Manejo anestésico en la extirpación de una tumoración intrarraquídea cervical con monitorización neurofisiológica intraoperatoria en una paciente gestante de 29 semanas / Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks

La monitorización neurofisiológica intraoperatoria se emplea para vigilar la función nerviosa, evitando lesiones neurológicas durante la cirugía y disminuyendo la morbilidad; esto la ha convertido en imprescindible para algunas intervenciones de neurocirugía. La baja incidencia de procedimientos neuroquirúrgicos en mujeres gestantes hace que la experiencia de la monitorización neurofisiológica intraoperatoria esté limitada a algún caso clínico. Se presenta el caso de una gestante de 29 semanas con un tumor intrarraquídeo cervical con evolución aguda que precisó cirugía. La participación de un equipo multidisciplinar compuesto por anestesiólogos, neurocirujanos, neurofisiólogos y obstetras, la monitorización fetal continua, la monitorización neurofisiológica intraoperatoria y el mantenimiento de las variables neurofisiológicas y uteroplacentarias fueron clave para el buen desarrollo de la cirugía. Bajo nuestra experiencia, así como en la escasa literatura publicada, no observamos efectos perjudiciales de esta técnica a nivel maternofetal, aportando importantes beneficios durante la cirugía y en su resultado final (AU)

The intraoperative neurophysiological monitoring is a technique used to test and monitor nervous function. This technique has become essential in some neurosurgery interventions, since it avoids neurological injuries during surgery and reduces morbidity. The experience of intraoperative neurophysiological monitoring is limited in some clinical cases due to the low incidence of pregnant women undergoing a surgical procedure. A case is presented of a 29-weeks pregnant woman suffering from a cervical intraspinal tumour with intense pain, which required surgery. The collaboration of a multidisciplinary team composed of anaesthesiologists, neurosurgeons, neurophysiologists and obstetricians, the continuous monitoring of the foetus, the intraoperative neurophysiological monitoring, and maintaining the neurophysiological and utero-placental variables were crucial for the proper development of the surgery. According to our experience and the limited publications in the literature, no damaging effects of this technique were detected at maternal-foetal level. On the contrary, it brings important benefits during the surgery and for the final result (AU)

[Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks]. / Manejo anestésico en la extirpación de una tumoración intrarraquídea cervical con monitorización neurofisiológica intraoperatoria en una paciente gestante de 29 semanas.

The intraoperative neurophysiological monitoring is a technique used to test and monitor nervous function. This technique has become essential in some neurosurgery interventions, since it avoids neurological injuries during surgery and reduces morbidity. The experience of intraoperative neurophysiological monitoring is limited in some clinical cases due to the low incidence of pregnant women undergoing a surgical procedure. A case is presented of a 29-weeks pregnant woman suffering from a cervical intraspinal tumour with intense pain, which required surgery. The collaboration of a multidisciplinary team composed of anaesthesiologists, neurosurgeons, neurophysiologists and obstetricians, the continuous monitoring of the foetus, the intraoperative neurophysiological monitoring, and maintaining the neurophysiological and utero-placental variables were crucial for the proper development of the surgery. According to our experience and the limited publications in the literature, no damaging effects of this technique were detected at maternal-foetal level. On the contrary, it brings important benefits during the surgery and for the final result.

Consideraciones perioperatorias para la realización de una biopsia cerebral en un paciente con enfermedad de Creutzfeldt-Jakob esporádica subtipo VV2 / Perioperative considerations for performing a brain biopsy on a patient with subtype VV2 sporadic Creutzfeldt-Jakob disease

La enfermedad de Creutzfeldt-Jakob (ECJ) es la encefalopatía espongiforme transmisible más común. Consiste en una afección neurológica infecciosa, progresiva y degenerativa, con un periodo de incubación presumiblemente prolongado, pero un curso rápidamente fatal. La ECJ es transmitada por un agente infeccioso proteico o «prion». Dado que los priones son difíciles de erradicar y son resistentes a los métodos de esterilización actualmente empleados, se deben tomar precauciones especiales con los instrumentos quirúrgicos. Se recomiendan equipos de un solo uso, destrucción del equipo contaminado, descontaminación de los instrumentos reutilizables, uso de ropa de protección, y almacenamiento y puesta en cuarentena de los instrumentos quirúrgicos. El equipo de un solo uso y algunos tejidos y fluidos corporales del paciente con ECJ son altamente infecciosos y deben ser incinerados. Se presenta un caso de un paciente al que se le realizó una biopsia cerebral por la sospecha de ECJ, siendo confirmada una ECJ esporádica. Para ello llevamos a cabo unas medidas preventivas específicas para reducir el riesgo de contagio al personal sanitario (AU)

Creutzfeldt-Jakob disease (CJD) is the most common transmissible spongiform encephalopathy. It is an infectious, progressive, degenerative neurological disorder, with a presumably long incubation period, but a rapid fatal course. CJD is transmitted by a proteinaceous infectious agent, or «prion». Because the prions are difficult to eradicate and are resistant to the currently used sterilization methods, special precautions must be taken with all surgical instruments. It is recommended the single-use equipment, destruction of contaminated equipment, decontamination of reusable instruments, use of protective clothing, and storing and quarantining surgical instruments. The single-use equipment and some tissues and body fluids from the patient with CJD are highly infectious and must be incinerated. We report a case of a patient who had undergone brain biopsy for suspected of CJD, being confirmed to have sporadic CJD. Specific preventive measures were taken to reduce the risk of transmission to healthcare workers (AU)

[Perioperative considerations for performing a brain biopsy on a patient with subtype VV2 sporadic Creutzfeldt-Jakob disease]. / Consideraciones perioperatorias para la realización de una biopsia cerebral en un paciente con enfermedad de Creutzfeldt-Jakob esporádica subtipo VV2.

Creutzfeldt-Jakob disease (CJD) is the most common transmissible spongiform encephalopathy. It is an infectious, progressive, degenerative neurological disorder, with a presumably long incubation period, but a rapid fatal course. CJD is transmitted by a proteinaceous infectious agent, or «prion¼. Because the prions are difficult to eradicate and are resistant to the currently used sterilization methods, special precautions must be taken with all surgical instruments. It is recommended the single-use equipment, destruction of contaminated equipment, decontamination of reusable instruments, use of protective clothing, and storing and quarantining surgical instruments. The single-use equipment and some tissues and body fluids from the patient with CJD are highly infectious and must be incinerated. We report a case of a patient who had undergone brain biopsy for suspected of CJD, being confirmed to have sporadic CJD. Specific preventive measures were taken to reduce the risk of transmission to healthcare workers.

[Questionnaire on the anaesthesiology treatment of patients subjected to posterior fossa neurosurgery]. / Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior.

OBJECTIVES: To find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa. MATERIAL AND METHODS: A closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery. RESULTS: The questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%). CONCLUSIONS: The results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.

Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior / Questionnaire on the anaesthesiology treatment of patients subjected to posterior fossa neurosurgery

Objetivos: Conocer por medio de una encuesta la actuación de los anestesiólogos españoles en el manejo perioperatorio de los pacientes intervenidos neuroquirúrgicamente de enfermedades de fosa posterior del cráneo. Material y métodos: Se remitió a los servicios de anestesiología de hospitales con servicio de neurocirugía un cuestionario con un planteamiento cerrado sobre la participación de los anestesiólogos en el tratamiento perioperatorio de los pacientes sometidos a cirugía de fosa posterior. Resultados: De los 73 hospitales nacionales públicos que disponen de servicio de neurocirugía, completaron el formulario 42 (57,5%). En 36 centros se realiza la cirugía de fosa posterior con el paciente en sedestación, aunque se emplea con menor frecuencia que el decúbito lateral o el decúbito prono. La monitorización neurológica específica es escasa, así como el empleo del Doppler precordial y/o transcraneal para la detección de embolia vascular aérea. La técnica anestésica más empleada en estos procedimientos es la intravenosa. En menos del 10% de los centros se emplea óxido nitroso, y en un 15% se evitan los bloqueadores neuromusculares cuando se usa monitorización neurofisiológica intraoperatoria. Los problemas cardiovasculares durante la cirugía se refieren como muy frecuentes en el 29% de los centros, mientras que en el postoperatorio las complicaciones referidas como más habituales son los déficit de pares craneales, el edema de vía aérea (23%) y los vómitos postoperatorios (47%). Conclusiones: Los resultados obtenidos de la encuesta muestran que en las cirugías de fosa posterior la sedestación se utiliza menos que el decúbito prono y que apenas se usa monitorización neurofisiológica intraoperatoria(AU)

Objectives: To find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa. Material and methods: A closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery. Results: The questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve deficit, airway oedema (23%), and post-operative vomiting (47%). Conclusions: The results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used(AU)

Hematoma cervical compresivo postquirúrgico en un paciente con prótesis traqueal / No disponible

No disponible

[Subarachnoid hemorrhage: epidemiology, social impact and a multidisciplinary approach]. / Epidemiología de la hemorragia subaracnoidea: impacto social y abordaje multidisciplinario.

Cerebrovascular disease, whether ischemic or hemorrhagic, is a worldwide problem, representing personal tragedy, great social and economic consequences, and a heavy burden on the health care system. Estimated to be responsible for up to 10% of mortality in industrialized countries, cerebrovascular disease also affects individuals who are still in the workforce, with consequent loss of productive years. Subarachnoid hemorrhage (SAH) is a type of cerebrovascular accident that leads to around 5% of all strokes. SAH is most often due to trauma but may also be spontaneous, in which case the cause may be a ruptured intracranial aneurysm (80%) or arteriovenous malformation or any other abnormality of the blood or vessels (20%). Although both the diagnosis and treatment of aneurysmal SAH has improved in recent years, related morbidity and mortality remains high: 50% of patients die from the initial hemorrhage or later complications. If patients whose brain function is permanently damaged are added to the count, the percentage of cases leading to severe consequences rises to 70%. The burden of care of patients who are left incapacitated by SAH falls to the family or to private and public institutions. The economic cost is considerable and the loss of quality of life for both the patient and the family is great. Given the magnitude of this problem, the provision of adequate prophylaxis is essential; also needed are organizational models that aim to reduce mortality as well as related complications. Aneurysmal SAH is a condition which must be approached in a coordinated, multidisciplinary way both during the acute phase and throughout rehabilitation in order to lower the risk of unwanted outcomes.

[Neuroanesthesia for embolization of a ruptured cerebral aneurysm: clinical practice guidelines]. / Recomendaciones-guía de práctica clínica del manejo neuroanestesiológico para la embolización terapéutica del aneurisma intracraneal.

When the neuroanesthesia working group of the Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor surveyed Spanish anesthesiologists to learn the degree of their involvement in the diagnosis and treatment of spontaneous subarachnoid hemorrhage, a surprising finding was that anesthetists did not participate in endovascular repair of intracranial aneurysms when the procedure was carried out in an interventional radiology department. These interventions, which are considered minimally invasive and are performed outside the operating room, are not risk-free. Based on the survey results and a systematic review of the literature, the working group has provided practice guidelines for the perioperative management of anesthesia for endovascular repair of ruptured cerebral aneurysms. In our opinion, the diversity of practice in the hospitals surveyed calls for the application of practice guidelines based on consensus if we are to reduce variability in clinical and anesthetic approaches as well as lower the rates of morbidity and mortality and shorten the hospital stay of patients undergoing exclusion of an aneurysm.

[Psychological profile of anesthesia residents in the province of Andalucia]. / Perfil psicológico de la población de médicos residentes de anestesiología en una provincia de Andalucía.

OBJECTIVES: To describe the personality traits and value systems of the population of residents in anesthesiology of a province in Andalusia and to analyze what the ideal profile of an anesthesiologist in training would be. SUBJECTS AND METHOD: Forty-four residents in anesthesiology were invited to participate, of whom 22 accepted. The participants voluntarily completed anonymous written questionnaires with 232 items: the sixteen personality factors questionnaire, form A (R.B. Cattell), and the survey of interpersonal values (L.V. Gordon). RESULTS: The residents scored high on primary factors of intelligence (B), self-sufficiency (Q2) and conservatism (Q1). High scores were also recorded on the secondary factors of anxiety (QI) and socialization (QIII); low scores were seen for independence (QIV). Four theoretical personality models (alpha, beta, gamma and delta) were established based on the data. Four residents were alphas (18%), 10 were betas (45%), 6 were gammas (27%) and 2 were deltas (10%). CONCLUSIONS: An ideal personal profile for residents in anesthesiology by American authors has been available since the 1960s. An ideal resident should be independent, calm, aware, stable, secure, self-disciplined and alert; moreover, he or she should enjoy team work. The residents with alpha personalities were ideal. At present, the training of residents and the selection criteria for access to specialized training based on a personality test are scarcely valued in our discipline.