ABSTRACT
La tiroidectomía endoscópica transoral por abordaje vestibular (TOETVA) constituye un procedimiento novedoso y mínimamente invasivo, libre de cicatrices visibles y que presenta resultados alentadores en cuanto a la rápida recuperación y menor dolor posoperatorio. Consiste en realizar la tiroidectomía a través de su orificio natural, empleando tres puertos en el área oral vestibular y llevando a cabo una disección cuidadosa hasta la muesca esternal y los bordes de ambos músculos esternocleidomastoideos. El objetivo es describir las diferentes implicaciones anestésicas que conlleva esta técnica quirúrgica, dado que la evidencia publicada hasta la fecha en la literatura es muy limitada. Se considera esencial la monitorización del nervio laríngeo recurrente mediante tubo endotraqueal con electromiografía para garantizar su identificación e integridad, así como la utilización de otros monitores como el TOF-watch o el índice biespectral para asegurar una adecuada profundidad anestésica y un óptimo nivel de relajación muscular.(AU)
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel and minimally invasive procedure, free of visible scars and showing encouraging results in terms of rapid recovery and less postoperative pain. It consists of performing the thyroidectomy through its natural orifice, using three ports in the oral vestibular area and carrying out a careful dissection to the sternal notch and the edges of both sternocleidomastoid muscles. The objective of this article is to describe the different anesthetic implications that this surgical technique entails, given that the evidence published to date in the literature is very limited. It is considered essential to control the recurrent laryngeal nerve using an endotracheal tube with electromyography to ensure its identification and integrity, as well as the use of other monitors such as the TOF watch or the bispectral index to ensure adequate anesthetic depth and an optimal level of muscle relaxation.(AU)
Subject(s)
Humans , Female , Middle Aged , Thyroidectomy/methods , Anesthesia , Recurrent Laryngeal Nerve/surgery , Intubation, Intratracheal , Electromyography , Recurrent Laryngeal Nerve Injuries/surgery , Inpatients , Physical Examination , Anesthesiology , Anesthesia, EndotrachealABSTRACT
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel and minimally invasive procedure, free of visible scars and showing encouraging results in terms of rapid recovery and less postoperative pain. It consists of performing the thyroidectomy through its natural orifice, using three ports in the oral vestibular area and carrying out a careful dissection to the sternal notch and the edges of both sternocleidomastoid muscles. The objective of this article is to describe the different anesthetic implications that this surgical technique entails, given that the evidence published to date in the literature is very limited. It is considered essential to control the recurrent laryngeal nerve using an endotracheal tube with electromyography to ensure its identification and integrity, as well as the use of other monitors such as the TOF watch or the bispectral index to ensure adequate anesthetic depth and an optimal level of muscle relaxation.
Subject(s)
Anesthetics , Recurrent Laryngeal Nerve Injuries , Endoscopy , Humans , Recurrent Laryngeal Nerve , ThyroidectomyABSTRACT
La enfermedad de CADASIL (arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía) es una angiopatía sistémica hereditaria que afecta fundamentalmente a los vasos cerebrales de pequeño y mediano calibre. Alrededor de 500 familias están afectadas en el mundo, la mayoría de ellas en Europa. Se caracteriza por presentar crisis de migraña, demencia subcortical, trastornos neuropsiquiátricos e ictus isquémicos de repetición. Nuestro objetivo ha sido describir por primera vez en la literatura el manejo mediante anestesia general de un procedimiento neuroquirúrgico intracraneal en un paciente con la enfermedad de CADASIL. Consideramos esencial la monitorización continua de la presión arterial, así como el mantenimiento de normocapnia y normotermia para evitar el desarrollo de nuevos accidentes cerebrovasculares. Esta enfermedad resulta relevante debido a sus implicaciones anestésicas y las escasas publicaciones hasta la fecha
CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy) disease is an inherited systemic arterial disease that affects the small and medium calibre cerebral vessels. Around 500 families are affected in the world, most of them in Europe. It is characterised by migraine attacks, subcortical dementia, neuropsychiatric disorders, and recurrent ischaemic strokes. The objective of this article is to describe, for the first time in the literature, the management by general anaesthesia of an intracranial neurosurgical procedure in a patient with CADASIL disease. Continuous monitoring of blood pressure is considered essential, as well as the maintenance of normocapnia and normothermia to avoid the development of new cerebrovascular accidents. This disease is relevant due to its anaesthetic implications and the few publications to date
Subject(s)
Humans , Female , Middle Aged , Anesthesia, General/methods , CADASIL/surgery , Neurosurgical Procedures/methods , Monitoring, Intraoperative/methods , Rare Diseases/surgery , Intracranial Pressure/physiologyABSTRACT
CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy) disease is an inherited systemic arterial disease that affects the small and medium calibre cerebral vessels. Around 500 families are affected in the world, most of them in Europe. It is characterised by migraine attacks, subcortical dementia, neuropsychiatric disorders, and recurrent ischaemic strokes. The objective of this article is to describe, for the first time in the literature, the management by general anaesthesia of an intracranial neurosurgical procedure in a patient with CADASIL disease. Continuous monitoring of blood pressure is considered essential, as well as the maintenance of normocapnia and normothermia to avoid the development of new cerebrovascular accidents. This disease is relevant due to its anaesthetic implications and the few publications to date.
