Reacción de hipersensibilidad tras inyección de azul patente V sódico para detección de ganglio centinela / No disponible

No disponible

[Lazarus phenomenon: spontaneous resuscitation]. / El fenómeno de lázaro: reanimación espontánea.

A 94-year-old woman undergoing surgery for simple repair of a duodenal perforation experienced a sudden massive hemorrhage (1500 mL) when the duodenum was separated from adjacent structures. Hemodynamic stability was re-established when fluids were replaced. After the abdominal wall was closed, increased amplitude of the QRS wave was observed and heart rate slowed until there was no pulse. Electromechanical dissociation (EMD) was diagnosed and cardiopulmonary resuscitation was started. When EMD persisted after 40 minutes, resuscitative measures were stopped and the ventilator was disconnected, though orotracheal intubation and arterial and electrocardiographic monitoring were maintained. After 2 or 3 minutes, heart rhythm restarted spontaneously and arterial pressure waves reappeared on the monitor. The patient progressed well for 72 hours, after which she developed septic shock and multiorgan failure, dying 18 days later. The Lazarus phenomenon may be more common than the medical literature would indicate, possibly because a large gap in our understanding of the pathophysiology of the phenomenon underlies anecdotes about "miracles". As we wait for adequate international consensus on a protocol for monitoring the withdrawal of resuscitative measures, we should act prudently before definitively certifying death. The case we report occurred during a surgical intervention in which the patient had received general anesthesia. We believe that the causes that might explain the Lazarus phenomenon are quite different in that context than they would be in a nonsurgical setting, such that it would be useful to create a national database to keep a record of such intraoperative events.

[Arrhythmias in the pulmonary exeresis postoperative period]. / Arritmias en el postoperatorio de cirugía para exéresis pulmonar.

OBJECTIVES: To determine the frequency of episodes of cardiac arrhythmia during the period following elective exeresis of the pulmonary parenchyma (pneumonectomies, double and single lobectomies), and to study the temporal patterns of occurrence and the association of arrhythmia and certain risk factors. PATIENTS AND METHODS: Retrospective analysis of data recorded in the case histories of 100 patients admitted to the postoperative intensive care unit (PICU) between November 1991 and March 1995. RESULTS: We monitored changes in heart rate after surgery by continuous electrocardiography in 38 of the 100 patients (38%). Changes were more common in certain subgroups: older patients, those with preoperative cardiovascular and electrocardiographic abnormalities, and those who needed prolonged postoperative mechanical ventilation. Most arrhythmias were supraventricular (97.3%), the most common being atrial fibrillation (55.3%). Most diagnoses of arrhythmia (87%) were made within the first three days after surgery. Several drugs were used for treatment, based on the diagnosing anesthesiologist's criteria. Digitalis was the drug most often prescribed. Seven patients (7%) died in the PICU. Three were discharged with atrial fibrillation with ventricular response of less than 100 beats per minute. Postoperative cardiac arrhythmia was a direct cause of death of only one patient, who had ventricular fibrillation upon admission to the PICU.