Pectus excavatum grave / No disponible

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[Acute myocardial infarction as an incidental finding: reflections on the preanesthesia evaluation]. / Infarto agudo de miocardio como hallazgo casual: consideraciones sobre la evaluación preanestésica.

A preoperative electrocardiogram in a 16-year-old boy scheduled for surgery for a fractured radius and mandibular condyle after a motorcycle accident showed signs of myocardial ischemia as an incidental finding. Coronary arteriography revealed complete occlusion of the anterior descending artery, confirming a diagnosis of acute coronary syndrome with ST elevation, with no myocardial viability. As the patient's general condition was acceptable, to prevent severe functional sequelae, surgery was rescheduled for 17 days later. An axillary block was well tolerated at that time. While indiscriminate ordering of preoperative tests is not recommended in the literature, such testing continues to be practiced in many hospitals, possibly for reasons of organization and legal cover. In our case, the electrocardiogram made it possible to diagnose a severe lesion and adjust the anesthetic technique to suit this situation, thereby possibly preventing devastating consequences. We recommend performing an electrocardiogram on all patients with suspected blunt chest trauma, regardless of the severity of the lesions, particularly in patients scheduled for surgery.

[Total intravenous anesthesia for repositioning an implantable defibrillator in a patient with long QT syndrome]. / Anestesia total intravenosa para recolocación de un desfibrilador automático implantable en paciente con síndrome de QT-largo.

We report the case of a 27-year-old woman with congenital long QT syndrome (LQTS) who was scheduled for surgery to reposition an implantable defibrillator. Given the risk of sudden death due to fatal ventricular arrhythmia, the woman required implantation of a defibrillator with pacemaker capability. Combined anesthesia-analgesia was used in order to minimize the risk of ventricular arrhythmia caused by increased serum concentrations of catecholamines. When cardioversion, defibrillation and anti-tachycardia functions had been deactivated, anesthesia was induced with propofol, fentanyl and rocuronium. Anesthesia was maintained with an infusion of propofol and remifentanil. We describe the pathophysiology and treatment of LQTS and discuss anesthetic management for repositioning a defibrillator in a patient with congenital LQTS.

Anestesia total intravenosa para recolocación de un desfibriladorautomático implantable en paciente con síndrome de QT-largo / Total intravenous anesthesia for repositioning an implantable defibrillator in a patient with long QT syndrome

Presentamos el caso de una mujer de 27 años, con síndromede QT-largo (SQTL) de origen congénito, programadapara recolocación de un desfibrilador automáticoimplantable (DAI). Debido al riesgo de muerte súbitasecundario a arritmias ventriculares letales, precisó laimplantación de un DAI con capacidad de marcapasos.Para minimizar el riesgo de arritmias ventricularessecundarias al incremento de las concentraciones séricasde catecolaminas, la técnica anestésica elegida se basó enla analgesia. Desactivadas las funciones de cardioversión,desfibrilación y antitaquiarritmias, se procedió a lainducción anestésica con propofol, fentanilo y rocuronio.El mantenimiento anestésico se realizó con perfusión depropofol y remifentanilo. Describimos la fisiopatología yel tratamiento del SQTL, y se discute el manejo anestésicopara la recolocación de un DAI en una pacienteafecta de SQTL de origen congénito (AU)

We report the case of a 27-year-old woman withcongenital long QT syndrome (LQTS) who was scheduledfor surgery to reposition an implantable defibrillator.Given the risk of sudden death due to fatal ventriculararrhythmia, the woman required implantation of adefibrillator with pacemaker capability. Combinedanesthesia-analgesia was used in order to minimize therisk of ventricular arrhythmia caused by increased serumconcentrations of catecholamines. When cardioversion,defibrillation and anti-tachycardia functions had beendeactivated, anesthesia was induced with propofol,fentanyl and rocuronium. Anesthesia was maintainedwith an infusion of propofol and remifentanil. Wedescribe the pathophysiology and treatment of LQTS anddiscuss anesthetic management for repositioning adefibrillator in a patient with congenital LQTS (AU)

Exantema petequial por síndrome de embolia grasa / No disponible

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Exéresis de un liposarcoma bajo en anestesia combinada intradural - epidural y sedación con propofol y renifentanilo en paciente embarazada / No disponible

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[Spinal anesthesia in a patient with congenital complete atrioventricular block]. / Anestesia subaracnoidea en paciente portador de bloqueo auriculoventricular completo congénito.

Congenital complete atrioventricular block is a rare cardiac conduction abnormality that predisposes to arrhythmias and cardiac arrest. Recommendations for the anesthetic management of patients with this condition are based on the few case reports that have been published. We describe the successful use of spinal anesthesia for ankle osteosynthesis in a patient with asymptomatic congenital complete atrioventricular block detected during preoperative assessment.

Anestesia subaracnoidea en paciente portador de bloqueo auriculoventricular completo congénito / Spinal anesthesia in a patient with congenital complete atrioventricular block

El bloqueo auriculoventricular completo congénito esuna rara anomalía de la conducción cardiaca que predisponea la aparición de arritmias y paro cardiaco. Lasrecomendaciones para su manejo anestésico se basan enlos pocos casos clínicos publicados. Se describe la utilización,con éxito, de la anestesia subaracnoidea paraosteosíntesis de tobillo en una paciente portadora debloqueo auriculoventricular completo congénito asintomático,detectado en el estudio preoperatorio (AU)

Congenital complete atrioventricular block is a rare ;;cardiac conduction abnormality that predisposes to ;;arrhythmias and cardiac arrest. Recommendations for ;;the anesthetic management of patients with this ;;condition are based on the few case reports that have ;;been published. We describe the successful use of spinal ;;anesthesia for ankle osteosynthesis in a patient with ;;asymptomatic congenital complete atrioventricular ;;block detected during preoperative assessment (AU)

Lesión inhalatoria en quemado grave / Inhalational lesions in a patient with severe burns

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[Prolonged coma due to fat embolism syndrome after fracture of the femur]. / Coma prolongado por síndrome de embolia grasa tras fractura de fémur.

A 24-year-old male came to the emergency department with a diaphyseal fracture of the femur resulting from a motorcycle accident. Neurological deterioration was progressive, although a computed tomography scan was normal. Endotracheal intubation for mechanical ventilation was necessary. His condition progressed to sepsis and multiorgan failure before resolving. Magnetic resonance images of the brain suggested a fat embolism. The presence of a patent foramen ovale was investigated. The patient remained in a state of coma vigil for 3 months after the accident. After ruling out other more likely causes of neurological deterioration after trauma with fractures, fat embolism should be suspected. The prognosis for the neurological manifestations of fat embolism syndrome are generally good. Severe cases suggest massive (paradoxical) embolization of the brain and are associated with a patent foramen ovale. Early diagnosis will identify the patient at high surgical risk. A favorable course and outcome have been reported with preoperative closure of the foramen ovale.