[Cerebrospinal fluid drainage and deep systemic hypothermia with total absence of circulation for spinal cord protection during surgery on the thoracic aorta]. / Drenaje de líquido cefalorraquídeo e hipotermia profunda sistémica con parada circulatoria total como método de protección medular durante la cirugía de aorta torácica.

A 53-yearold man with a dissecting aneurysm of Stanford's type-B or Crawford's type I measuring 8.5 cm in diameter underwent replacement of the distal descending aorta and the thoracic aorta using techniques for spinal cord protection involving deep hypothermia at 17 degrees C and lasting 38 minutes with total absence of circulation. A subarachnoid catheter was inserted at the lumbar level to monitor spinal fluid pressure as well as to provide drainage if pressure exceeded 10 mm Hg. During surgery 60 ml was drained, followed by 95 ml after surgery on the same day and 325, 262 and 169 ml on the following three days. No signs of neurological deficit were observed during the postoperative period. Clinical course was good until hypovolemic shock developed 27 days after the operation due to upper digestive tract bleeding caused by two duodenal ulcers that perforated the gastroduodenal artery. Emergency antrectomy and vagotomy were performed. The patient died from multiple organ failure. Spinal cord injury continues to be one of the most feared complications after excision of thoracic and thoracoabdominal aorta aneurysm. Currently, various ways of protecting the spinal cord are practiced, including drainage of cerebrospinal fluid, partial bypass of the femoral artery, intercostal artery reimplantation, drug therapy and local spinal and/or systemic hypothermia. These methods, together with shorter clamping time have achieved a reduction in the incidence of spinal cord injuries.

Drenaje de líquido cefalorraquídeo e hipotermia profunda sistémica con parada circulatoria total como método de protección medular durante la cirugía de aorta torácica / Cerebrospinal fluid drainage and deep systemic hypothermia with total absence of circulation for spinal cord protection during surgery on the thoracic aorta

A un paciente de 53 años con aneurisma disecante tipo B de Stanford o tipo I de Crawford de 8,5 cm de diámetro se le realizó recambio de cayado aórtico distal y aorta torácica, usando como métodos de protección medular hipotermia profunda de 17 °C durante 38 min y parada circulatoria total, además de un catéter subaracnoideo lumbar para la monitorización de la presión del líquido cefalorraquídeo y drenaje del mismo cuando la presión superaba los 10 mmHg. El día de la intervención se drenaron 60 ml intraoperatoriamente y 95 ml en el postoperatorio y en los 3 días siguientes 325, 262 y 169 ml, sucesivamente. No se objetivó ningún déficit neurológico durante el postoperatorio. La evolución del paciente fue buena hasta que 27 días después de la intervención sufrió un shock hipovolémico por una hemorragia digestiva alta debida a 2 úlceras duodenales que perforaban la arteria gastroduodenal; se realizó antrectomía y vagotomía de urgencia. El paciente falleció 4 días después por fallo multiorgánico. La lesión de la médula espinal continúa siendo una de las complicaciones más temidas tras resecciones de aneurisma de aorta torácica y toracoabdominales. En la actualidad se utilizan diferentes métodos de protección medular como drenaje del líquido cefalorraquídeo, derivación parcial a la arteria femoral, reimplantación de arterias intercostales, fármacos e hipotermia medular local y/o sistémica que junto a un tiempo de pinzamiento corto han logrado reducir la incidencia de alteraciones medulares (AU)

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[Acute pancreatitis after resection of abdominal aortic aneurysm]. / Pancreatitis aguda tras la resección de un aneurisma de aorta abdominal.

The case of a patient who developed acute pancreatitis following resection of a ruptured aneurysm of the abdominal aorta is presented. During the first postoperative days the patient evolved satisfactorily except for specific abdominal symptoms. On the sixth day the patient suddenly presented tachycardia, hypotension, increase in abdominal distension and anemia for which emergency laparotomy was performed with signs of diffuse peritoneal steatonecrosis with an increase in the size and inflammation of the pancreas with necrotic and hemorrhagic zones being observed. The patient developed multiorganic failure and died at 18 days later. In this case, as in others described in the literature the beginning was uneventful. Only the determination of amylase and/or lipase, and the performance of abdominal CAT when these are increased, may be useful to obtain early diagnosis.

[Prolonged neurologic deficiency after accidental spinal anesthesia]. / Déficit neurológico prolongado tras anestesia espinal accidental.

A case of severe prolonged neurological deficit following inadvertent spinal anesthesia is presented. Intradural block occurred after a test dose of Bupivacaine and vasoconstrictor when inserting an epidural catheter for post-thoracotomy pain-relief treatment. The likely triggering and etiological factors responsible for the neurological damage after spinal anesthesia were studied and evaluated, mainly those toxic and traumatic. Special mention of the local anesthetics and sodium bisulfite used is made. Preventive measures for this sort of complication are suggested.