ABSTRACT
A 28-year-old woman with systemic lupus erythematosus and a history of aseptic meningitis, digestive bleeding due to thrombopenia and deep venous thrombosis underwent elective cesarean for transverse presentation at 35 weeks. Preoperative blood work-up showed an antinuclear antibody titre that was slightly positive and steroid treatment was started. Surgery operation was performed with general anesthesia. The outcome was satisfactory even though serious complications can develop during the management of anesthesia in such patients. Systemic lupus erythematosus is a chronic, multisystemic disease that mainly affects women of childbearing age. Antibodies and immunocomplexes play a fundamental role. Given the multiorgan involvement in this disease, preoperative study of the lupus patient should assess all such involvement, including maternal-fetal risk, as well as consider the drug and anesthetic management to be applied. Among the clinical signs that can affect management of anesthesia are the following: aseptic meningitis, high blood pressure, pericarditis, pneumonitis and recurrent venous thrombosis. Anemia, thrombopenia and significantly altered coagulation events are common.
Subject(s)
Anesthesia, General/methods , Anesthesia, Obstetrical/methods , Autoimmune Diseases , Cesarean Section , Intraoperative Complications/prevention & control , Lupus Erythematosus, Systemic , Postoperative Complications/prevention & control , Pregnancy Complications , Adult , Autoimmune Diseases/complications , Female , Gastrointestinal Hemorrhage/complications , Humans , Lupus Erythematosus, Systemic/complications , Meningitis, Aseptic/complications , Nitrous Oxide , Pregnancy , Pregnancy, High-Risk , Preoperative Care , Propofol , Succinylcholine , Thrombocytopenia/complications , Venous Thrombosis/etiology , Venous Thrombosis/prevention & controlABSTRACT
A una mujer de 28 años afectada de lupus eritematoso sistémico, con antecedentes de meningitis aséptica, hemorragia digestiva por trombopenia y trombosis venosa profunda, se le practicó una cesárea electiva por presentación transversa a las 35 semanas de gestación. En la analítica preoperatoria se observó un título de anticuerpo antinuclear (ANA) débilmente positivo, iniciándose tratamiento esteroide. La intervención se realizó bajo anestesia general. El caso evolucionó satisfactoriamente a pesar de las graves complicaciones que se pueden presentar en el manejo anestésico de estas pacientes.El lupus eritematoso sistémico es una enfermedad crónica, multisistémica, que afecta sobre todo a mujeres en edad fértil, en las que los anticuerpos y los inmunocomplejos desempeñan un papel postogenético fundamental.Dada la afectación multiorgánica de esta enfermedad, el estudio preoperatorio de la paciente lúpica debe evaluar cada una de estas afectaciones, los riesgos maternofetales y el manejo farmacológico y anestésico a desarrollar.Las manifestaciones clínicas que pueden determinar el manejo anestésico son, entre otras, meningitis aséptica, hipertensión arterial, pericarditis, neumonitis, trombosis venosas recidivantes, etc. Son frecuentes la anemia, la trombopenia e importantes alteraciones de la coagulación (AU)
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Subject(s)
Pregnancy , Adult , Female , Humans , Pregnancy Complications , Autoimmune Diseases , Cesarean Section , Lupus Erythematosus, Systemic , Succinylcholine , Thrombocytopenia , Propofol , Pregnancy, High-Risk , Meningitis, Aseptic , Postoperative Complications , Preoperative Care , Venous Thrombosis , Anesthesia, General , Anesthesia, Obstetrical , Gastrointestinal Hemorrhage , Intraoperative Complications , Nitrous OxideABSTRACT
Management of the cervical spine in orotracheal intubation for general anesthesia is an important aspect of daily practice in anesthesiology. Also important are the requirements, techniques and consequences of patient position during surgery. We report a case of tetraplegia during the early postoperative period after stapedectomy for otosclerosis. After surgery, the spontaneously breathing patient was transferred to the recovery room, where a clinical picture of anesthesia and paralysis of all four limbs was evident. We ordered an emergency magnetic resonance image of the cervical spine, which revealed a massive acutely herniated disk at C6-C7 with signs of ischemia or necrosis of the medulla at the same level. After eight months, the patient was still paraplegic and lacked sensation in the lower limbs. Sensation and motor function in the upper limbs was nearly normal. We review the etiopathogenetic mechanisms that might be responsible for this clinical profile.
Subject(s)
Quadriplegia/etiology , Stapes Surgery/adverse effects , Adult , Humans , Male , Time FactorsABSTRACT
OBJECTIVES: This paper describes our MAS (major ambulatory surgery) unit and its application in urology. METHODS: We reviewed our series of 415 patients seen over a period of 14 months; of these, 71 (17%) did not meet the criteria and the remaining 344 patients (83%), with ages ranging from 6 months to 78 years, were treated in our MAS unit. Surgery was performed for circumcision, cryptorchidism, PVCP and hydrocele. RESULTS: Only 2 (0.5%) of the patients were hospitalized and 5 (1.4%) were reoperated. The degree of patient satisfaction was over 90%. CONCLUSIONS: 1. MAS is efficacious in providing care and efficiently resolves difficult urological cases. 2. Patient satisfaction is very high and there were only a few complications in the patients treated in this unit.