ABSTRACT
La placenta pércreta es un subtipo de acretismo placentario, en el que este órgano invade la totalidad de la pared uterina, llegando a afectar a los órganos circundantes. Se trata de una afección de alto riesgo quirúrgico, que por lo general va a requerir una histerectomía obstétrica. Presentamos el caso de una gestante de 36 años, con diagnóstico de placenta pércreta con invasión de vejiga e intestino. Durante la intervención desarrolló un cuadro de shock hipovolémico, que precisó transfusión masiva de hemoderivados y apoyo inotrópico. Fueron necesarias 3 reintervenciones sucesivas debido a la hemorragia, realizándose, en una de ellas, embolización selectiva de las arterias hipogástricas. Precisó 13 días en Cuidados Intensivos. El volumen total de hemoderivados transfundidos fue de 43 concentrados de hematíes, 28 unidades de plasma y 8 pools de plaquetas. Se destaca la importancia del diagnóstico prenatal precoz, para poder llevar a cabo un planteamiento adecuado de la intervención, en la que se cuente con un equipo multidisciplinario (cirujanos generales, urólogos, cirujanos vasculares), además de anestesiólogos y obstetras experimentados(AU)
Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians(AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Accreta/drug therapy , Placenta Accreta/surgery , Hysterectomy/methods , Anesthesia, General/instrumentation , Anesthesia, General/methods , Anesthesia, General , Propofol/therapeutic use , Fentanyl/therapeutic use , Neuromuscular Blockade/methods , Anesthesiology/instrumentation , Early Diagnosis , Hemorrhage/complications , Hemorrhage/drug therapy , Laparotomy/methods , Laparotomy , Myometrium , Myometrium/pathology , Adrenal Cortex Hormones/therapeutic use , Neuromuscular BlockadeABSTRACT
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Subject(s)
Humans , Female , Brachial Plexus , Nerve Block/methods , Nerve Block , Bardet-Biedl Syndrome/complications , Bardet-Biedl Syndrome/diagnosis , Anesthesia, Conduction/methods , Anesthesia, Conduction , Bardet-Biedl Syndrome/drug therapy , Anesthesia, Conduction/trendsABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Cardiac Tamponade/diagnosis , Cardiac Tamponade/drug therapy , Cardiac Tamponade/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Catheterization, Central Venous/trends , Pneumonia/complications , Echocardiography/methods , Echocardiography , Cardiography, ImpedanceABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Psoriasis/diagnosis , Psoriasis/drug therapy , Psoriasis/surgery , Intubation/methods , Anesthesia, General/instrumentation , Anesthesia, General/methods , Risk Factors , Psoriasis , Anesthesia, General/trends , Anesthesia, GeneralABSTRACT
Introducción. Comparar la eficacia de un régimen analgésico multimodal con 2 técnicas diferentes (bloqueo del nervio femoral con dosis única y bloqueo continuo del nervio femoral) en el control del dolor, consumo de opioides y efectos secundarios en pacientes intervenidos de artroplastia total de rodilla. Material y métodos. Estudio prospectivo aleatorizado, de pacientes intervenidos de prótesis de rodilla con anestesia subaracnoidea. La analgesia postoperatoria consistió en tramadol, dexketoprofeno y paracetamol, y una de las 2 técnicas siguientes: bloqueo del nervio femoral con dosis única de 30ml de ropivacaína 0,5% o la anterior dosis más perfusión continua por un catéter femoral de ropivacaína 0,375%, 6ml/h durante 48h. Se registraron las variables demográficas, anestésicas y quirúrgicas, intensidad del dolor según escala visual analógica, consumo de opiáceos y complicaciones a las 24 y 48h. Resultados. Se incluyeó a 104 pacientes. No hubo diferencias demográficas entre los grupos. La intensidad del dolor fue menor en el grupo en el que se realizó bloqueo femoral continuo, especialmente a las 48h, frente al bloqueo con dosis única, con menor consumo de analgesia de rescate en el bloqueo femoral continuo. La incidencia de efectos secundarios fue similar, observándose un menor bloqueo sensitivo de larga duración en el bloqueo femoral con dosis única. Conclusiones. El uso de los bloqueos nerviosos periféricos está aceptado para la analgesia postoperatoria de las artroplastias de las rodillas. El bloqueo femoral continuo es una alternativa válida disminuyendo el consumo de opiáceos de rescate y la intensidad del dolor (especialmente a las 48h) respecto al bloqueo femoral aislado(AU)
Introduction. To compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement. Material and methods. A prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6ml/h for 48h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48h after surgery. Results. A total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose. Conclusions. The use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48h) compared to isolated femoral block(AU)
Subject(s)
Humans , Male , Female , Pain, Postoperative/complications , Pain, Postoperative/diagnosis , /methods , Nerve Block/methods , Nerve Block , Femoral Nerve , Pain, Postoperative/drug therapyABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Charcot-Marie-Tooth Disease/drug therapy , Charcot-Marie-Tooth Disease/epidemiology , Anesthesia, General/methods , Propofol/therapeutic use , Fentanyl/therapeutic use , Anesthesia, Conduction/methods , Anesthesia, Conduction , Appendectomy/methods , Anesthesia, Conduction/instrumentationABSTRACT
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Subject(s)
Middle Aged , Adult , Male , Female , Humans , Anesthesia, Intravenous , Sterilization , Propofol , Laryngeal Masks , Equipment Reuse , Carcinoma, Ductal, Breast , Parotitis , Postoperative Complications , Pressure , Radius , Acute Disease , Intraoperative Period , Insufflation , Equipment Failure , Hot Temperature , Breast NeoplasmsABSTRACT
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