Juan Evangelista Manrique, the true pioneer of spinal anesthesia in Colombia / El verdadero pionero de la raquianestesia en Colombia: Juan Evangelista Manrique

Abstract Several findings paved the way to the use of the spinal approach for anesthesia. Information about the originators and dates of their discoveries is controversial. According to personal communications, doctors Juan Bautista Montoya y Flórez, in Medellín, and Lisandro Leyva, in Bogotá, in 1904 and 1905 respectively, would appear to be the pioneers of spinal anesthesia in Colombia. Pioneering cases of this procedure carried out in 1901 by doctor Juan Evangelista Manrique and which continued to be performed by his colleagues and assistants of the medical community at the time are documented in the Corporis Fabrica dissertation collection of the National University of Colombia.

Resumen Son varios los hallazgos que contribuyeron al abordaje de la columna vertebral como vía para la administración de anestesia. Los autores y las fechas de tales descubrimientos han sido controvertidos. En Colombia, según fuentes orales, los doctores Juan Bautista Montoya y Flórez, en Medellín, y Lisandro Leyva, en Bogotá, en 1904 y 1905 respectivamente, serían los pioneros de la anestesia raquídea en Colombia. En las tesis de la Facultad de Medicina de la Universidad Nacional, Colección Corporis Fabrica, se documentan los casos pioneros de este procedimiento realizados en 1901, por el doctor Juan Evangelista Manrique y continuados enseguida por sus colegas y ayudantes de la comunidad médica de ese entonces.

Understanding Fatal Fat Embolism in Gluteal Lipoinjection: A Review of the Medical Records and Autopsy Reports of 16 Patients.

BACKGROUND: Deaths secondary to gluteal lipoinjection are relatively recent events of major importance. However, little is known in relation to their behavior and clinical evolution. Therefore, an analysis was performed of case records from clinical cases that encountered this problem, correlating the results with the findings during autopsies. METHODS: An analysis was performed of records from patients who died secondary to gluteal lipoinjection. Patient-specific data, surgical procedure, clinical picture, evolution, and outcome were analyzed. The findings of the autopsies and the involvement of other organs were also analyzed and correlated. RESULTS: From 2000 to 2009, 16 files were obtained that fulfilled the indicated requirements. There were no statistically significant differences in the general characteristics of the patients, such as age, body mass index, or volume lipoinjected or liposuctioned. The clinical pictures were similar in all cases, and the autopsy findings showed the presence of microembolism in all cases and macroembolism in the most severe cases. CONCLUSIONS: The most significant parameter of severity in patients who undergo gluteal lipoinjection is the presence of fat in macroscopic form in the circulation. The volumes of liposuctioned or lipoinjected fat have little influence. Hypoxemia, hypotension, and bradycardia are the characteristic clinical features. Although there is no specific treatment, immediate aggressive vital support to attempt to stabilize the patient is crucial. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Deaths Caused by Gluteal Lipoinjection: What Are We Doing Wrong?

BACKGROUND: Intramuscular gluteal lipoinjection has become one of the most commonly used surgical procedures for achieving improvement in the gluteal contour; however, there are few studies that report and analyze the causes of secondary death from this surgical procedure. METHODS: An analysis of secondary deaths from gluteal lipoinjection procedures was performed in Mexico and Colombia over periods of 10 and 15 years, respectively. In Mexico, the study was performed through a survey of all members of the Mexican Association of Reconstructive, Plastic and Aesthetic Surgery. In Colombia, the study was performed through an analysis of deaths and autopsies documented by the National Institute of Legal Medicine and Forensic Sciences Regional Bogotá. RESULTS: A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery. In the Colombian autopsy results, seven cases of macroscopic fat embolism and two cases with a microscopic embolism were reported, with abundant fatty tissue in the infiltrated gluteal muscles. CONCLUSIONS: In this study, the authors found that intramuscular gluteal lipoinjection is associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism; therefore, buttocks lipoinjection should be performed very carefully, avoiding injections into deep muscle planes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.