Association between telomere length in the DNA of peripheral blood leukocytes and the propofol dose in anesthesia induction: an observational study

Abstract Introduction: Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. Telomerase RNA component (TERC) plays an important role in maintaining TL. We proposed a hypothesis that propofol dose in general anesthesia can be predicted by measuring TL before operation, which greatly reduced the risk of anesthesia, especially the elderly. Methods: The association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight; sex; difference of the Bispectral Index (BIS) before and after anesthesia induction in patients was evaluated by multivariable linear regression analyses. The mutation at the 5'end or 3'end of TERC was detected. We recruited 100 patients of elective surgery. Results: We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p < 0.001), body weight (r = 0.84, p = 0.004), sex (r = 0.83, p= 0.84, p = 0.004), sex (r = 0.83, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.21, 0.19, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, the mutation at the 5' end or 3' end of TERC was not found. Conclusions: These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.

Postoperative complications and predictors of mortality in patients with COVID-19.

BACKGROUND: There are limited data about the perioperative outcomes of coronavirus disease 2019 (COVID-19) patients that needed emergency general surgery. The aim of the present study was to describe the perioperative outcomes and mortality of patients with COVID-19 who underwent emergency surgery. MATERIALS AND METHODs: Retrospective study of COVID-19 patients symptomatic versus asymptomatic from March 2020 to February 2022 that needed an emergency surgery in a national referral hospital. RESULTS: Forty-four patients were included in this study. Patients with symptomatic COVID-19 have higher ICU admissions and prolonged length of stay (LOS) as compared with asymptomatic COVID-19 patients. The 90-day survival probability of the entire cohort was 70.1% (60.3-79.9) and was significantly lower in patients with COVID-19 symptomatic 63.4% (50.5-76.2). The cut-off preoperative values for the prediction of mortality: Ferritin ≥ 438.5 ng/mL (Area under the curve [AUC] = 0.908), C-reactive protein (CRP) ≥ 12.5 mg/dL (AUC = 0.715), leukocyte ≥ 13.8 × 103/mL (AUC = 0.706), and albumin ≤ 2.78 g/dL (AUC = 704). Furthermore, a cut-off value of CRP of ≥ 12.5 mg/dL yielded an accuracy of 82.9% for the prediction of postoperative complications (p < 0.001). CONCLUSION: Patients with symptomatic COVID-19 who needed emergency surgery have higher ICU admissions, prolonged LOS, and decreased 90-day survival as compared with asymptomatic COVID-19 patients. Preoperative ferritin, CRP, leukocytes, and albumin could be used as predictors of mortality.

ANTECEDENTES: Hay datos limitados sobre los pacientes con COVID-19 que necesitaron cirugía de emergencia. El objetivo del presente estudio fue describir los resultados perioperatorios y la mortalidad de pacientes con COVID-19 que se sometieron a cirugía de emergencia. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes con COVID-19 sintomáticos vs. asintomáticos de marzo 2020 a febrero 2022 que requirieron cirugía de emergencia en un Hospital de Referencia Nacional. RESULTADOS: Se incluyeron 44 pacientes. Los pacientes con COVID-19 sintomático tienen más admisiones en la UCI y estancia hospitalaria prolongada en comparación con los pacientes con COVID-19 asintomático. La supervivencia a 90 días de la cohorte fue del 70,1% (60,3-79,9) y fue menor en los pacientes con COVID-19 sintomáticos del 63.4% (50.5-76.2). Los valores preoperatorios para la predicción de mortalidad: ferritina ≥ 438.5 ng/mL (AUC = 0.908), PCR ≥ 12.5 mg/dL (AUC = 0.715), leucocitos ≥ 13.8 × 103/mL (AUC = 0.706) y albúmina ≤ 2.78 g/dl (AUC = 704). La PCR de ≥ 12.5 mg/dL tiene una precisión del 82.9% para la predicción de complicaciones posoperatorias (p < 0.001). CONCLUSIÓN: Los pacientes con COVID-19 sintomático tienen más admisiones en la UCI, estancia hospitalaria prolongada y menor supervivencia en comparación con los pacientes con COVID-19 asintomáticos. La ferritina, PCR, leucocitos y albúmina preoperatoria pueden utilizarse como predictores de mortalidad.

Minimally invasive surgery versus laparotomy in women with high risk endometrial cancer: A multi-center study performed in Argentina.

Objective: Compare the perioperative outcomes and disease-free survival between minimally invasive and open surgery in women with stage I-II high-risk endometrial cancer. Methods: A retrospective, cohort study was performed involving twenty-four centers from Argentina. Patients with grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 2010-2018 were included. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival. Results: Of 343 eligible patients, 214 (62 %) underwent open surgery and 129 (38 %) underwent laparoscopic surgery. No significant differences were seen between the two groups with respect to greater or equal grade III Clavien-Dindo postoperative complications (11 % in the open surgery group vs 9 % minimally invasive surgery group; P = 0.34) Minimally invasive surgery was not associated with worse disease-free survival at four years (79.14 % [95 % CI 69.42- 86.08] vs 78.80 % [95 % CI 70.61-84.96]), (p = 0.25), even after creating a Cox proportional model (hazard ratio [HR] 1.08 95 % CI 0.63-1.84); (p = 0.76). Conclusion: There was no difference between postoperative complications nor oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.

Association between telomere length in the DNA of peripheral blood leukocytes and the propofol dose in anesthesia induction: an observational study.

INTRODUCTION: Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. Telomerase RNA component (TERC) plays an important role in maintaining TL. We proposed a hypothesis that propofol dose in general anesthesia can be predicted by measuring TL before operation, which greatly reduced the risk of anesthesia, especially the elderly. METHODS: The association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight; sex; difference of the Bispectral Index (BIS) before and after anesthesia induction in patients was evaluated by multivariable linear regression analyses. The mutation at the 5'end or 3'end of TERC was detected. We recruited 100 patients of elective surgery. RESULTS: We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p < 0.001), body weight (r = 0.84, p = 0.004), sex (r = 0.83, p= 0.84, p = 0.004), sex (r = 0.83, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.21, 0.19, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, the mutation at the 5' end or 3' end of TERC was not found. CONCLUSIONS: These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.

The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand Surgery.

Purpose: The wide-awake local anesthesia technique in hand surgery is widely used, but there are currently no guidelines or protocols for the number of operating room personnel required to optimize patient safety intraoperatively. This study aimed to evaluate perioperative complication rates of wide-awake local anesthesia hand surgeries performed at surgery centers that used different numbers of operating room nurses. Methods: We conducted a retrospective review of patients who underwent wide-awake local anesthesia hand surgery at 4 surgical centers over a 30-month consecutive period. Two surgical centers used 3 operating room nurses, and 2 centers used 2 operating room nurses. The complications reported included intraoperative case abortion because of critical change in patient vitals, intraoperative medication delivery, intraoperative intravenous placement for medication delivery, intraoperative conversion to sedation, intraoperative medical complications, and postoperative transfer to the emergency department or a hospital. Results: A total of 1,771 wide-awake local anesthesia surgical procedures were identified, with 925 performed at a facility that used 2 operating room nurses and 846 performed at a facility that used 3 operating room nurses. There were no perioperative complications in either group during the study period. Conclusions: There was no difference in perioperative complications between the surgery centers that used 3 versus 2 intraoperative nurses during wide-awake local anesthesia hand surgery. This study supports that limiting the nursing personnel for wide-awake local anesthesia hand surgeries could be an efficient way to cut procedural costs without compromising patient safety. Type of study/level of evidence: Therapeutic IV.

Reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos en dos hospitales de Guinea Bissau

RESUMEN Introducción: la seguridad durante los procedimientos médicos o quirúrgicos se ve amenazada por la anafilaxia. Objetivo: evaluar el cuadro clínico, método de estudio y eventual resultado de la reexposición en pacientes con reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en 11 pacientes con diagnóstico de anafilaxia en el curso de una intervención quirúrgica o proceder médico, en los hospitales Militar Principal y Nacional Simão Méndes, de Guinea Bissau, entre 2018 y 2020. Se evaluaron las variables: edad, sexo, procedimiento, método anestésico, antecedentes alérgicos, gravedad de la anafilaxia y agente causal. Resultados: de los 11 pacientes estudiados, 10 tuvieron reacciones en procedimientos quirúrgicos. La media de edad fue de 46,09 años, con una relación por sexo de 0,57 casos masculinos por cada caso femenino. Cinco pacientes (45,45 %) desarrollaron el grado máximo de severidad de la anafilaxia. Los agentes anestésicos fueron la causa de la anafilaxia en dos de los cuatro pacientes sometidos al método de anestesia general y en dos de los cinco sometidos al método de anestesia regional. Por su parte, el látex resultó ser el agente causal en el 45,45 % de los pacientes. Conclusiones: la apropiada identificación de las reacciones anafilácticas durante su aparición, constituye la piedra angular de la actuación médica. En cualquier caso, conllevará estudios alergoanestésicos posteriores que definan el agente causal.

ABSTRACT Introduction: safety during medical or surgical procedures is threatened by anaphylaxis. Objective: to evaluate the clinical characteristics, study method and eventual outcome of re-exposure in patients with anaphylactic and allergic reactions during medical or surgical procedures. Materials and methods: a quantitative, observational and descriptive study was carried out in 11 patients with a diagnosis of anaphylaxis in the course of a surgical intervention or medical procedure, in the Main Military Hospital and the National Hospital Simão Méndes, of Guinea Bissau between 2018 and 2020. The evaluated variables were: age, sex, procedure, anesthetic method, allergic history, severity of anaphylaxis and causal agent. Results: of the 11 patients studied, 10 had reactions in surgical procedures. The mean age was 46.09 years with a sex ratio of 0.57 male cases for each female case. Five patients (45.45 %) developed the maximum degree of anaphylaxis severity. Anesthetic agents were the cause of anaphylaxis in two of the four patients who underwent the general anesthesia method, and in two of the five who underwent the regional anesthesia method. Latex was found to be the causal agent in 45.45 % of the patients. Conclusions: the proper identification of anaphylactic reactions during their appearance is the cornerstone of medical action. In any case, subsequent allergo-anesthetic studies would be needed to define the causative agent.

Incidencia de complicaciones intra y posoperatorias en pacientes geriátricos durante la cirugía abdominal mayor electiva / Incidence of intraoperative and postoperative complications in geriatric patients during major elective abdominal surgery

Introducción: El aumento de la expectativa de vida determina un incremento en la incidencia de enfermedades con indicación quirúrgica. El avance en las técnicas quirúrgicas, los cuidados intensivos y el conocimiento más profundo del proceso de envejecimiento tiende a favorecer la disminución de la morbimortalidad perioperatoria del paciente geriátrico. Objetivo: Determinar la incidencia de complicaciones intra y posoperatorias en pacientes geriátricos durante la cirugía abdominal mayor electiva. Métodos: Se realizó un estudio observacional descriptivo, de corte transversal a 373 pacientes geriátricos programados para intervención quirúrgica abdominal mayor desde enero de 2017 hasta diciembre de 2019 en el Hospital Clínico Quirúrgico Dr. Miguel Enríquez. Se registró la incidencia de complicaciones perioperatorias relacionándolas con las variables de estudio. Resultados: Las complicaciones más frecuentes fueron las cardiovasculares. La mortalidad fue escasa. Conclusiones: Las complicaciones perioperatorias detectadas en los pacientes geriátricos estudiados, se relacionan con las enfermedades previas, el tipo y la envergadura de la cirugía y con el tiempo quirúrgico(AU)

Introduction: The increase in life expectancy determines an increase in the incidence of diseases with surgical indication. Advances in surgical techniques, intensive care and deeper understanding of the aging process tend to favor the reduction of perioperative morbidity and mortality among geriatric patients. Objective: To determine the incidence of intraoperative and postoperative complications among geriatric patients during elective major abdominal surgery. Methods: A descriptive, cross-sectional and observational study was carried out with 373 geriatric patients scheduled for major abdominal surgery from January 2017 to December 2019 at Dr. Miguel Enríquez Clinical-Surgical Hospital. The incidence of perioperative complications was recorded, relating them to the study variables. Results: The most frequent complications were the cardiovascular ones. Mortality was low. Conclusions: The perioperative complications identified among the geriatric patients studied are related with previous diseases, with the type and extent of surgery, and with the surgical time(AU)

Transient acute kidney injury after cardiac surgery does not independently affect postoperative outcomes.

BACKGROUND: The objective of this study was to assess the incidence of in-hospital acute kidney injury (AKI) after cardiac surgery by comparing preoperative baseline renal function with renal function during the postoperative period and at discharge, and to relate these indices with in-hospital postoperative outcomes. METHODS: A retrospective analysis was performed over a 4-year period from a series of 426 adult patients. Kidney function was based on serum creatinine (SCr), Cockroft-Gault estimated creatinine clearance (eCrCl), and glomerular filtration rate estimated with the Modification of Diet in Renal Disease formula (eGFR). Baseline values were compared with "peak" values of altered kidney function postoperatively, and "discharge" values. In-hospital mortality and complication rates were compared between patients with transient and persistent AKI, and those without postoperative AKI. RESULTS: After surgery, AKI (Risk-Injury-Failure-Loss-Endstage [RIFLE] classes Injury and Failure) was diagnosed in 14.6-17.5% of patients based on peak values. AKI diagnosis was reduced to 3.6-4.5% when SCr, eCrCl, and eGFR were measured at discharge. In-hospital mortality of patients with transient AKI was 4% versus 26% in patients with AKI at discharge (odds ratio = 0.11, 95% confidence interval 0.02-0.62, P = 0.011). CONCLUSIONS: A diagnosis of AKI based on measurements of eGFR during the postoperative period was nearly four times more frequent than the same diagnosis at discharge. Transient AKI was the predominate presentation of postoperative kidney dysfunction in this study. Transient AKI did not affect in-hospital outcomes compared with patients without AKI. Patients with persistent AKI at discharge had the highest mortality.

Predictors of major complications after elective abdominal surgery in cancer patients.

BACKGROUND: Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. METHODS: We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events. RESULTS: Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01-1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33-5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21-4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03-4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98-1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00-4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55-27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75-0.84, p < 0.001). CONCLUSIONS: Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.

Evaluación de la técnica de Biopsia de Ganglio Centinela Axilar a través de la incisión mamaria en la cirugía conservadora / Evaluation of Sentinel Lymph Node Axilar Biopsy through the mammary incision in conservative surgery

Introducción El abordaje del ganglio centinela por incisión mamaria única permite acceder al ganglio evitando la realización de incisión axilar, lo que disminuiría el linfedema, el dolor y las disestesias y mejoraría el resultado estético. Objetivos Describir el abordaje quirúrgico del ganglio centinela a través de la incisión mamaria utilizada para la tumorectomía del carcinoma mamario. Material y método Entre septiembre de 2013 y agosto de 2015, se evaluaron 83 pacientes consecutivas con axila clínicamente negativa, que fueron sometidas a cirugía conservadora más biopsia de ganglio centinela, un grupo mediante abordaje clásico (incisión axilar) y otro por la incisión mamaria. Se estudió: edad; tamaño tumoral y ubicación; tipo histológico; técnica de identificación del ganglio centinela; número de ganglios resecados; ganglios centinelas positivos; y complicaciones perioperatorias. Resultados La detección del ganglio centinela por una única incisión se logró en todas las pacientes (100% de éxito). La realización de una única incisión presentó menores complicaciones en comparación con las pacientes a las que se les realizó diferentes incisiones; además, se encontraron mejores resultados estéticos. Conclusiones El abordaje del ganglio centinela mediante la misma incisión de la cirugía mamaria conservadora presenta una excelente tasa de detección, ofreciendo menos complicaciones y mejores resultados estéticos.

Introduction The sentinel node approach through a single breast incision allows its detection avoiding axillary incision, which could reduce complications and improve aesthetic result. Objectives The aim of this work was to describe the surgical approach of sentinel node via the single incision used for conservative surgery for breast carcinoma. Materials and method Patients (n=83) with clinically negative axilla, who went through conservative surgery and axillary sentinel node biopsy using classical approach (axillary incision) and single breast incision, in early-stage breast cancer, were studied. Clinical, anatomical and pathological variables and perioperative complications were considered. Results Our results showed that the method of detection of sentinel node by a single breast incision was successful in 100 % of the cases. The performance of a single incision presented minor complications compared to patients who underwent different incisions; also better aesthetic results were also found. Conclusions The surgical approach of the sentinel node through the single incision of breast conserving surgery presents an excellent detection rate, fewer complications and better aesthetic results.

Cistectomía radical por cáncer vesical en un hospital docente-asistencial: análisis de resultados perioperatorios / Radical cystectomy for bladder cancer in a state teaching hospital: analysis of perioperative outcomes

Introduction: A number of patients have been studied after undergoing Radical Cystectomy (RC) for bladder cancer, to review prognostic factors and analyze perioperative outcomes. A contemporary benchmark was established for future comparisons. Material and Methods: Retrospective study of 46 patients that underwent RC for bladder cancer between July 2003 and September 2012, assessing demographic characteristics, comorbidities, anesthetic risk and clinical status, interval between transurethral resection (TUR) and cystectomy, operative times, bleeding and transfusions, surgical technique, nutritional management, pathologic findings, hospital stay and complications. Complications were detailed by type and frequency and classified as early (within 30 days) or late. In addition, we used the Clavien-Dindo classification for reporting postoperative complications. Mortality rates at 30, 60 and 90 days after cystectomy were estimated. Results: Average patient age was 70 years (49-88) and mean ASA classification was 2.7. The average between TUR and cystectomy was 68.2 days (median = 57.5 days). Mean operative time for cutaneous ureterostomy was 194 minutes, 320 for ileal conduit and 342 for neobladder. 60.8 percent had pathological stage major than pT2 and 41 percent had nodal involvement. There were 19.5 percent of positive margins. The 23.9 percent had Clavien-Dindo postoperative complications grade 3 or 4. The 90-day global mortality was 17.3 percent. Conclusions: CR was associated with a high morbidity and mortality, which seems to be explained by an advanced stage of the disease and the high presence of poor prognostic factors.

Objetivos: Estudiamos una serie de pacientes sometidos a cistectomía radical (CR) por cáncer vesical para examinar factores pronósticos y analizar los resultados perioperatorios, estableciendo así un punto de referencia para futuras evaluaciones. Material y Método: Estudio retrospectivo de 46 pacientes sometidos a CR por cáncer vesical entre julio de 2003 y septiembre de 2012, evaluando características demográficas, comorbilidades, riesgo anestésico y condición clínica, lapso entre la resección transuretral (RTU) y la cistectomía, tiempos operatorios, sangrado y transfusiones, técnica quirúrgica utilizada, manejo nutricional, resultados anatomopatológicos, estada hospitalaria y complicaciones. Estas últimas fueron detalladas según tipo y frecuencia y catalogadas como precoces (durante los primeros 30 días) o tardías. Además, se utilizó la clasificación de Clavien-Dindo para reportar las complicaciones postoperatorias. Se estimaron las tasas de mortalidad a 30, 60 y 90 días post cistectomía. Resultados: El promedio de edad fue 70 años (49-88) y la media de la clasificación ASA fue 2,7. El promedio entre la RTU y la cistectomía fue 68,2 días. Los tiempos operatorios promedio fueron de 194 min la ureterostomía cutánea, 320 el conducto ileal y 342 la neovejiga. Un 60,8 por ciento tenía un pT > 2 y un 41 por ciento compromiso ganglionar. Hubo 19,5 por ciento de márgenes positivos. Un 23,9 por ciento tuvo complicaciones grado 3 ó 4 según Clavien-Dindo. La mortalidad global a 90 días fue 17,3 por ciento. Conclusiones: la CR se asoció a una elevada morbimortalidad, lo que parece explicarse por un estado avanzado de la enfermedad y por la alta presencia de factores de mal pronóstico.

Anestesia en la neurofibromatosis tipo 1. A propósito de un caso / Anesthesia in case of type 1 neurofibromatosis

Introducción: La neurofibromatosis tipo 1 o neurofibromatosis de Von Recklinghausen es el trastorno neurocutáneo más frecuente, presentándose aproximadamente en 1 de cada 3000 personas. Es un síndrome genético que se transmite de manera autosómica dominante. Los criterios para el diagnóstico clínico se establecieron desde 1988, a partir de dos o más manchas color café con leche de más de cinco milímetros de diámetro en individuos pospuberales; dos o más neurofibromas de cualquier tipo o un neurofibromas plexiforme; pecas axilares o en región inguinal; glioma óptico; dos o más nódulos de Lisch; lesiones óseas tales como displasia de esfenoides o afinamiento de la corteza de los huesos largos, con o sin pseudoartrosis; así como un familiar de primer grado de consanguinidad con el diagnóstico de neurofibromatosis tipo 1. Objetivo Presentar la conducta perioperatoria de los pacientes portadores de neurofibromatosis tipo 1. Caso clínico IRA masculino, blanco de 71 años con antecedentes patológicos de neurofibromatosis tipo 1 diagnosticada desde los 15 años, insuficiencia cardíaca izquierda, hipertensión arterial y fibrilación auricular crónica con respuesta ventricular normal. Se diagnostica neurofibroma lumbar, se realizó exéresis total de la lesión. Conclusiones: resulta un desafío para el anestesiólogo la conducción peri anestésica del paciente con enfermedad de Von Recklinghausen.

Introduction: The type 1 neurofibromatosis or Von Recklinghausen's neurofibromatosis is the more frequent neurocutaneous disorder, present in approximately 1 of each 3000 persons. It is a genetic syndrome with an autosomal dominant way of transmission. Criteria for the clinical diagnosis were made in 1988, from two or more spots of white coffee color larger than 5 millimeters diameter in postpubertal subjects, two or more neurofibroma of any type or a plexiform neurofibroma, axillary freckles or in the inguinal region, optical glioma; two or more Lisch's nodules, bone lesions such as sphenoid dysplasia or a thin cortex of large bones with or without pseudoarthrosis, as well as a first grade relative blood relation diagnosed with type 1 neurofibromatosis. Objective: To present the operative behavior of patients presenting with type 1 neurofibromatosis. Clinical case: IRA white male patient aged 71 with a pathologic history of type 1 neurofibromatosis diagnosed from 15 years old with a left heart insufficiency, high blood pressure and chronic auricular fibrillation with a normal ventricular response. Diagnosis of lumbar neurofibroma was made carrying out a total exeresis of the lesion. Conclusions: The peri-anesthetic conduction of patient diagnosed with Von Recklinghausen's disease is a challenge for the anesthesiologist.

Complicaciones cardiovasculares perioperatorias en pacientes portadores de síndrome metabólico / Perioperative cardiovascular complications present in patients carriers of metabolic syndrome

Introducción: Se realizó un estudio de cohorte prospectivo, con el objetivo de evaluar la influencia del síndrome metabólico en la aparición de complicaciones cardiovasculares perioperatorias. Objetivos: identificar como contribuyó el síndrome metabólico al incremento de la incidencia de complicaciones cardiovasculares perioperatorias en pacientes quirúrgicos. Método: La selección de la muestra se realizó de forma sistemática en el HMC Dr. Luis Díaz Soto y se conformaron: 1 grupo de 38 pacientes compuesto por individuos portadores de síndrome metabólico y otro de 42 pacientes no portadores de esta enfermedad. Ambos grupos se sometieron a cirugía abdominal con anestesia general endotraqueal. Las principales variables analizadas fueron: tensión arterial sistólica, media y diastólica, frecuencia cardíaca y el trazado electro cardiográfico. Resultados: La hipertensión arterial sistodiastólica, y los trastornos del ritmo cardiaco, en particular las contracciones prematuras supraventriculares y ventriculares fueron las alteraciones detectadas con mayor frecuencia en los pacientes con síndrome metabólico, mostrándose diferencias significativas (p< 0,05) entre los dos grupos. Conclusiones: El síndrome metabólico predispone a la aparición de complicaciones cardiovasculares perioperatorias, además de estar presente de manera frecuente, en pacientes quirúrgicos tributarios de intervención anestesiológica.

Introduction: A prospective cohort study was conducted to assess the influence of metabolic syndrome on appearance of perioperative cardiovascular complications. Aims: To identify how the metabolic syndrome contributed to increase of above mentioned complications in surgical patients. Method: Sample selection was carried out in a systemic way in the "Dr. Luís Díaz Soto" Central Military Hospital including three groups: Group I (38 patients) composed of subjects carriers of metabolic syndrome and another one (42 patients) composed of non-carriers of this condition. Both groups underwent abdominal surgery placed under endothracheal general anesthesia. Main analyzed variables were: systolic, mean and diastolic arterial tension and cardiac rhythm disorders, heart rate and electrocardiographic tracing. Results: Systolic-diastolic arterial hypertension and the cardiac rhythm disorders particularly, the supraventricular early contractions were the more frequent disturbances present in patients presenting with metabolic syndrome with significant differences (p < 0,05) between both groups. Conclusions: Metabolic syndrome predisposes to appearance of perioperative cardiovascular complications as well as being frequently present in surgical patients requiring anesthesia intervention.