Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case.

BACKGROUND: Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. CASE REPORT: A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. DISCUSSION: With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.

Sphenopalatine ganglion block - a new treatment for burning mouth syndrome?: a case report

Abstract Burning mouth syndrome is a poorly understood entity for which current treatment modalities fail to provide effective relieve. Branches of the maxillary and mandibular nerves are responsible for the innervation of the affected area. These are also the nerves involved in trigeminal neuralgia, an entity where sphenopalatine block has proved to be effective. We present a case of a patient with burning mouth syndrome in whom a bilateral sphenopalatine ganglion block was successfully performed for pain treatment. It is an easy and safe technique that can be a valuable treatment option for these patients, although more studies are needed.

Capsaicin 8% for Peripheral Neuropathic Pain Treatment: A Retrospective Cohort Study.

BACKGROUND: Chronic neuropathic pain is a disabling condition that affects quality of life. Despite recommendations and guidelines, treatment remains suboptimal as it often does not result in significant symptom relief. Capsaicin 8% patch has been used for the treatment of several peripheral neuropathic pain etiologies with encouraging results. OBJECTIVES: To assess the results of capsaicin 8% patch on neuropathic pain by evaluating pain intensity and the painful treatment area. STUDY DESIGN: Observational retrospective cohort study. SETTING: All patients submitted to capsaicin treatment at the Chronic Pain Unit of the Hospital Centre of Tondela Viseu, from 2011 through 2019. METHODS: Records of capsaicin treatments were reviewed, and the data collected. The primary outcome was pain intensity and painful treatment area reduction between the first and last treatment. Also, the number of treatments performed, neuropathic pain duration, anatomic location, pain etiology, and concomitant oral pain medication at baseline and upon treatment conclusion was also listed. RESULTS: Postsurgical neuropathic pain was the most common etiology (49%), followed by postherpetic (28%). The median (interquartile range [IQR]) baseline pain intensity assessed by the Numeric Rating Scale (NRS-11) was 6 (5-8) and the median (IQR) final NRS-11 was 3 (1-5), with a median (IQR) relative difference of -0.5 (-0.85-0.17) with statistically significant differences (P < 0.001) between baseline and last pain intensity, regarding all groups. Also, there was a reduction in the painful treatment area between baseline and the last evaluation, with a median (IQR) relative difference of -0.4 (-0.625-0.167). LIMITATIONS: A relatively small sample and occasional different timing for pain intensity and pain treatment area assessment due to logistical difficulties. CONCLUSIONS: Capsaicin 8% patch is a valuable option for the treatment of peripheral neuropathic pain, providing a significant reduction in pain intensity and painful area. It is well tolerated and has a high treatment compliance.Ethics Committee Reference Number: 16/16//04/2021.

Scarlet fever in an adult patient: A challenging diagnosis in an airway emergency.

Scarlet fever is essentially a childhood disease, although it may occur in all ages. Early diagnosis and treatment are essential in preventing the spread of infection and progression to life-threatening complications. The case presented describes the clinical difficulty in the diagnosis of scarlet fever in an adult patient with acute involvement of the airway (oedematous laryngitis) and the need for emergent orotracheal intubation and eventually tracheotomy. A high degree of suspicion related to the airway involvement is of utmost importance in an emergency room setting.

Ultrasound-guided pulsed radiofrequency for chronic shoulder pain: a prospective study.

BACKGROUND AND OBJECTIVES: Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting. METHODS: Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient's motor function improvement. The secondary outcome was patient satisfaction. RESULTS: A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient's global impression of change superior to six. CONCLUSION: This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients' satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case / Hipotensão associada ao bloqueio bilateral do quadrado lombar realizado para analgesia pós-operatória em caso de cirurgia aórtica aberta

Abstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.

Resumo Justificativa e objetivos: O bloqueio bilateral do quadrado lombar foi descrito para procedimentos abdominais de grande porte quando há presença de sepse, uma vez que os riscos associados à peridural são considerados altos. Em uma cirurgia aórtica aberta, um único bloqueio bilateral do quadrado lombar tipo 1 (QL tipo 1) pode ser uma opção ao bloqueio peridural torácico para analgesia pós-operatória em paciente com risco cumulativo aumentado de hematoma epidural torácico. Relato de caso: Paciente feminina de 56 anos, portadora de hipertensão arterial controlada, doença renal crônica (estágio 3 b), dislipidemia, plaquetopenia de 102.000/µl e tomava aspirina, estava programada para endarterectomia aortoilíaca bilateral. A paciente foi submetida à anestesia geral e, no fim da cirurgia, a bloqueio do quadrado lombar tipo 1 bilateralmente para analgesia pós-operatória com 20 mL de ropivacaína a 0,5%, para cada lado, antes da extubação. Imediatamente após a internação na sala de recuperação pós-anestésica, a paciente evoluiu com hipotensão moderada (necessidade de infusão de dopamina durante 18 horas), concomitante à rápida redução dos escores de dor. Escore numérico para dor baixo e consumo de opioides foram observados, especialmente nas primeiras 24 horas de pós-operatório. Conclusões: O bloqueio do quadrado lombar foi uma técnica analgésica eficaz nesse caso de cirurgia aórtica aberta, embora a hipotensão associada ao bloqueio bilateral do quadrado lombar possa ocorrer. O bloqueio simpático associado, causado pelo bloqueio do QL tipo 1, provavelmente relacionado à extensão paravertebral bilateral do bloqueio, pode contribuir para a hipotensão pós-operatória associada à síndrome de isquemia-reperfusão em paciente submetido a pinçamento aórtico intraoperatório de longa duração. Alta concentração de anestésico local para prolongar a ação de uma injeção única no bloqueio do quadrado lombar, com o objetivo de evitar cateterização de ambas as anestesias peridural e do quadrado lombar bilateral, deve ser usada de modo criterioso.

[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case]. / Hipotensão associada ao bloqueio bilateral do quadrado lombar realizado para analgesia pós­operatória em caso de cirurgia aórtica aberta.

BACKGROUND AND OBJECTIVES: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. CASE REPORT: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24h post-operatively. CONCLUSIONS: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.

Use of bronchial blocker in emergent thoracotomy in presence of upper airway hemorrhage, and cervical spine fracture: a difficult decision / Uso de bloqueador brônquico em toracotomia de emergência na presença de hemorragia das vias aéreas superiores e fratura cervical: uma decisão difícil

Abstract Female, 85 y.o., weighting 60 kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double-lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case.

Resumo Paciente do sexo feminino, 85 anos, 60 kg, com trauma múltiplo. Após uma laparotomia inicial, uma toracotomia de emergência foi feita com um bloqueador brônquico para isolamento pulmonar (sucção inicial ativa foi aplicada). Durante a cirurgia, o balonete brônquico foi desinflado, causou um derrame hemorrágico traqueal autolimitado. Reisolamento foi tentado, mas não foi tão eficaz como inicialmente. Provavelmente, o colapso do pulmão com o mesmo bloqueador brônquico foi prejudicado na segunda tentativa devido à obstrução do lúmen do bloqueador brônquico pela hemorragia endobrônquica intraoperatória. A sucção ativa do bloqueador brônquico pode contribuir para obter ou acelerar o colapso pulmonar, particularmente em pacientes que não toleram a técnica de desconexão do ventilador ou a compressão cirúrgica pulmonar. O uso da tecnologia de bloqueadores brônquicos foi uma opção valiosa para os tubos de duplo lúmen neste caso de toracotomia de emergência em paciente com trauma torácico e abdominal, laceração grave da língua e fratura da apófise odontoide associados a hemorragia maciça, apesar de vários riscos que poderiam comprometer seu uso. Os autores pretendem discutir as vantagens e desvantagens dos bloqueadores brônquicos em comparação com os tubos de duplo lúmen para isolamento pulmonar e quais foram os riscos de nossa abordagem neste complexo caso de múltiplo trauma.

[Use of bronchial blocker in emergent thoracotomy in presence of upper airway hemorrhage, and cervical spine fracture: a difficult decision]. / Uso de bloqueador brônquico em toracotomia de emergência na presença de hemorragia das vias aéreas superiores e fratura cervical: uma decisão difícil.

Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double-lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case.

Quadratus lumborum block in chronic pain after abdominal hernia repair: case report / Bloqueio do quadrado lombar em dor crônica pós-hernioplastia abdominal: relato de caso

Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL) and depot (vial) methylprednisolone (20 mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Resumo Justificativa e objetivos: O bloqueio da fáscia do músculo quadrado lombar foi descrito por R. Blanco nas suas duas abordagens (I e II). A deposição de anestésico local nessa localização pode conferir bloqueio dos dermátomos T6-L1. Os autores fizeram esse bloqueio de fáscia, guiado por ultrassom, para tratamento de uma dor crônica neuropática da parede abdominal. Relato de caso: Paciente do gênero masculino, 61 anos, 83 kg, com antecedentes de trombocitopenia por hepatopatia alcoólica, entre outros, apresentava dor crônica da parede abdominal após hernioplastias abdominais múltiplas havia um ano e meio, com má resposta ao tratamento com neuromoduladores e opioides. No exame clínico, apresentava uma dor neuropática, com predomínio de alodinia ao toque, que abrangia toda a parede abdominal anterior, desde os dermátomos T7 a T12. Optou-se pela realização de um bloqueio do quadrado lombar tipo II bilateral, guiado por ultrassom, com administração de 25 mL de ropivacaína 0,2% e 20 mg de metilprednisolona depot (ampola) em cada um dos lados. O procedimento conferiu alívio imediato da sintomatologia e, após seis meses, o paciente mantinha redução significativa da alodinia, sem compromisso da qualidade de vida. Conclusões: Os autores consideram que a realização do bloqueio do quadrado lombar tipo II foi uma opção analgésica relevante no tratamento de um paciente com dor crônica pós-hernioplastia abdominal e salientaram os efeitos da dispersão do anestésico local até o espaço paravertebral torácico. A técnica mostrou ser segura e bem tolerada. É desejável a publicação de mais casos clínicos que reproduzam a eficácia desse bloqueio no contexto de dor crônica.

[Quadratus lumborum block in chronic pain after abdominal hernia repair: case report]. / Bloqueio do quadrado lombar em dor crônica pós­hernioplastia abdominal: relato de caso.

BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient; 61 years old; 83kg; with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Quadratus lumborum block in chronic pain after abdominal hernia repair: case report.

BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient, 61 years old, 83kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases.

OBJECTIVE: We present a series of 3 cases in which the impact in outcome was, first of all, related to the capacity to offer early and safer treatment to some hip fracture high-risk patients using a fascia iliaca block (FIB; ropivacaine 0,5% 20 cc and mepivacaine 1,3% 15 cc, given 30 minutes before incision) associated only with deep sedation, contributing to better practice and outcome. CASE REPORTS: All elderly patients were American Society of Anesthesiologists IV patients, under P2Y12 receptor inhibitors, suffering from an intertrochanteric fracture, and purposed for intramedullary femoral fixation (IMF). All patients have been managed successfully through a deep sedation using a low-dose infusion of propofol and bolus of fentanyl without face mask ventilation, supraglottic device placement, or endotracheal intubation after an FIB. Bispectral index was always greater than 75, and no CO2 retention or respiratory depression was present. No signs of pain or hemodynamic instability were observed. CONCLUSIONS: In these cases, surgery would be postponed if the choice was neuroaxial anesthesia, particularly because of P2Y12 receptor inhibitors' effect. FIB puncture site is distal to the fracture and incision site, but proximal local anesthetic migration through the interfascial planes allows for constant block of femoral nerve and lateral cutaneous of femur nerve and, less constantly, block of obturator. FIB may reduce the risk of perineural hematoma associated with several injections in nerve vicinity of different lumbar plexus branches. Frequently, indications for extramedullary or IMF are overlapping, but IMF is associated with less blood loss and may be managed using a low anesthetic depth if an FIB is done, increasing safety. This way, these less invasive surgical techniques combined with an adjusted anesthetic technique may have a crucial role in high-risk patients, particularly if taking P2Y12 receptor inhibitors. In these cases of IMF, surgical manipulation of sciatic and/or inferior subcostal nerves territories was managed with systemic analgesia and deep sedation.

Anestesia e retalhos microvascularizados / Anesthesia and surgical microvascular flaps / Anestesia y colgajos microvascularizados

JUSTIFICATIVA E OBJETIVOS: A cirurgia reconstrutiva de cabeça e pescoço representa um grande desafio perante a necessidade de se conseguir um bom resultado estético e funcional. A anestesia pode ser um fator importante e determinante no sucesso da técnica dado o seu papel na estabilidade hemodinâmica e no fluxo de sangue regional. Por outro lado, a anestesia regional, as variações no volume sanguíneo e o uso de fármacos vasoativos podem também influenciar o fluxo de sangue no retalho. Assim, devido à falta de recomendações baseadas em evidência, a técnica anestésica destes procedimentos é inspirada na maioria das vezes nas considerações patofisiológicas. O objetivo deste artigo é rever os aspectos relevantes no que diz respeito à prática anestésica destes casos. CONTEÚDO: Importância do tipo do retalho, considerações fisiológicas e abordagem anestésica. CONCLUSÕES: O papel do anestesiologista inclui para cirurgia com retalhos microvasculares a otimização das condições fisiológicas para a sobrevida do retalho sem aumentar a morbidade não cirúrgica.

BACKGROUND AND OBJECTIVES: Head and neck reconstructive surgery represents a major challenge facing the need to achieve a good cosmetic and functional outcome. Anesthesia may be an important and determining factor in the technique success due to its role in hemodynamic stability and regional blood flow. On the other hand, regional anesthesia, changes in blood volume, and vasoactive drugs may influence blood flow in the flap. Thus, due to the lack of recommendations based on evidence, the anesthetic technique of these procedures is most often inspired in pathophysiological considerations. The aim of this paper is to review relevant aspects regarding anesthetic practice in these cases. CONTENT: Importance of the type of surgical flap, physiological considerations, and anesthetic approach. CONCLUSIONS: In surgery with microvascular flaps, the anesthesiologist role includes optimizing the physiological conditions for the survival of the flap without increasing the non-surgical morbidity.

JUSTIFICATIVA Y OBJETIVOS: La cirugía reconstructiva de la cabeza y cuello representa un gran reto frente a la necesidad de conseguir un buen resultado estético y funcional. La anestesia puede ser un factor importante y determinante en el éxito de la técnica por su rol en la estabilidad hemodinámica y en el flujo de sangre regional. Por otro lado, la anestesia regional, las variaciones en el volumen sanguíneo y el uso de fármacos vasoactivos pueden también influir en el flujo de sangre en el colgajo. Por eso, y a causa de la falta de recomendaciones con base en las evidencias, la técnica anestésica de esos procedimientos se basa, en la mayoría de los casos, en las consideraciones patofisiológicas. El objetivo de este artículo, es analizar nuevamente los aspectos relevantes en lo concerniente a la práctica anestésica de esos casos. CONTENIDO: Importancia del tipo de colgajo, consideraciones fisiológicas y abordaje anestésico. CONCLUSIONES: El rol del anestesiólogo dentro de la cirugía con colgajos microvasculares, incluye la optimización de las condiciones fisiológicas para la sobrevida del colgajo sin aumentar la morbilidad no quirúrgica.

Anesthesia and surgical microvascular flaps.

BACKGROUND AND OBJECTIVES: Head and neck reconstructive surgery represents a major challenge facing the need to achieve a good cosmetic and functional outcome. Anesthesia may be an important and determining factor in the technique success due to its role in hemodynamic stability and regional blood flow. On the other hand, regional anesthesia, changes in blood volume, and vasoactive drugs may influence blood flow in the flap. Thus, due to the lack of recommendations based on evidence, the anesthetic technique of these procedures is most often inspired in pathophysiological considerations. The aim of this paper is to review relevant aspects regarding anesthetic practice in these cases. CONTENT: Importance of the type of surgical flap, physiological considerations, and anesthetic approach. CONCLUSIONS: In surgery with microvascular flaps, the anesthesiologist role includes optimizing the physiological conditions for the survival of the flap without increasing the non-surgical morbidity.