Manejo anestésico en síndrome corazón izquierdo hipoplásico: Reporte de un caso / Anesthetic management in hypoplastic left heart syndrome: A case report

Introducción: El síndrome corazón izquierdo hipoplásico puede presentarse con signos clínicos inmediato al nacimiento, siendo responsable de las muertes neonatales en la primera semana de vida. El reconocimiento clínico y los hallazgos ecocardiográficos son claves para un diagnóstico y tratamiento oportuno. Reporte de caso: describe el manejo anestésico de un neonato con inestabilidad hemodinámica que requirió cirugía de emergencia con banding pulmonar bilateral para mantener el equilibrio entre la relación del flujo sanguíneo pulmonar y sistémico cercano a la unidad, junto a maniobras de ventilación mecánica, medicamentos anestésicos, inotrópicos y adyuvantes con el objetivo de manipular las resistencias vasculares y el flujo sanguíneo logrando estabilidad hemodinámica del paciente que permitió al quinto día ser sometido a una cirugía electiva de Norwood Sano, tolerando procedimiento con extubación a los 15 días de la cirugía. Conclusión: el momento oportuno de la indicación quirúrgica aumenta la sobrevida de los pacientes síndrome corazón izquierdo hipoplásico.

Background: Hypoplastic left heart syndrome may appear with clinical signs immediately at birth, being responsible for neonatal deaths within the first week of life. Clinical recognition and echocardiographic findings are key to timely diagnosis and treatment. Case report: describes the anesthetic procedure of a neonate with hemodynamic instability who required emergency surgery for bilateral pulmonary banding to maintain the balance between pulmonary and near-unit systemic flow ratio, along with mechanical ventilation maneuvers, anesthetic, inotropic and adjuvant drugs to control vascular resistance and blood flow, thus achieving hemodynamic stability of the patient, which allowed him to undergo an elective Norwood Sano procedure on the fifth day, and which was tolerated with extubation 15 days after surgery. Conclusion: The right timing of the surgical indication increases the survival of patients with hypoplastic left heart syndrome.

Endoscopic type 1 tympanoplasty; a composite graft technique for subtotal and total perforations.

OBJECTIVE: Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques. METHODS: We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6 months. The main outcome measures were membrane closure rates and hearing results. RESULTS: 73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air-bone gap of 10db (+ - 10 dB). CONCLUSION: Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.

Fibrilación Auricular que requirió Cardioversión en la Unidad de Recuperación Post Anestésica en Cirugía Ambulatoria. Un reporte de caso / Atrial Fibrillation that required Cardioversion in the Post Anesthetic Recovery Unit in Ambulatory Surgery. A case report

Durante los últimos años, ha cambiado el perfil de los pacientes que pueden someterse a procedimientos de cirugía ambulatoria, en centros quirúrgicos ambulatorios independientes. Es muy importante considerar la disponibilidad, competencias, flujos de atención del personal asistencial, asimismo el estudio integral del paciente, la capacidad resolutiva de dichos centros y las evaluaciones con los indicadores de calidad de atención, para obtener así resultados óptimos. El presente caso fue de un paciente de sexo masculino, de 34 años de edad quien presentó por primera vez fibrilación auricular rápida y sintomática, documentada en el postoperatorio inmediato. Se describe la atención, la estrategia diagnóstica y el tratamiento, ya que requirió cardioversión eléctrica.

In recent years, the profile of patients who can undergo ambulatory surgery procedures in independent ambulatory surgical centers has changed. It is very important to consider the availability, skills and experience of the care staff, as well as the integral study of the patient, the resolution capacity of these centers and evaluations with quality care indicators to obtain optimal results. The present case was of a 34-year-old male, first presentation of rapid and symptomatic atrial fibrillation documented in the immediate postoperative period. Patient care, diagnostic strategy and treatment were described, since the patient required electrical cardioversion.

Neurofibromatosis gastrointestinal: una causa poco frecuente de cirugía abdominal / Gastrointestinal neurofibromatosis: an infrequent cause of abdominal surgery

Objetivo: reportar dos casos de neurofibromatosis gastrointestinal que requirieron tratamiento quirúrgico para su resolución. Antecedentes: la neurofibromatosis es una enfermedad congénita que se divide en dos tipos. En la neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen el paciente presenta algunas manifestaciones clásicas de la enfermedad como lesiones dérmicas café con leche, alteraciones óseas y neurofibromas de nervios periféricos y centrales. Hasta 25 por ciento de los pacientes con neurofibromatosis tipo 1 presenta afección gastrointestinal, y los órganos más frecuentemente involucrados son el estómago y el yeyuno. La sintomatología principal de los pacientes con neurofibromatosis gastrointestinal es oclusión intestinal o hemorragia. Método: dos pacientes con neurofibromatosis gastrointestinal que ameritaron manejo quirúrgico para su resolución. Resultados: dos casos de neurofibromatosis gastrointestinal, un paciente tuvo como manifestación clínica hemorragia de tubo digestivo y el segundo paciente oclusión intestinal. Se les realizó laparotomía exploradora teniendo como hallazgos neurofibromatosis gastrointestinal como causa de sus síntomas. Conclusiones: el manejo de la neurofibromatosis gastrointestinal puede requerir tratamiento quirúrgico, y cuando esto se realiza generalmente la recuperación posoperatoria es satisfactoria.

[Gastrointestinal neurofibromatosis. A rare cause of abdominal surgery]. / Neurofibromatosis gastrointestinal. Una causa poco frecuente de cirugía abdominal.

OBJECTIVE: Report two cases of gastrointestinal neurofibromatosis that required surgical intervention for their resolution. BACKGROUND: Neurofibromatosis is a congenital disease which is classified in two types. In neurofibromatosis type 1 or Von Recklinghausen's disease the patients have some classical manifestations as cafe au lait pigmentation, bony abnormalities and neurofibromas of both peripheral and central nerves. In up to 25% of the patients with neurofibromatosis 1, the gastrointestinal tract is involved. The most affected organs are the stomach and the jejunum. The symptoms of the patients with gastrointestinal neurofibromatosis are related to gastrointestinal bleeding or obstruction. METHOD: Two patients with gastrointestinal neurofibromatosis that required surgical intervention for the resolution of their manifestations. RESULTS: Two cases of gastrointestinal neurofibromatosis, one of them had as her main clinical feature gastrointestinal bleeding, and the other patient intestinal obstruction. They were submitted to exploratory laparotomy finding gastrointestinal neurofibromatosis in both as the cause of their symptomatology. CONCLUSIONS: The management of gastrointestinal neurofibromatosis could need surgical intervention, and when this is done the postoperative evolution is satisfactory.