[Anesthetic management of coagulation factor V deficiency]. / Manejo anestésico en el déficit de factor V de la coagulación.

Factor V deficiency, or Owren's disease, is a rare inherited recessive autonomic disorder that is congenital. The bleeding in patients with this disease depends on plasma levels of factor V. Anesthetic management is similar to that used for patients with other coagulation disorders. On the one hand, it is useful to initiate infusion of plasma if purified concentrates are not available. On the other hand, it is important to monitor hemostasis carefully so that bleeding during postoperative recovery can be prevented. Plasma and antifibrinolytic drugs such as tranexamic acid should continue to be administered in the first few days after surgery. We report the case of a man with homozygotic factor V deficiency who underwent surgery for colon cancer. This article reviews the main aspects of anesthetic management of this coagulation disorder.

Réplica a "consideraciones sobre la conversión de tubo nasotraqueal a orotraqueal" / Author's reply to "on conversion from nasotracheal to orotracheal intubation

No disponible

No disponible

Manejo anestésico en el déficit de factor V de la coagulación / Anesthetic management of coagulation factor V deficiency

El déficit del factor V o enfermedad de Owren en un raro trastorno congénito de herencia autonómica recesiva. La clínica hemorrágica que presentan los pacientes, está en función de los niveles plasmáticos de factor V. La conducta anestésica a seguir será similar a la utilizada en pacientes con otros tipos de coagulopatías. Por un lado, es conveniente iniciar un protocolo de administración de plasma, en aquellos déficits en los que no se disponga de concentrados purificados. Por otro lado, es importante un control estricto de los parámetros hemostáticos, con el fin de prevenir el riego hemorrágico en el postoperatorio inmediato. En los primeros días del postoperatorio, se continuará la administración de plasma y fármacos antifibrinólicos como el ácido tranexámico. Se presenta el caso de un paciente varón, intervenido de cirugía oncológica de colon, homocigoto para el déficit de factor V. En el presente trabajo se revisan los principales puntos de la actuación anestésica en este tipo de pacientes (AU)

Factor V deficiency, or Owren's disease, is a rare inherited recessive autonomic disorder that is congenital. The bleeding in patients with this disease depends on plasma levels of factor V. Anesthetic management is similar to that used for patients with other coagulation disorders. On the one hand, it is useful to initiate infusion of plasma if purified concentrates are not available. On the other hand, it is important to monitor hemostasis carefully so that bleeding during postoperative recovery can be prevented. Plasma and antifibrinolytic drugs such as tranexamic acid should continue to be administered in the first few days after surgery. We report the case of a man with homozygotic factor V deficiency who underwent surgery for colon cancer. This article reviews the main aspects of anesthetic management of this coagulation disorder (AU)

[Anesthesia in intrahepatic cholestasis: Alagille syndrome]. / Anestesia en la colestasis intrahepática. Síndrome de Alagille.

A 42-year-old patient, diagnosed with Alagille syndrome when he was 1 month old, was admitted to the general surgery department to undergo right hepatectomy for right lobe carcinoma. Alagille syndrome, also known as biliary duct hypoplasia, is an extremely rare genetic condition with multiorganic implications. Liver and heart dysfunction will play key roles in the course of the disease and its prognosis. An exhaustive preoperative assessment of liver and heart function, blood chemistry and the skeleton will be essential for managing these patients. This article reviews the main principles underlying the anesthetic management of patients with Alagille syndrome.

Anestesia en la colestasis intrahepática. Síndrome de Alagille / Anesthesia in intrahepatic cholestasis: Alagille syndrome

Paciente de 42 años, diagnosticada de Síndrome de Alagille en el primer mes de vida. Ingresa en el Servicio de Cirugía General con diagnóstico de hepatocarcinoma de lóbulo derecho, para la realización de hepatectomía derecha. El Síndrome de Alagille, también conocido como Síndrome de escasez de conductos biliares, es una enfermedad genética extremadamente rara, de afectación multiorgánica. La disfunción hepática y cardíaca será fundamental para la evolución y pronóstico de la enfermedad. Un estudio preoperatorio exhaustivo de la función hepática, cardiológico, hematológica y ósea se antoja funda- mental para el manejo de estos pacientes. En el presente trabajo se revisan los principales pun- tos de la actuación anestésica en los pacientes portado- res de este síndrome

A 42-year-old patient, diagnosed with Alagille syndrome when he was 1 month old, was admitted to the general surgery department to undergo right hepatectomy for right lobe carcinoma. Alagille syndrome, also known as biliary duct hypoplasia, is an extremely rare genetic condition with multiorganic implications. Liver and heart dysfunction will play key roles in the course of the disease and its prognosis. An exhaustive preoperative assessment of liver and heart function, blood chemistry and the skeleton will be essential for managing these patients. This article reviews the main principles underlying the anesthetic management of patients with Alagille syndrome

[Exchanging and maintaining the airway in hyoid surgery: using a flexible exchanger during new surgical treatments for obstructive sleep apnea syndrome]. / Modificación y mantenimiento de la vía aérea en la cirugía del hioides. Empleo de un intercambiador flexible en las nuevas técnicas quirúrgicas del síndrome de apnea obstructiva del sueño.

OBJECTIVE: To assess the level of intubation difficulty and anatomical changes after hyoid surgery. To evaluate the difficulty of switching from nasotracheal to orotracheal intubation after hyoid and palatopharyngeal surgery using an exchanger. MATERIAL AND METHODS: Prospective study enrolling 30 patients undergoing surgery for obstructive sleep apnea syndrome (OSAS) in 2 consecutive phases. Anatomical features suggesting risk of difficult intubation, anatomical changes caused by surgery, the incidence of failure to intubate upon first attempt during the first surgical session, and upon switching from nasal to oral intubation, and the time required to intubate were recorded. The rate of complications during and after surgery was also noted. RESULTS: The incidence of difficult intubation was 15% and no complications developed in the switch from nasotracheal to orotracheal intubation (100% success rate). CONCLUSION: New surgical treatments for the OSAS patient require new anesthetic maneuvers such as nasotracheal-orotracheal intubation exchange after hyoid surgery. The exchanger used in the present study offers a valid way to achieve airway management in this situation.

Anestesia en la enfermedad de Wilson / Anesthesia in Wilson's disease

No disponible

Modificación y mantenimiento de la vía aérea en la cirugía del hioides. Empleo de un intercambiador flexible en las nuevas técnicas quirúrgicas del síndrome de apnea obstructiva del sueño / Exchanging and maintaining the airway in hyoid surgery: using a flexible exchanger during new surgical treatments for obstructive sleep apnea syndrome

OBJETIVO: Establecer el grado de dificultad de intubación así como las alteraciones anatómicas tras la cirugía hioidea. Valorar la dificultad que plantea el cambio de intubación nasotraqueal a orotraqueal tras la cirugía hioidea y palatofaríngea empleando un intercambiador. MATERIALES Y MÉTODOS: Estudio prospectivo en el que se incluyeron 30 pacientes intervenidos de cirugía del Síndrome de Apnea Obstructiva del Sueño (SAOS) en dos tiempos quirúrgicos consecutivos. Se recogieron variables anatómicas predictivas de intubación difícil, los cambios anatómicos producidos por la cirugía, la incidencia de intubaciones fallidas en el primer tiempo quirúrgico y en el cambio de intubación nasal a oral, recogiéndose el tiempo empleado en dicho cambio. También se recogieron las complicaciones intra y postoperatorias. RESULTADOS: La incidencia de intubación difícil fue de un 15%, ninguno de los cambios de intubación nasotraqueal a orotraqueal presentó complicaciones, obteniéndose un 100% de intubaciones exitosas. CONCLUSIÓN: Las nuevas técnicas quirúrgicas en el paciente con SAOS, implican nuevas actuaciones anestésicas, como el cambio de intubación nasotraqueal a orotraqueal necesario tras la cirugía hioidea. El intercambiador empleado en el presente trabajo plantea una alternativa valida para el manejo de la vía aérea en esa situación

OBJECTIVE: To assess the level of intubation difficulty and anatomical changes after hyoid surgery. To evaluate the difficulty of switching from nasotracheal to orotracheal intubation after hyoid and palatopharyngeal surgery using an exchanger. MATERIAL AND METHODS: Prospective study enrolling 30 patients undergoing surgery for obstructive sleep apnea syndrome (OSAS) in 2 consecutive phases. Anatomical features suggesting risk of difficult intubation, anatomical changes caused by surgery, the incidence of failure to intubate upon first attempt during the first surgical session, and upon switching from nasal to oral intubation, and the time required to intubate were recorded. The rate of complications during and after surgery was also noted. RESULTS: The incidence of difficult intubation was 15% and no complications developed in the switch from nasotracheal to orotracheal intubation (100% success rate). CONCLUSION: New surgical treatments for the OSAS patient require new anesthetic maneuvers such as nasotracheal- orotracheal intubation exchange after hyoid surgery. The exchanger used in the present study offers a valid way to achieve airway management in this situation

[Comparison of 4 techniques for general anesthesia for carotid endarterectomy: inflammatory response, cardiocirculatory complications, and postoperative analgesia]. / Estudio comparativo de cuatro técnicas de anestesia general en endarterectomía carotídea: respuesta inflamatoria, complicaciones cardiocirculatorias y analgesia postoperatoria.

OBJECTIVE: [corrected] To study the analgesia, hemodynamic stability and inflammatory response in patients undergoing carotid endarterectomy under different types of general anesthesia. MATERIALS AND METHODS: A comparison of 80 patients randomized to 4 groups: group 1, maintenance with sevoflurane at a minimum alveolar concentration (MAC) of 1; group 2, sevoflurane at MAC 1.5; group 3, remifentanil; group 4, propofol. Variables studied were hemodynamic alterations during and after surgery, level of postoperative analgesia, differential white cell counts, levels of interleukin-6 (IL-6), and clinical signs and symptoms of systemic inflammatory response syndrome in the first 24 hours after surgery. RESULTS: The incidences of episodes of intraoperative hypertension were 60% in group 1, 65% in group 2, 50% in group 3, and 60% in group 4. The incidences of episodes of intraoperative hypotension were 85% in group 1, 80% in group 2, 80% in group 3, and 75% in group 4. Patients in groups 3 and 4 had higher incidences of systemic inflammatory response syndrome (p<0.05) in the first 24 hours after surgery and higher levels of IL-6 (p<0.05). Postoperative analgesia was similar in all 4 groups. CONCLUSIONS: Increased levels of IL-6 in peripheral blood and of systemic inflammatory response syndrome were found in the early postoperative period in groups that did not receive halogenated gases. Hemodynamic stability and analgesia were similar in all groups, however.

Anestesia en la enfermedad de Wegener nasofacial / Anesthesia in Wegener nasofacial granulomasotis

No disponible