considered as a vital sign and all staff involved in the care of surgical patients must be aware that it has to be maintained within normal limits. Maintaining body temperature is the result, as in any other system, of the balance between heat production and heat loss. Temperature regulation takes place through a system of positive and negative feedback in the central nervous system, being developed in three phases: thermal afferent, central regulation and efferent response. Prevention is the best way to ensure a normal temperature. The active warming of the patient during surgery is mandatory. Using warm air is the most effective, simple and cheap way to prevent and treat hypothermia.

Anclaje esofágico de una autosutura esofágica, liberado con ayuda de un videolaringoscopio McGrath / No disponible

No disponible

Manejo anestésico de una paciente con enfermedad de Farh / No disponible

Los trastornos neurodegenerativos motores, de características hipocinéticas, se ven especialmente representados por los parkinsonismos. En esta categoría se incluyen la enfermedad de Fahr. Presentamos en esta ocasión el caso de una mujer diagnosticada con esta patología programada para intervención quirúrgica, con el fin de realizar una puesta al día del manejo anestésico de pacientes con este tipo de trastornos. Mujer de 60 años de edad, diagnosticada de Enfermedad de Fahr desde hacía 3 años, programada para colecistectomía vía laparoscópica. La paciente clínicamente se encontraba asintomática con leve-moderado grado de rigidez muscular. La Enfermedad de Fahr es una causa poco frecuente de Parkinsonismo atípico. El diagnóstico de sospecha es clínico y el de confirmación se realiza recurriendo a las pruebas de imagen. La elección de la técnica anestésica, depende del tipo de paciente y de la intervención quirúrgica. Son de elección las técnicas de anestesia loco-regional frente a la anestesia general. Los puntos más importantes en el manejo anestésico de este grupo de pacientes son el control de las alteraciones músculo-esqueléticas y autonómicas, el manejo farmacológico adecuado y el control de la sintomatología que pudiera aparecer en el curso de la intervención. Se recomienda que el paciente tome sus medicamentos anti-parkinsonianos el día de la cirugía lo más cerca posible al inicio de la anestesia y los reinicie tan pronto sea factible en el postoperatorio. La seguridad anestésica en estos casos vendrá dada por un exhaustivo estudio preoperatorio del paciente, el mantenimiento de la pauta farmacológica específica y su reanudación lo más precozmente posible tras la misma, así como la evitación de agentes que puedan reproducir una crisis parkinsoniana(AU)

Neurodegenerative hypo kinetic disorders are particularly represented by parkinsonism. This category includes Fahr´s disease. We present in this occasion the case of a woman diagnosed with this disease scheduled for surgery, to perform an update of the anesthetic management of patients with these disorders. Female 60 years old, diagnosed with Fahr´s disease for 3 years, scheduled for laparoscopic cholecystectomy. The patient was clinically asymptomatic with mild to moderate degree of muscle stiffness. Fahr's disease is a rare cause of atypical parkinsonism. The suspicion diagnosis is clinical and confirmation was performed using imaging tests. The choice of anesthetic technique depends on the type of patient and surgery. Local anesthesia are preferred versus general anesthesia. The most important points in the anesthetic management of these patients are to control musculoskeletal and autonomic disorders, an appropriate pharmacological management and control of symptoms that may appear in the course of the surgery. It is recommended that the patient is taking anti-parkinsonian medications the day of surgery as close as possible to the onset of anesthesia and restart as soon as practicable after the operation. The safety of anesthesia in these cases is given by a thorough preoperative evaluation of the patient, maintaining the specific drug regimen and its resumption as early as possible after it, as well as avoidance of agents that may play a parkinsonian crisis(AU)

[Anesthesia in a patient with Ellis-van Creveld syndrome]. / Tratamiento anestésico de una paciente con síndrome de Ellis-Van Creveld.

Ellis-van Creveld syndrome is a rare type of developmental chondroectodermal dysplasia. We report the case of a 32-year-old woman with this syndrome who was scheduled for cesarean section. She had no related heart defect. A spinal block was attempted but after confirming that no sensory blockade had been achieved, general anesthesia was administered. Both the operation and the anesthetic procedure were without complications. The clinical manifestations of Ellis-van Creveld syndrome are short-limbed dwarfism, postaxial polydactyly, fingernail dysplasia, cleft palate and lips, and heart defects. Diagnosis is based on clinical manifestations and radiography. Treatment involves correction of heart defects and orthopedic problems. Perioperative airway management problems may develop. A preoperative echocardiogram should be done to assess heart function and ascertain anatomical abnormalities. Thoracic deformities may make mechanical ventilation difficult and there is risk of barotrauma. Intraoperative management requires rapid control of the airway and prevention of bronchial aspiration. Vigilance in preventing hemodynamic instability and myocardial depression is essential. Postoperative analgesia must be managed carefully and adverse cardiorespiratory events avoided.

Tratamiento anestésico de una paciente con síndrome de Ellis-Van Creveld / Anesthesia in a patient with Ellis-van Creveld syndrome

INTRODUCCIÓN: El síndrome de Ellis-Van Creveld es una enfermedad rara del desarrollo, perteneciente al grupo de las displasias condroectodérmicas. CASO CLÍNICO: Mujer de 32 años diagnosticada de síndrome de Ellis van Creveld, programada para cesárea. Carecía de patología cardiaca. Se realizó un bloqueo subaracnoideo pero tras la comprobación de que no había bloqueo sensitivo, se decidió anestesia general. Tanto la cesárea como el procedimiento anestésico trascurrieron sin incidencias. DISCUSIÓN: Las manifestaciones clínicas del síndrome de Ellis van Creveld son enanismo con extremidades muy cortas, polidactilia postaxial, tórax pequeño, displasia ungueal, alteraciones de la boca y labios y anomalías cardiacas. El diagnóstico es clínico-radiológico. El tratamiento viene dado por la corrección de las alteraciones cardiacas y el tratamiento ortopédico. La morbilidad perioperatoria puede venir dada por las dificultades en el manejo de la vía aérea. Es necesaria la realización de una ecocardiografía preoperatoria para valorar la función cardiaca y concretar las anormalidades anatómicas. Las anormalidades torácicas también pueden dificultar la ventilación mecánica, incluido el riesgo de barotrauma. El manejo intraoperatorio debe basarse en un rápido control de la vía aérea, con prevención de la broncoaspiración. Debe evitarse la inestabilidad hemodinámica y la depresión miocárdica. En el postoperatorio, es primordial el correcto manejo de la analgesia y la prevención de episodios cardiorrespiratorios desfavorables(AU)

Ellis-van Creveld syndrome is a rare type of developmental chondroectodermal dysplasia. We report the case of a 32-year-old woman with this syndrome who was scheduled for cesarean section. She had no related heart defect. A spinal block was attempted but after confirming that no sensory blockade had been achieved, general anesthesia was administered. Both the operation and the anesthetic procedure were without complications. The clinical manifestations of Ellis-van Creveld syndrome are short-limbed dwarfism, postaxial polydactyly, fingernail dysplasia, cleft palate and lips, and heart defects. Diagnosis is based on clinical manifestations and radiography. Treatment involves correction of heart defects and orthopedic problems. Perioperative airway management problems may develop. A preoperative echocardiogram should be done to assess heart function and ascertain anatomical abnormalities. Thoracic deformities may make mechanical ventilation difficult and there is risk of barotrauma. Intraoperative management requires rapid control of the airway and prevention of bronchial aspiration. Vigilance in preventing hemodynamic instability and myocardial depression is essential. Postoperative analgesia must be managed carefully and adverse cardiorespiratory events avoided(AU)

Luxación cervical C6-C7 / No disponible

No disponible

[Sugammadex, a novel drug for neuromuscular blockade reversal]. / Sugammadex. Nuevo fármaco reversor del bloqueo neuromuscular.

Significant progress in the management of aminosteroid nondepolarizing neuromuscular blockers will follow the introduction of sugammadex (Org 25969). Safety and rapid recovery of muscle force will improve and the adverse effects of acetylcholinesterase inhibitors will be avoided. Sugammadex is a modified gamma-cyclodextrin agent developed for the specific reversal of rocuronium and, to a lesser extent, vecuronium. This novel drug functions by means of encapsulation (chelation). Sugammadex was recently approved by the European Medicines Evaluation Agency and became available in Spain in 2009, leading to a series of changes related to patient safety and surgical conditions. We review the literature on sugammadex published to date.

Usos clínicos del videolaringoscopio McGrath® / No disponible

Dos de los principales objetivos de todo anestesiólogo es el manejo de la vía aérea y el mantenimiento de la oxigenación del paciente. Las complicaciones derivadas del inadecuado logro de estos objetivos constituyen la primera causa de accidentes y la primera causa de demandas legales. Desde su invención, el laringoscopio de Macintosh ha sido el más usado en la práctica clínica diaria. Un gran adelanto tecnológico ha sido la aparición en el mercado de los videolaringoscopios, entre los que destaca el McGrath®, dispositivo totalmente portátil y de fácil empleo, que nos permite mejorar el grado de visión de la laringe durante la maniobra de intubación traqueal, con respecto a la laringoscopia directa, en diversas situaciones. Entre las ventajas de su uso destacan la completa portabilidad, la ausencia de necesidad de esterilización entre pacientes y la fácil desarticulación de la pala y el mango (AU)

Two of the main objectives of any anesthesiologist are airway management and maintenance of the oxygenation of the patient. Complications arising from inadequate achievement of these goals are the primary cause of accidents and the leading cause of lawsuits. Since its invention, the Macintosh laryngoscope has been the most used in daily clinical practice. A technological breakthrough has been the emergence in the market for videolaryngoscopes, most notably the McGrath®, completely portable device and easy to use, allowing us to improve the degree of vision of the larynx during tracheal intubation maneuver with respect to direct laryngoscopy, in various situations. Among the advantages of its use include the complete portability, no need for sterilization between patients and the easy disarticulation of the blade and the handle (AU)

[Anesthetic considerations in sickle cell anemia: a case report]. / Descripción de un caso de drepanocitosis y consideraciones anestésicas.

Sickle cell anemia is the most common hemoglobinopathy. Advances in therapeutic techniques and anesthetic procedures have led to a considerable increase in the success of surgical procedures in these patients. We report the case of a 16-year-old black boy diagnosed with sickle cell anemia and beta-thalassemia who presented with chronic osteomyelitis of the tibia. He was scheduled for debridement of the lesion and musculocutaneous flap repair. We emphasize the importance of communication between anesthesiologists, surgeons, and hematologists in the perioperative period in order to determine the risk of complications and anticipate them.

Descripción de un caso de drepanocitosis y consideracionesanestésicas / Anesthetic considerations in sickle cell anemia: a case report

La drepanocitosis es la forma más frecuente de hemoglobinopatíaestructural. El avance en las técnicas y en eltratamiento anestésico de estos pacientes han determinadoun aumento importante en el éxito de los procedimientosquirúrgicos. Presentamos el caso de un varón de16 años, de raza negra, diagnosticado de drepanocitosisy ß-talasemia, que presentó osteomielitis crónica tibial yfue programado en quirófano para desbridamiento de lalesión y colgajo musculocutáneo. Destacamos la importancia,en el período perioperatorio, de la intercomunicaciónentre anestesiólogos, cirujanos y hematólogos,teniendo como propósito determinar el riesgo de padecercomplicaciones para poder anticiparse (AU)

Sickle cell anemia is the most commonhemoglobinopathy. Advances in therapeutic techniquesand anesthetic procedures have led to a considerableincrease in the success of surgical procedures in thesepatients. We report the case of a 16-year-old black boydiagnosed with sickle cell anemia and ß-thalassemia whopresented with chronic osteomyelitis of the tibia. He wasscheduled for debridement of the lesion and musculocutaneous flap repair. We emphasize theimportance of communication between anesthesiologists,surgeons, and hematologists in the perioperative periodin order to determine the risk of complications andanticipate them (AU)