Ictus isquémico en niño como complicación de adenoamigdalectomía / Ischemic stroke in childhood. A complication of tonsillectomy

Dentro de la edad pediátrica, la amigdalectomía es una de las cirugías otorrinolaringológicas más realizadas. Las complicaciones postoperatorias se clasifican en: primarias o inmediatas, de aparición generalmente en las primeras 24 h; y secundarias o tardías, a partir de las 48 h. Presentamos el caso de un infarto cerebral en un niño de 3 años, tras la realización de una amigdalectomía, que fue diagnosticado en el postoperatorio inmediato. En la eco-doppler y la angio-TC cerebral se visualizó un trombo intraluminal en la arteria carótida interna izquierda de etiología traumática directa, probablemente secundario a la ligadura arterial durante los procedimientos de hemostasia (AU)

Tonsillectomy is one of the most frecuently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24 h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis (AU)

[Ischemic stroke in childhood. A complication of tonsillectomy]. / Ictus isquémico en niño como complicación de adenoamigdalectomía.

Tonsillectomy is one of the most frequently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis.

Anestesia local para artroscopia de rodilla en pacientes ambulatorios / Local anesthesia for arthroscopy of the knee in day-surgery patients

Objetivo. En este artículo valoramos la eficacia de la anestesia local para la cirugía artroscópica de la rodilla en pacientes ambulatorios y la analgesia postoperatoria. Material y método. De enero a diciembre de 2003 y dentro del programa de cirugía ambulatoria fueron intervenidos 56 pacientes de diferentes patologías de la rodilla mediante cirugía artroscópica y bajo anestesia local, e infiltración intraarticular postoperatoria con bupivacaína. Se ha valorado la eficacia de la anestesia local y la analgesia postoperatoria determinando la intensidad del dolor mediante la escala visual analógica y el consumo de analgésicos tras la cirugía artroscópica. Resultados. De los 56 pacientes, 50 no tuvieron dolor durante la cirugía, en los otros 6 fue necesario suplementar la analgesia. Todos los pacientes fueron dados de alta hospitalaria en las primeras 6 horas tras la cirugía y no se detectó ninguna complicación. Conclusiones. La anestesia local intraarticular es un método ideal para la artroscopia de la rodilla dentro del programa de cirugía ambulatoria, permitiendo la realización de esta técnica quirúrgica disminuyendo el consumo de analgésicos por proporcionar una adecuada analgesia y una alta satisfacción. Permite una recuperación, un alta hospitalaria y una rehabilitación precoces

Purpose. In this study we assess the effectiveness of local anesthesia in knee arthroscopies carried out in outpatients and the use of subsequent postoperative analgesia. Materials and methods. From January to December 2003, within the framework of our Outpatient Program, 56 patients with different knee conditions underwent arthroscopy with local anesthesia and postoperative intraarticular infiltration with bupivacaine. The effectiveness of local anesthesia and postoperative analgesia were assessed by determining pain intensity using a visual analogical scale and by quantifying the use of postoperative analgesia after arthroscopy. Results. Fifty of the 56 patients, had no pain during surgery, with the remaining 6 requiring supplementary analgesia. All patients were discharged from hospital during the 6 hours following surgery and no complications were seen. Conclusions. Local intraarticular anesthesia is ideal for knee arthroscopy since it allows this surgical procedure to be performed as part of an outpatient program, it decreases the need for pain-killers and shows high rates of patient satisfaction. It allows early recovery, rehabilitation, and hospital discharge (AU)

Terapia electroconvulsiva en el tercer trimestre de la gestación. A propósito de un caso / Electroconvulsive therapy in the third trimester of pregnancy: a case report

El tratamiento electroconvulsivo o electrochoque(TEC) es una forma terapéutica efectiva en la prácticapsiquiátrica. En la mujer gestante, la necesidad de untratamiento psiquiátrico eficaz junto con la reducción defármacos psicotrópicos ha estimulado el desarrollo delTEC en los últimos 50 años. Presentamos una pacientede 35 años, gestante de 30 semanas, ingresada en nuestrohospital por un episodio depresivo grave. Tras iniciarsetratamiento médico, presentó una evolución desfavorable,por lo que se estimó la posibilidad de TEC,recibiendo tres sesiones semanales hasta un total de nueve.Durante los TEC la paciente recibió anestesia generalcon propofol, succinilcolina e intubación endotraqueal.No encontramos variaciones significativas en lasvariables hemodinámicas de la madre y el feto, ni indiciosde sufrimiento fetal. La paciente experimentó unaclara mejoría y dos días después del último TEC comenzóespontáneamente con trabajo de parto, dando a luzpor vía vaginal un niño sano

Electroconvulsive or electroshock therapy is aneffective psychiatric treatment. The need for effectivepsychotherapy in the pregnant patient and the need tolimit application of psychotropic drugs have encouragedthe use of electroshock therapy in the past 50 years. Wereport the case of a 35-year-old woman at 30 weeks'gestation who was hospitalized with severe depression.When her condition worsened after initiation of medicaltreatment, electroshock therapy was considered. Shereceived a total of 9 sessions (3 per week). Duringtreatments the patient received general anesthesia withpropofol and succinylcholine with insertion of a trachealtube. Significant variations in the hemodynamicvariables of mother and fetus were not observed; norwere there signs of fetal distress. The patientexperienced clear improvement and 2 days after the lasttreatment spontaneous labor commenced. A healthy boywas born by vaginal delivery

[Electroconvulsive therapy in the third trimester of pregnancy: a case report]. / Terapia electroconvulsiva en el tercer trimestre de la gestación. A propósito de un caso.

Electroconvulsive or electroshock therapy is an effective psychiatric treatment. The need for effective psychotherapy in the pregnant patient and the need to limit application of psychotropic drugs have encouraged the use of electroshock therapy in the past 50 years. We report the case of a 35-year-old woman at 30 weeks' gestation who was hospitalized with severe depression. When her condition worsened after initiation of medical treatment, electroshock therapy was considered. She received a total of 9 sessions (3 per week). During treatments the patient received general anesthesia with propofol and succinylcholine with insertion of a tracheal tube. Significant variations in the hemodynamic variables of mother and fetus were not observed; nor were there signs of fetal distress. The patient experienced clear improvement and 2 days after the last treatment spontaneous labor commenced. A healthy boy was born by vaginal delivery.