RESUMO
Presentamos el tratamiento eficaz de una filtración espontánea de líquido cefalorraquídeo (LCR) asociada a un síndrome de hipoten-sión/hipovolumen de LCR a nivel cervical alto, caracterizado por delirio y hematomas subdurales secundarios, refractarios al drenaje quirúrgico, que se resolvió con dos parches de sangre epidurales cervicales consecutivos.
We present the case of a cerebrospinal fluid (CSF) hypotension/hypovolume syndrome due to a spontaneous CSF fistula at the upper cervical level characterized by loss of consciousness and bilateral subdural hematomas refractory to two drainage surgeries that resolved with two consecutive blood patches on the leak site.
RESUMO
Spinal anesthesia is a very important and widely used technique nowadays. In order to obtain successful results and avoid complications, it is essential to perform it with the correct methods. The operator must be familiar with the procedure and prepare correctly for it, including material and drug selections which may vary according to the patient. Risk reduction is fundamental, and it is accomplished by carrying out the previously mentioned preparation and an adequate monitorization of the patient being intervened. Once this is in order, the patient must be positioned into being sited, or placed in supine or lateral position. The chosen approach depends mainly on the characteristics of anatomical repairs and may be medial, paramedian or a Taylor approach. The correct needle must be selected, and these are categorized mainly into those which cut or separate the dura's fibers. In this revision, the correct technique for performing spinal anesthesia is described, along with some of its most important variations such as sectorized anesthesia, continuous spinal anesthesia and combined epidural spinal anesthesia.
La anestesia espinal es una técnica ampliamente utilizada hoy en día. Para obtener resultados exitosos y evitar complicaciones, es fundamental una buena técnica a la hora de realizarla. Debe contarse con un buen conocimiento basal del método a utilizar y una preparación adecuada según el paciente, incluyendo en esto tanto los materiales como los fármacos de elección en cada caso. Es fundamental reducir los riesgos tanto locales como sistémicos del procedimiento, lo cual se logra con la preparación mencionada y una adecuada monitorización del paciente. Una vez listo esto, debe posicionarse al paciente de manera que quede sentado, en decúbito lateral o decúbito prono. El abordaje es elegido principalmente según los reparos anatómicos de cada caso particular y puede ser medio, paramediano o de Taylor. Se debe seleccionar una aguja adecuada, las cuales se dividen principalmente entre aquellas que cortan y aquellas que separan las fibras de la duramadre. En esta revisión se expone la técnica adecuada para realizar el procedimiento de anestesia espinal, junto con algunas de sus variaciones principales como lo son la anestesia sectorizada, la anestesia espinal continua y la anestesia combinada espinal epidural.
Assuntos
Humanos , Raquianestesia/métodosRESUMO
Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. CASE REPORT: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15mm adapter was reattached to the tracheal tube. CONCLUSION: The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.
