[Anesthesia for a patient with superior vena cava syndrome]. / Manejo anestésico del síndrome de vena cava superior.

An 18-year-old male with a history of surgery to correct partial drainage of the pulmonary veins had been experiencing symptoms of superior vena cava syndrome (SVCS) for 2 years. Severe obstruction of the superior vena cava where it joined the right atrium became evident upon cardiac catheterization. Because the catheter could not be inserted into the atrium, angioplasty was ruled out and surgery was scheduled. Surgery was performed with the patient in Fowler's position. Electrocardiographic signals, oxygen saturation (pulse oximetry), temperature, bispectral index, diuresis, and invasive arterial pressure were monitored. A large vein was catheterized in the left foot, and a central venous catheter was inserted through the right femoral vein. Balanced anesthesia without nitrous oxide was provided, and a right axillary artery-inferior vena cava cardiopulmonary bypass was established. Once the defect was repaired, central venous pressure became normal and edema in the upper thoracic region decreased. Anesthesia for surgical correction of SVCS carries considerable risk related to such events as difficult intubation and ventilation, bleeding, and vessel collapse. Extreme precautions must be taken and certain procedures followed in order to avoid life-threatening complications.

Cesárea a una paciente con hemoptisis amenazante por carcinoide traqueal / Cesarean section in a patient with massive hemoptysis caused by tracheal carcinoid tumor

A una gestante, de 29 semanas, en situación de insuficiencia respiratoria aguda y hemoptisis amenazante sin etiología conocida se le practicó una cesárea urgente, bajo anestesia general, para evitar las posibles repercusiones fetales durante los episodios de hipoxemia materna. El cuadro se debió a la inesperada localización endotraqueal de un tumor carcinoide, próximo a la carina, que provocaba la obstrucción distal de la traquea y que por su localización y características histológicas pudo ocasionar complicaciones fatales durante las maniobras de intubación endotraqueal. La respuesta oximétrica a las pautas habituales de ventilación mecánica fue insatisfactoria y precisó un manejo cuidadoso que permitió oxigenar suficientemente a la madre y el feto, aunque provocó yatrogenia en la vía aérea, neumotórax y neumomediastino. La aparición de un carcinoide traqueal durante el embarazo es excepcional. Es recomendable la intubación traqueal, o bronquial, bajo visión endoscópica ante cuadros de hemoptisis que, como en este caso, carezcan de diagnóstico etiológico confirmado (AU)

A woman 29 weeks pregnant presented with acute respiratory insufficiency and massive hemoptysis of unknown origin. An emergency cesarean section was performed to avoid hypoxic fetal damage during episodes of maternal hypoxemia. BIeeding was due to an unsuspected endotracheal carcinoid tumor located near the carina. The tumor obstructed the distal portion of the trachea, leading lo life-threatening complications during tracheal intubation because of its histological characteristics and placement. Pulse oximetry response to standard mechanical ventilation was unsatisfactory. Special measures to ventilate mother and fetus were successful, in spite of iatrogenic pneumothorax and pneumomediastinum. We report an exceptional case of tracheal carcinoid tumor during the pregnancy and recommend that tracheal or bronchial intubation take place under fiber optic guidance in cases of hemoptysis with no firm etiologic diagnosis (AU)

[Cesarean section in a patient with threatening hemoptysis caused by tracheal carcinoid]. / Cesárea a una paciente con hemoptisis amenazante por carcinoide traqueal.

A woman 29 weeks pregnant presented with acute respiratory insufficiency and massive hemoptysis of unknown origin. An emergency cesarean section was performed to avoid hypoxic fetal damage during episodes of maternal hypoxemia. Bleeding was due to an unsuspected endotracheal carcinoid tumor located near the carina. The tumor obstructed the distal portion of the trachea, leading to life-threatening complications during tracheal intubation because of its histological characteristics and placement. Pulse oximetry response to standard mechanical ventilation was unsatisfactory. Special measures to ventilate mother and fetus were successful, in spite of iatrogenic pneumothorax and pneumomediastinum. We report an exceptional case of tracheal carcinoid tumor during the pregnancy and recommend that tracheal or bronchial intubation take place under fiber optic guidance in cases of hemoptysis with no firm etiologic diagnosis.