ABSTRACT
The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.
ABSTRACT
La lesión de vía aérea causada por tubos de doble luz es una complicación infrecuente pero potencialmente muy grave. Describimos el caso de una paciente que presentó una rotura bronquial durante la ventilación unipulmonar con un tubo de doble luz izquierdo, complicándose con una parada cardíaca secundaria de la que se recuperó sin secuelas. Causas intrínsecas de la paciente, como el antecedente de radioterapia externa, y un posible sobreinflado del neumotaponamiento pudieron contribuir al desarrollo de esta complicación. La posible lesión de vía aérea debe ser considerada por todos los profesionales que empleen tubos de doble luz durante el cuidado de sus pacientes (AU)
Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients (AU)
Subject(s)
Humans , Female , Aged , Bronchi/injuries , Intubation/adverse effects , Respiration, Artificial , Heart Arrest/complications , Rupture/etiology , Risk Factors , Iatrogenic DiseaseABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Takotsubo Cardiomyopathy/prevention & control , Premedication/methods , Colectomy/methods , Risk Factors , Anesthesia/methods , Preoperative Care/methodsABSTRACT
Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients.
Subject(s)
Adenocarcinoma/surgery , Bronchi/injuries , Intubation/adverse effects , Lung Neoplasms/surgery , Neoplasms, Second Primary/surgery , One-Lung Ventilation/instrumentation , Radiotherapy, Adjuvant/adverse effects , Rupture/etiology , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Bronchi/pathology , Bronchi/radiation effects , Female , Fibrosis , Heart Arrest , Humans , Mastectomy, Segmental , Pneumonectomy , Pressure/adverse effects , Pulmonary Disease, Chronic Obstructive/complications , Radiation Injuries/complications , Radiation Injuries/pathologyABSTRACT
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Subject(s)
Humans , Male , Adult , Odontoid Process/injuries , Fractures, Open/surgery , Neck Injuries/surgery , Multiple Trauma/complicationsABSTRACT
We describe the case of a fit 17-year-old man who developed a severe allergic reaction to a low clinical dose of sugammadex (3.2 mg kg(-1) , 200 mg intravenously), 1 min after its administration. This was manifest by an intense erythema over the anterior part of the thorax, severe lip and palpebral oedema and bilateral wheeze. On later investigation, the patient had a positive skin prick test to sugammadex (5-mm diameter response, with a negative saline control and positive histamine control of 5 mm) and no response to any other drug tested. Other diagnostic tests supported a diagnosis of allergic reaction to sugammadex.
Subject(s)
Drug Hypersensitivity/etiology , gamma-Cyclodextrins/adverse effects , Adolescent , Anaphylaxis/chemically induced , Androstanols/antagonists & inhibitors , Drug Administration Schedule , Humans , Male , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Postoperative Complications , Rocuronium , Sugammadex , gamma-Cyclodextrins/administration & dosage , gamma-Cyclodextrins/pharmacologySubject(s)
Athletic Injuries/etiology , Cervical Vertebrae/injuries , Fractures, Open/etiology , Adult , Animals , Cattle , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Anaphylaxis/complications , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Dopamine Agents/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Critical Care/trends , Critical CareABSTRACT
The fracture of an implantable subclavian venous access device and the subsequent embolization of a catheter fragment is a known complication that is usually associated with a set of clinical and radiologic signs of costoclavicular compression. This scenario is also known as pinch-off syndrome. We describe 2 cases of venous port fracture which led us to review the efficacy of follow-up procedures used in our hospital. As a result, we added instructions for radiologic and clinical verification of catheter placement, taking into consideration the dynamic nature of compression. We also established protocols for coordinating the involvement of different services.
Subject(s)
Catheterization, Central Venous/instrumentation , Catheterization/adverse effects , Embolism/etiology , Foreign-Body Migration/etiology , Heart , Pressure/adverse effects , Subclavian Vein , Thoracic Outlet Syndrome/complications , Adult , Antineoplastic Agents/administration & dosage , Embolism/diagnostic imaging , Embolism/therapy , Equipment Failure , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/therapy , Heart/diagnostic imaging , Humans , Infusions, Intravenous/instrumentation , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , RadiographySubject(s)
Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Anesthesia, Intravenous , Intraoperative Complications/drug therapy , Pheochromocytoma/surgery , Pregnancy Complications, Neoplastic/surgery , Pregnancy Trimester, First , Adrenal Gland Neoplasms/complications , Adrenergic alpha-Antagonists/therapeutic use , Blood Loss, Surgical , Contraindications , Erythrocyte Transfusion , Female , Humans , Hypertension/drug therapy , Hypertension/etiology , Infant, Newborn , Intraoperative Complications/etiology , Magnesium , Monitoring, Intraoperative , Nitroprusside/therapeutic use , Phenoxybenzamine/therapeutic use , Pheochromocytoma/complications , Preanesthetic Medication , Pregnancy , Propanolamines/therapeutic use , Tachycardia/drug therapy , Tachycardia/etiology , Young AdultABSTRACT
Una de las complicaciones de los dispositivos venososimplantables subclavios es la rotura y posterior embolizaciónde un fragmento de catéter, que habitualmente seasocia a signos clínicos y radiológicos de pinzamientocostoclavicular, también llamado síndrome de pinchoff.Describimos dos casos de rotura ocurridas en nuestrohospital que nos llevaron a revisar la eficacia delseguimiento aplicado. Se añadieron instrucciones para lacomprobación radiológica y clínica del catéter, teniendoen cuenta el carácter dinámico del pinzamiento y se establecieronprotocolos de coordinación entre los serviciosimplicados)(AU)
The fracture of an implantable subclavian venousaccess device and the subsequent embolization of acatheter fragment is a known complication that is usuallyassociated with a set of clinical and radiologic signs ofcostoclavicular compression. This scenario is also knownas pinch-off syndrome. We describe 2 cases of venousport fracture which led us to review the efficacy offollow-up procedures used in our hospital. As a result, weadded instructions for radiologic and clinical verificationof catheter placement, taking into consideration thedynamic nature of compression. We also establishedprotocols for coordinating the involvement of differentservices(AU)
Subject(s)
Humans , Female , Middle Aged , Male , Adult , Catheterization/adverse effects , Catheterization, Central Venous/instrumentation , Embolism/etiology , Heart , Foreign-Body Migration/etiology , Pressure/adverse effects , Thoracic Outlet Syndrome/complications , Subclavian Vein , Antineoplastic Agents/administration & dosage , Embolism , Embolism/therapy , Equipment Failure , Foreign-Body Migration , Foreign-Body Migration/therapy , Infusions, Intravenous/instrumentation , Lymphoma, Non-Hodgkin/drug therapySubject(s)
Humans , Female , Adult , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Pregnancy Complications/drug therapy , Propofol/therapeutic use , Respiration, Artificial/methods , Anesthesiology/methods , Pheochromocytoma/drug therapy , Prenatal Diagnosis , Heart Rate , HemodynamicsSubject(s)
Airway Obstruction/etiology , Carotid Artery Injuries/etiology , Catheterization, Central Venous/adverse effects , Hematoma/etiology , Intraoperative Complications/etiology , Punctures/adverse effects , Carcinoma, Renal Cell/surgery , Carotid Artery Injuries/diagnostic imaging , Cyanosis/etiology , Device Removal , Humans , Intubation, Intratracheal , Jugular Veins , Kidney Neoplasms/surgery , Laryngeal Edema/etiology , Male , Middle Aged , Nephrectomy , UltrasonographyABSTRACT
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.
Subject(s)
Anesthesia, Spinal , Bacteroides Infections/etiology , Discitis/etiology , Epidural Abscess/etiology , Gram-Negative Bacterial Infections/etiology , Lumbar Vertebrae , Pilonidal Sinus/surgery , Punctures/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Bacteroides Infections/diagnosis , Bacteroides Infections/drug therapy , Bacteroides Infections/surgery , Combined Modality Therapy , Debridement , Discitis/diagnosis , Discitis/drug therapy , Discitis/surgery , Epidural Abscess/diagnosis , Epidural Abscess/drug therapy , Epidural Abscess/epidemiology , Epidural Abscess/surgery , Fatal Outcome , Fever/etiology , Gram-Negative Anaerobic Cocci , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/surgery , Humans , Incidence , Low Back Pain/etiology , Magnetic Resonance Imaging , Male , Shock, Septic/etiologyABSTRACT
Las infecciones vertebrales tras punción subaracnoidea son excepcionales y a menudo están insuficientemente documentadas. Su incidencia no supera la de los abscesos epidurales espontáneos, lo que debería obligarnos a ser prudentes antes de afirmar la relación causal entre punción y absceso. Tras analizar 10 casos publicados observamos que sólo en la mitad de ellos se aportan datos sobre las condiciones de asepsia de las punciones y únicamente en dos pacientes parece haber una infección previa. En tres casos los abscesos aparecen tras punciones técnicamente sencillas, mientras que en la mitad de ellos ni siquiera se menciona este evento. Debe considerarse esta complicación ante un paciente con dolor de espalda y fiebre, aunque no aparezcan déficit neurológicos, e incluso tras punción subaracnoidea sencilla. Es importante solicitar urgentemente una resonancia magnética, con el fin de establecer con premura un tratamiento adecuado, puesto que el diagnóstico y tratamiento precoces han demostrado su eficacia para mejorar la supervivencia y disminuir el porcentaje de pacientes con secuelas neurológicas
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established
Subject(s)
Male , Aged , Humans , Anesthesia, Spinal , Bacteroides Infections/etiology , Discitis/etiology , Epidural Abscess/etiology , Lumbar Vertebrae , Pilonidal Sinus/surgery , Punctures/adverse effects , Gram-Negative Bacterial Infections/etiology , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Bacteroides Infections/diagnosis , Bacteroides Infections/drug therapy , Bacteroides Infections/surgery , Combined Modality Therapy , Debridement , Discitis/diagnosis , Discitis/drug therapy , Discitis/surgery , Epidural Abscess/diagnosis , Epidural Abscess/drug therapy , Epidural Abscess/epidemiology , Epidural Abscess/surgery , Fatal Outcome , Fever/etiology , Gram-Negative Anaerobic Cocci , Incidence , Low Back Pain/etiology , Magnetic Resonance Imaging , Shock, Septic/etiology , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/surgeryABSTRACT
No disponible
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