Manejo de la vía aérea en una paciente con síndrome de Treacher Collins en 2 tiempos quirúrgicos / Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery

El síndrome de Treacher Collins (STC), Franceschetti-Zwahlen-Klein o disostosis mandibulofacial, se caracteriza por un desarrollo craneofacial anormal. Es una anomalía congénita infrecuente que presenta una incidencia de un caso por cada 50.000 nacidos vivos. El STC es importante para la planificación anestésica debido a que la mayoría de los pacientes con esta afectación nos planteará dificultades en el manejo de la vía aérea. A continuación presentamos el caso de una paciente de 24 años con STC que es remitida a nuestro centro para la realización de una cirugía de reconstrucción facial en dos tiempos. En ambos tiempos quirúrgicos el videolaringoscopio Airtraq(R) fue esencial para el manejo de la vía aérea. Con la presentación de este caso se muestra como la planificación previa, la comunicación y el trabajo en equipo son esenciales para la seguridad del paciente

Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq(TM) was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety

Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery. / Manejo de la vía aérea en una paciente con síndrome de Treacher Collins en 2 tiempos quirúrgicos.

Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq™ was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety.

Bloqueo posterior del plexo lumbar para analgesia postoperatoria de artroplastias de cadera / Posterior lumbar plexus block for analgesia after hip arthroplasty

OBJETIVOS: Se estudió la calidad analgésica, con carácter descriptivo, en el postoperatorio precoz, del bloqueo posterior del plexo lumbar en el compartimento del psoas, localizado mediante neuroestimulación y con punción única, según la técnica de Chayen, a nivel paramedial L4, en pacientes sometidos a artroplastias de cadera no cementadas, realizadas bajo anestesia subaracnoidea con bupivacaína 0,5%. MATERIAL y MÉTODOS: Se analizó en 20 pacientes la intensidad del dolor según la escala visual analógica (EVA) cada hora durante las primeras 12 horas y cada 2 horas las siguientes 12 horas, el consumo de analgésico antiinflamatorio no esteroideo de rescate (AINE) si el dolor fue superior a 3 en la EVA, y el de morfina si la analgesia era insuficiente, y una valoración por el enfermo de la analgesia recibida según una escala de valoración verbal así como las complicaciones de la técnica. RESULTADOS: Las puntuaciones en la EVA se mantuvieron por debajo de 3 las primeras 11 horas, ascendiendo progresivamente hasta un máximo de 4,7 a las 24 horas. Durante las primeras 12 horas sólo 5 pacientes (25 %) necesitaron alguna dosis de AINE y ninguno morfina. En las segundas 12 horas 16 pacientes (80%) precisaron una media de 1,6 dosis de AINE, y en 3 (15%) fue necesario administrar morfina por dolor refractario o mayor de 5. En la encuesta de valoración verbal únicamente el 10% refería haber padecido un dolor intenso durante el tiempo de postoperatorio estudiado, mientras que para el 90% el dolor fue leve o moderado. CONCLUSIONES: El bloqueo posterior del plexo lumbar, con punción única, tiene efectividad analgésica durante las primeras 12 horas de postoperatorio, asociado a la anestesia espinal. Su utilización de forma continua mediante catéter podría proporcionar unas mejores condiciones analgésicas que las observadas (AU)

OBJETIVES: To describe early postoperative analgesic quality from a posterior lumbar plexus block in the psoas compartment, located by neurostimulation. We used a single paramedial puncture at L4, following Chayen's approach, in patients undergoing uncemented hip arthroplasty under subarachnoid anesthesia with 0,5% bupivacaine. MATERIAL AND METHODS: Twenty patients were enrolIed. We studied pain intensity on a visual analogical (VAS) scale every hour for the first 12 hours and every 2 hours for the next 12. The need for rescue analgesia, specifically non-steroidal anti-inflammatory drugs (NSAIDs) if pain was over 3 on the VAS and for morphine if analgesia was still insufficient. The patients assessed quality of analgesia received on a verbal scaIe. Complications were also noted. RESULTS: VAS scores were under 3 throughout the first 11 hours, gradually rising to 4,7 at 24 h. Only 5 patients (2%) needed NSAIDs in the first 12 hours and none needed morphine. Sixteen patients (80%) needed a mean 1,6 doses of NSAIDs and 3 (15%) needed morphine for persistent pain or for pain greater than 5 on the VAS. On the verbal sea le, only 10% reported experiencing intense pain during the postoperative period, whereas 90% said they had experienced mild or moderate pain. CONCLUSIONS: A posterior lumbar plexus block using a single shot gives effective analgesia in the first 12 hours after surgery performed with spinal anesthesia. Continuous infusion through a catheter may provide better analgesia than that observed in this study (AU)

[Posterior block of lumbar plexus for postoperative analgesia after hip arthroplasty]. / Bloqueo posterior del plexo lumbar para analgesia postoperatoria de artroplastias de cadera.

OBJECTIVES: To describe early postoperative analgesic quality from a posterior lumbar plexus block in the psoas compartment, located by neurostimulation. We used a single paramedial puncture at L4, following Chayen's approach, in patients undergoing uncemented hip arthroplasty under subarachnoid anesthesia with 0.5% bupivacaine. MATERIAL AND METHODS: Twenty patients were enrolled. We studied pain intensity on a visual analogical (VAS) scale every hour for the first 12 hours and every 2 hours for the next 12. The need for rescue analgesia, specifically non-steroidal anti-inflammatory drugs (NSAIDs) if pain was over 3 on the VAS and for morphine if analgesia was still insufficient. The patients assessed quality of analgesia received on a verbal scale. Complications were also noted. RESULTS: VAS scores were under 3 throughout the first 11 hours, gradually rising to 4.7 at 24 h. Only 5 patients (2%) needed NSAIDs in the first 12 hours and non needed morphine. Sixteen patients (80%) needed a mean 1.6 doses of NSAIDs and 3 (15%) needed morphine for persistent pain or for pain greater than 5 on the VAS. On the verbal scale, only 10% reported experiencing intense pain during the postoperative period, whereas 90% said they had experienced mild or moderate pain. CONCLUSIONS: A posterior lumbar plexus block using a single shot gives effective analgesia in the first 12 hours after surgery performed with spinal anesthesia. Continuous infusion through a catheter may provide better analgesia than that observed in this study.