Sinequia traqueal objetivada mediante fibrobroncoscopia flexible en inducción anestésica reglada para cirugía torácica / Tracheal synechia visualized in flexible fibrobronchoscopy in induction of anesthesia for thoracic surgery

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Aislamiento pulmonar en pacientes con resecciones pulmonares previas: bloqueo lobular selectivo secuencial con bloqueador bronquial Fuji Uniblocker® / Lung isolation in patients with previous lung resections: Selective sequential lobar blockade using a Fuji Uniblocker® endobronchial blocker

El aislamiento pulmonar es obligado durante la cirugía torácica, al permitir la visualización y manipulación por parte del cirujano del pulmón intervenido. La aparición de hipoxemia durante el aislamiento pulmonar es habitual, y aún es más frecuente en aquellos pacientes con reserva funcional pulmonar disminuida. Presentamos 2 casos clínicos de pacientes con antecedentes de resección pulmonar previa izquierda (1.° lobectomía inferior izquierda y 2.° lobectomía inferior izquierda y segmentectomía del lóbulo superior izquierdo), en los que se realizó bloqueo lobular secuencial selectivo (BLSS), con BB Fuji Uniblocker® para la realización de resecciones atípicas de pulmón derecho (LSD, LM y LID). En nuestra experiencia la técnica fue satisfactoria, el campo quirúrgico fue óptimo y no registramos ningún tipo de complicación intra o postoperatoria derivada de su uso, pudiendo ser una alternativa al aislamiento pulmonar tradicional, en pacientes con función respiratoria comprometida (reserva funcional escasa o resecciones pulmonares previas) (AU)

Lung isolation is essential during thoracic surgery, as it allows the thoracic surgeon to visualise and work in the surgical field. The occurrence of hypoxaemia during lung isolation is common, and is even more so in patients with decreased pulmonary functional reserve. The clinical cases are presented of 2 patients with a history of left pulmonary resections (1st left lower lobectomy, 2nd left lower lobectomy and left upper lobe segmentectomy), in which sequential selective lobar blockade was performed with Fuji Uniblocker® endobronchial blocker for performing right lung atypical resections (right upper lobe, middle lobe, and right lower lobe). In our experience the technique was successful, the surgical field was optimal and no intra- or post-operative complications were found. This technique may be an alternative to traditional lung isolation in patients with compromised respiratory function (low functional reserve or previous contralateral lung resections) (AU)

Lung isolation in patients with previous lung resections: Selective sequential lobar blockade using a Fuji Uniblocker® endobronchial blocker. / Aislamiento pulmonar en pacientes con resecciones pulmonares previas: bloqueo lobular selectivo secuencial con bloqueador bronquial Fuji Uniblocker®.

Lung isolation is essential during thoracic surgery, as it allows the thoracic surgeon to visualise and work in the surgical field. The occurrence of hypoxaemia during lung isolation is common, and is even more so in patients with decreased pulmonary functional reserve. The clinical cases are presented of 2 patients with a history of left pulmonary resections (1st left lower lobectomy, 2nd left lower lobectomy and left upper lobe segmentectomy), in which sequential selective lobar blockade was performed with Fuji Uniblocker® endobronchial blocker for performing right lung atypical resections (right upper lobe, middle lobe, and right lower lobe). In our experience the technique was successful, the surgical field was optimal and no intra- or post-operative complications were found. This technique may be an alternative to traditional lung isolation in patients with compromised respiratory function (low functional reserve or previous contralateral lung resections).

Isquemia aguda de la mano como complicación de la canalización de la arteria radial. A propósito de dos casos tras cirugía de sarcoma abdominal / Acute ischemia of the hand as a complication of radial artery catheterization: a report of two cases after surgery for abdominal sarcoma

La canalización arterial es una técnica sencilla que aporta grandes beneficios, como son la monitorización continua de la presión arterial y la posibilidad de extraer analíticas seriadas, pero no está exenta de complicaciones. Dentro de estas últimas, las principales son la isquemia de la extremidad y la embolia gaseosa. A fin de disminuir el riesgo de aparición de complicaciones, existen unas normas para la canalización y mantenimiento de los catéteres arteriales.Presentamos 2 casos clínicos de isquemia aguda de la mano secundaria a cateterización arterial. Ambos pacientes fueron intervenidos de cáncer abdominal tipo sarcoma y presentaron, en el intervalo de unas horas, isquemia aguda de la mano. Fueron tratados con prostaglandinas, y a uno de ellos se le realizaron bloqueos del ganglio estrellado. La mejoría en los días siguientes fue leve y quedó establecida una necrosis seca de parte de la mano. En los 2 casos se encontró, como antecedente predisponente para la presentación de la isquemia, la existencia de un tumor muy avanzado abdominal tipo sarcoma, probablemente asociado a un estado de hipercoagulabilidad (AU)

[Acute ischemia of the hand as a complication of radial artery catheterization. Apropos of 2 cases following abdominal sarcoma surgery]. / Isquemia aguda de la mano como complicación de la canalización de la arteria radial. A propósito de dos casos tras cirugía de sarcoma abdominal.

Arterial catheterization is a simple technique that yields great benefits, such as continuous monitoring of arterial pressure and the possibility of taking repeated samples for analysis. However, it is not free of complications, the main ones being limb ischemia and gas embolism. To reduce the risk of complications, guidelines for insertion and maintenance of arterial catheters have been established. We report two cases of acute hand ischemia secondary to arterial catheterization. Both patients were undergoing surgery for sarcoma-type abdominal cancer and developed acute ischemia of the hand lasting several hours. The predisposing factor in both cases was the existence of a highly advanced sarcoma-type abdominal tumor, probably related to a state of hypercoagulability.

Anesthetic support in synchronous liver and kidney transplantation.

BACKGROUND/AIMS: We performed a retrospective evaluation of 11 patients in the final stages of hepatic disease with chronic kidney failure, in whom simultaneous double liver-kidney transplantation was performed. METHODOLOGY: In the immediate pre-, intra- and postoperative periods, we assessed metabolic, hemodynamic and coagulation parameters; bicarbonate, calcium and inotropic drug requirements; the incidences during reperfusion of the graft; the surgical technique employed; the need for hemodialysis and/or ultrafiltration; and the survival rate of the patients. RESULTS: Of the 11 cases studied, four patients needed hemodialysis, while only one patient needed ultrafiltration; three patients required both techniques, and no dialysis or ultrafiltration was performed in three patients. The following surgical techniques were employed: Total clamping of the inferior vena cava using an external venovenous bypass in two cases; total clamping of the inferior vena cava without an external venovenous bypass in three cases; and partial clamping of the inferior vena cava with preservation of the retrohepatic cava in six cases. The results showed one death in the first postoperative month and two deaths in the course of subsequent follow-up. The survival rate was 72.7%. CONCLUSIONS: The use of conventional intraoperative hemodialysis and/or ultrafiltration is feasible, useful and achieves good results in patients undergoing double liver-kidney transplantation. Partial clamping of the inferior vena cava at the anhepatic stage appears to reduce the need for ultrafiltration. There is no increase in perioperative mortality in patients who underwent liver transplantation while conserving their renal function.