ABSTRACT
El abordaje laparoscópico es el tratamiento de elección para la cirugía de vesícula, sin embargo, algunos pacientes requieren una conversión de la técnica, lo que origina en ellos un dolor postoperatorio moderado-severo. Tradicionalmente los opioides han sido utilizados para tratar dicho dolor, pero sus efectos secundarios han llevado a la búsqueda de nuevas alternativas (administración de anestésicos locales en plexos, fascias, nervios o herida). Presentamos 4 casos clínicos a los que se realizó el bloqueo ecoguiado de las ramas cutáneas de los nervios intercostales en la línea axilar media de T6 a T12 con levobupivacaína como alternativa analgésica en cirugía abierta de vesícula, con unos buenos resultados (AU)
Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results (AU)
Subject(s)
Aged, 80 and over , Aged , Female , Humans , Male , Bundle-Branch Block/drug therapy , Bundle-Branch Block/therapy , Intercostal Nerves , Cholecystectomy/methods , Pain, Postoperative/complications , Pain, Postoperative/drug therapy , Bupivacaine/therapeutic use , Gallbladder , Gallbladder , Gallbladder/pathology , Gallbladder/surgery , Postcholecystectomy Syndrome/complications , Postcholecystectomy Syndrome/drug therapy , Acetaminophen/therapeutic use , Ketoprofen/therapeutic use , Anesthesia, LocalABSTRACT
Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results.
Subject(s)
Anesthetics, Local/administration & dosage , Bupivacaine/analogs & derivatives , Cholecystectomy/methods , Intercostal Nerves/drug effects , Nerve Block/methods , Pain, Postoperative/prevention & control , Ultrasonography, Interventional , Aged , Aged, 80 and over , Anesthetics, Local/therapeutic use , Bupivacaine/administration & dosage , Bupivacaine/therapeutic use , Cholecystitis/surgery , Emergencies , Female , Humans , Levobupivacaine , Male , Pain ManagementABSTRACT
La autotransfusión es una técnica conocida desde hace tiempo que consiste básicamente en la recuperación y transfusión al propio paciente de sangre autóloga. En el medio hospitalario se usa frecuentemente en sangrados intra operatorios o postquirúrgicos en intervenciones ortopédicas, cardiacas y vasculares. En Medicina de Urgencias se ha empleado principalmente en conflictos bélicos en casos de hemotórax o hemoperitoneos cuantiosos, recogiendo la sangre de estas cavidades corporales y reinfundiéndola, en pacientes en situación de hipovolemia crítica. Pensamos que es una técnica valiosa que adaptada a nuestro medio y en el contexto de una indicación cuidadosa en medicina de emergencia extrahospitalaria puede ser de enorme utilidad. Hay equipos comerciales relativamente sencillos para realizar esta técnica con eficacia y seguridad. Nosotros, ante la dificultad de acceso real que hoy día tenemos a estos sistemas proponemos un sistema de recogida y reinfusión sencillo partiendo de materiales básicos que podría permitirnos realizar una autotransfusión extrahospitalaria a la espera de contar con medios estándar más adecuados (AU)
Autotransfusion is a long-known technique basically comprising recovery from the patient and later transfusion to the same patient of autologous blood. In the hospitalary environment it is often used in intra or postoperative bleeding in orthopaedic, cardiac and vascular surgery. In the context of emergency medicine it has been used mainly in war in cases of severe haemothorax or haemoperitoneum, recovering the blood from these body cavities and reinfusing it to patients in critical hypovolaemia situations. We consider it to be a valuable technique which might be highly useful in the context of extrahospitalary emergencies, if adapted to our own environment and in the context of a careful indication. Thre are relatively simple commerciallyavailale kits for carrying out this technique with efficacy and safety. Considering the real difficulties in acceding to such kits we are at present faced with, we propose a simple recovery and reinfusion system based on basic material which might allow us to carry out extrahospitalary autotransfusion while awaiting the availability of more adequate standard equipment (AU)
Subject(s)
Male , Female , Humans , Blood Transfusion, Autologous/methods , Blood Transfusion, Autologous/trends , Blood Transfusion, Autologous , Emergency Medical Services/methods , Emergency Medicine/methods , Monitoring, Ambulatory/methods , Blood Transfusion/methods , Blood Transfusion , Monitoring, Ambulatory/classification , Monitoring, Ambulatory/standards , Monitoring, Ambulatory/trends , Monitoring, AmbulatoryABSTRACT
Although the most frequent cause associated to the alteration of hepatic function tests that some hyperthyroid patients show is concomitant heart insufficiency, some cases without heart insufficiency and normalisation of hepatic tests after normalising the thyroid function have been described. There is also some evidence of hyperthyroid patients with pulmonary arterial hypertension, with no clear cause, coming back later to normal figures or substantially descending, after the treatment for hyperthyroidism. We show the concrete case of a 66 years woman, who has a due to toxic multinodular goiter hyperthyroidism with jaundice and serious pulmonary hypertension associated, unexplainable by further causes, both regressing with normalisation of thyroid function with no evidence of associated autoimmune pathology. Following, the physiopathology explanations about this unusual association found in literature, are commented.
Subject(s)
Hypertension, Pulmonary/etiology , Hyperthyroidism/complications , Jaundice/etiology , Aged , Female , Humans , Hyperthyroidism/drug therapyABSTRACT
Aunque la causa más frecuentemente asociada a la alteración de las pruebas de función hepática que presentan algunos pacientes hipertiroideos es la insuficiencia cardiaca concomitante, se han descrito casos sin insuficiencia cardiaca, con normalización de las pruebas hepáticas tras normalizar la función tiroidea.También hay evidencia de enfermos hipertiroideos con hipertensión arterial pulmonar sin causa clara, regresando ésta a cifras normales, o descendiendo substancialmente, tras el tratamiento del hipertiroidismo. Nosotros presentamos el caso de una mujer de 66 años con un hipertiroidismo debido a un bocio tóxico multinodular, con ictericia e hipertensión arterial pulmonar severa asociadas y no explicables por otras causas, regresando ambas con la normalización de la función tiroidea y sin evidencia de patología autoinmune asociada.Posteriormente se comentan las explicaciones fisiopatológicas encontradas en la literatura sobre esta inusual asociación. (AU)
