Paraplegia due to spinal meningioma during the third trimester of pregnancy: case report and literature review.

INTRODUCTION: Spinal meningiomas represent 25-45% of intradural spinal tumors and ~2% of meningiomas of the central nervous system (CNS), and their occurrence during pregnancy is unusual. We present an updated literature review. CASE REPORT: A 36-year-old woman, at 32.6 weeks of gestation, was hospitalized for urinary tract infection and urinary retention. One month earlier, she had decreased strength in lower limbs, and this weakness rapidly progressed to flaccid paraplegia without sphincters control. Magnetic resonance imaging (MRI) revealed a well-defined intradural extramedullary lesion in T3-T4. Using a posterolateral approach, the tumor was completely removed; however, there was no clinical improvement, and the patient was discharged with an impairment scale (AIS) grade A. Histopathology examination indicated a psammomatous meningioma. DISCUSSION: Meningiomas are benign tumors that are slowly progressive; however, the hemodynamic and hormonal changes of pregnancy are related to their accelerated growth. Reports show that the onset of the symptoms during the third trimester of pregnancy, including early neurological symptoms or signs of spinal cord compression, can be easily attributed to those of pregnancy by both the patient and the doctor. The time to diagnosis and medulla compression time are thus prolonged, which can be further compounded in middle-high income countries due to limitations in obtaining images for evaluation. Although rare, spinal meningiomas should be considered in the differential diagnosis of patients with neurological symptoms during pregnancy. Their early recognition is important to avoid irreversible neurological damage.

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study.

INTRODUCTION: Closed loop total intravenous anesthesia is a technique in which the patient's hemodynamic and anesthetic depth variables are monitored, and based on this information, a computer controls the infusion rate of drugs to keep them within pre-established clinical parameters. OBJECTIVE: To describe the technical and clinical performance of a closed loop system for total intravenous anesthesia with propofol and remifentanil, using the SEDLineTM monitor. DESIGN: Multicentric prospective cohort study. SETTING: Surgery room. PATIENTS: ASA I-II undergoing elective surgery. MEASUREMENTS: The authors designed a closed loop system that implements a control algorithm based on anesthetic depth monitoring and the Patient State Index (PSITM) of the SEDLine monitor for propofol, and on hemodynamic variables for remifentanil. The measurement of clinical performance was made based on the percentage of PSITM maintenance time in the range 20-50. Precision analysis was evaluated by measuring median performance error (MDPE) can be defined as the median difference between actual and desired values, which refers to the degree of precision in which the controller is able to maintain the control variable within the objective set by the anesthesiologist; it represents the direction (over-prediction or under-prediction) of performance error (PE) rather than size of errors, which is represented by MDAPE, median absolute percentage error, Wobble index, which is used for measuring the intrasubject variability in performance error. RESULTS: Data were obtained from 93 patients in three healthcare centers. The percentage of PSITM maintenance time in the 20-50 range was 92% (80.7-97.0). MDPE was 10.7 (- 11.0-18.0), MDAPE 21.0 (14.2-26.8) and wobble 10.7 (7.0-16.9). No adverse surgical or anesthetic events were found. CONCLUSIONS: The closed loop total intravenous anesthesia system with SEDLine developed by the authors was used without major complication and appear to be feasible its use in clinical performance.

Síndrome Postcementación Ósea. Serie de Casos / Bone Cement Implantation Syndrome. Case Series

Introducción El síndrome de implantación de cemento óseo (SICO) es una complicacion intraoperatoria frecuente y potencialmente devastadora en pacientes sometidos a artroplastia de cadera cementada. Objetivo Describir la frecuencia del SICO en pacientes llevados a artroplastia total o parcial de cadera, mayores de 50 años, en el Hospital de San José de Bogotá, entre el 1 de enero del 2012 al 31 de Enero del 2018. Metodología Estudio serie de casos. Se revisaron los registros médicos de pacientes adultos mayores de 50 años con indicación de Artroplastia o Hemiatroplastia. Se analizaron las variables perioperatorias a través del registro de Anestesia. Mediante la clasificación de Donaldson se determinó el grado de SICO. Se emplearon estadísticas descriptivas y análisis de correspondencias múltiples para explorar la relación entre las variables. Resultados Incluimos 49 pacientes con una media de edad de 78 años (DE +/- 9.9), 39 eran mujeres (79.6%) y 37 (75.5%) tuvieron una clasificacion ASA II. Documentamos la presencia de SICO en 8 pacientes (16.3%): de los cuales 5 correspondian a Grado 1, 2 Grado 2 y 1 a Grado 3 con requerimiento de UCI. 7 eran mujeres; todos tenían antecedente de hipertension arterial, 2 diabetes mellitus, 2 EPOC y 1 osteoporosis. Ninguno reportó ingesta de Warfarina. Conclusiones SICO es un fenómeno frecuente en la artroplastia y hemiartroplastia cementada, siendo mayor en el sexo femenino, documentandose la presencia de predictores de severidad clasificacion ASA II ­III y el antecedente de EPOC en nuestro hospital.

Background The bone cement implantation syndrome (BCIS) is a frequent and potentially devastating intraoperative complication in patients undergoing cemented hip arthroplasty. The objective of study is to describe the frequency of BCIS in patients undergoing total or partial hip arthroplasty. Methods Case series study. We reviewed the medical records of adult patients over 50 years of age with an indication for Arthroplasty or Hemiatroplasty. The perioperative variables were analyzed through the Anesthesia registry. The degree of SICO was determined by Donaldson classification. Descriptive statistics and multiple correspondence analysis were used to explore the relationship between the variables. Results We included 49 patients with an average age of 78 years (SD +/- 9.9), 39 were women (79.6%) and 37 (75.5%) had an ASA II classification. We documented the presence of SICO in 8 patients (16.3%): of which 5 corresponded to Grade 1, 2 Grade 2 and 1 to Grade 3 with ICU requirement. 7 were women; all were hypertensive, 2 diabetes mellitus, 2 COPD and 1 osteoporosis. None reported Warfarin ingestion. Discussion BCIS is a frequent phenomenon in the arthroplasty and cemented hemiarthroplasty, being higher in the female sex, documenting the presence of predictors of severity ASA II -III classification and the history of COPD in our hospital.