[Criss-cross heart: anesthetic considerations for total cavopulmonary shunt (Fontan procedure)]. / Corazón en criss-cross. Consideraciones anestésicas para derivación cavopulmonar total (Fontan).

We report the anesthetic technique used for interatrial septal defect a 2-year-old girl weighing 11 Kg who presented with crossed atrioventricular connection (criss-cross heart), transposition of the great vessels, interatrial and interventricular septal defects, and subpulmonary and pulmonary valve stenoses. The patient was proposed for total cavopulmonary anastomosis with basal arterial oxygen saturation (SapO2) at 65%. Anesthesia was induced with inhaled agents and after intubation, hyperventilation was induced to achieve an end-tidal carbon dioxide pressure around 27 mm Hg. General anesthesia was provided in combination with spinal infusion of morphine chloride (100 microg Kg(-1)) for pain control. A Fontan procedure was carried out uneventfully with cardiopulmonary bypass. Milrinone was used at the extracorporeal circuit pump outlet. The patient was transferred to the pediatric intensive care unit where she was extubated without complications 90 minutes after admission. Anesthetic management is based on maintaining adequate preloading doses by administering volume, inhaled and/or intravenous agents, or use of vasoconstrictors and adjustment of ventilator parameters to modify pulmonary or systemic vascular resistance. We were able to maintain normal arterial pressure in our patient and provide adequate preloading through hyperventilation to reduce pulmonary vascular resistance.

Corazón en criss-cross. Consideraciones anestésicas para derivación cavopulmonar total (Fontan) / Criss-cross heart: anesthetic considerations for total cavopulmonary shunt (Fontan procedure)

Presentamos la técnica anestésica realizada en una paciente de 2 años de edad y 11 Kg de peso que presenta corazón con conexión atrioventricular cruzada o corazon en criss-cross, transposición de los grandes vasos, comunicación interauricular, comunicación interventricular, y estenosis subpulmonar y valvular pulmonar. Propuesta para anastomosis cavopulmonar total, presentaba SapO2 basal de 65%. Se realizó inducción inhalatoria y tras la intubación se inició hiperventilación para conseguir ETCO2 en torno a 27 mmHg. Se realizó una anestesia combinada general y caudal con cloruro mórfico (100 μg Kg-1) para control del dolor. Se practicó una intervención tipo Fontan, bajo circulación extracorpórea sin incidentes, empleándose milrinona a la salida de bomba. Se trasladó a la Unidad de Cuidados Intensivos pediátricos donde se extubó 90 minutos después de su ingreso, sin complicaciones. El manejo anestésico se basa en mantener precargas adecuadas mediante administración de volumen, uso de agentes inhalados y/o intravenosos, o uso de vasoconstrictores y variación parámetros ventilatorios para modificar resistencias vasculares pulmonares y/o sistémicas. En nuestro caso se procuró mantener una presión arte-rial normal y precarga adecuada, con hiperventilación para disminuir las resistencias vasculares pulmonares

We report the anesthetic technique used for interatrial septal defect a 2-year-old girl weighing 11 Kg who presented with crossed atrioventricular connection (criss-cross heart), transposition of the great vessels, interatrial and interventricular septal defects, and subpulmonary and pulmonary valve stenoses. The patient was proposed for total cavopulmonary anastomosis with basal arterial oxygen saturation (SapO2 ) at 65%. Anesthesia was induced with inhaled agents and after intubation, hyperventilation was induced to achieve an end-tidal carbon dioxide pressure around 27 mm Hg. General anesthesia was provided in combination with spinal infusion of morphine chloride (100 µg Kg–1) for pain control. A Fontan procedure was carried out uneventfully with cardiopulmonary bypass. Milrinone was used at the extra-corporeal circuit pump outlet. The patient was transferred to the pediatric intensive care unit where she was extubated without complications 90 minutes after admission. Anesthetic management is based on maintaining ad-equate preloading doses by administering volume, inhaled and/or intravenous agents, or use of vasoconstrictors and adjustment of ventilator parameters to modify pulmonary or systemic vascular resistance

[Efficacy of EMLA cream, effect of time and place of application]. / Eficacia de la crema EMLA, influencia del lugar y tiempo de aplicación.

OBJECTIVE: To evaluate the anesthetic efficacy of EMLA cream for alleviating pain associated with puncture and pressure in areas where venous catheters are normally inserted. MATERIAL AND METHODS: We performed a prospective, double blind study in 38 volunteers between 25 and 36 years of age, after obtaining informed consent. A 1.5 g dose of EMLA cream was applied to three sites on each patient: the back of the hand, the antecubital fossa and the side of the neck. Placebo cream with similar characteristics was applied to contralateral sites. Pain was evaluated on a visual analog scale (VAS, 0-10). Tactile sensitivity was assessed on a four-point scale (0 = no sensation; 1 = slight sensation; 2 = moderate, and 3 = strong). An analysis of variance study was performed to compare baseline scores to results over time, and placebo results to EMLA scores for each test site. RESULTS: The assessment of response to puncture and pressure gradually decreased over time for the sites where EMLA cream was applied, but not for the areas where placebo was applied. CONCLUSION: The efficacy of EMLA cream varies demonstrably depending on type of stimulus, site of application and time since application.

[Analysis of regional anesthetic efficacy in pediatric postop pain]. / Análisis de la eficacia analgésica de la anestesia locorregional en cirugía infantil.

A randomized, double blind study was carried out in 76 paediatric surgical patients scheduled for herniography or circumcision. Patients were randomly assigned to receive ilioinguinal and iliohipogastric nerve block (group A), penile block (group B), caudal block (group C) or metamizol intravenously (group D). Postoperative pain was evaluated by Objective pain scale at the end of surgical process and at 15, 30, 60 minutes and 6 hours after surgery. Pain free time was also recorded. There was no difference between groups regarding demographic data. We find a significatively less pain scores in the children who received regional anaesthesia. In those groups the administration of any analgesic were not necessary. No side effects were recorded. We conclude that locorregional anaesthesia techniques are safe and effective for minor surgery in children, because they are easy to carry out, comfortable for the patient, and provide a good postoperative analgesia.