RESUMEN
Neonates with Treacher Collins syndrome can present difficult airways. Ventilation through a face mask and laryngoscopy for tracheal intubation may prove impossible due to the craniofacial malformations that are characteristic of this syndrome. Furthermore, patients with this syndrome are at high risk of airway obstruction, meaning that awake fiberoptic endoscopy provides the best option for tracheal intubation. This technique is especially difficult in children, however, and material required for performing it in neonates is not always available. We report the case of a 5-day-old infant boy with Treacher Collins syndrome and bilateral choanal atresia in whom we used a flexible metal guide inserted into the working channel of a fiberoptic scope. The tracheal tube could then be inserted.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Atresia de las Coanas/complicaciones , Endoscopios , Tecnología de Fibra Óptica/instrumentación , Intubación Intratraqueal/métodos , Disostosis Mandibulofacial/complicaciones , Cateterismo , Atresia de las Coanas/cirugía , Diseño de Equipo , Humanos , Recién Nacido , Masculino , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugía , Insuficiencia Respiratoria/etiologíaRESUMEN
We describe a series of 16 cases in which recombinant activated factor VII (rFVIIa) was used in our postanesthetic recovery unit. The mean age of the patients was 53.5 years (range, 30-84 years). Eleven were men and 5 women. The mean dose of rFVIIa used was 75 microg x kg(-1) (range, 60-90 microg x kg(-1)) and 25% of the patients needed a second dose. All the patients had postoperative bleeding, 62.5% after general surgery, 25% after a liver transplant, and 12.5% after a lung transplant. rFVIIa therapy was effective in 66% of the patients and no adverse thrombotic events related to treatment were observed. rFVIIa can be an efficacious therapeutic option for bleeding and coagulation disorders that are refractory to conventional replacement therapy. Approval to use rFVIIa in this setting and the establishment of indications should be based on further research.
Asunto(s)
Factor VII/uso terapéutico , Hemorragia Posoperatoria/tratamiento farmacológico , Sala de Recuperación , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Evaluación de Medicamentos , Factor VII/administración & dosificación , Factor VII/efectos adversos , Factor VIIa , Femenino , Trastornos Hemorrágicos/tratamiento farmacológico , Trastornos Hemorrágicos/etiología , Humanos , Trasplante de Hígado , Trasplante de Pulmón , Masculino , Persona de Mediana Edad , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos , Trombofilia/inducido químicamente , Resultado del TratamientoRESUMEN
A 35-year-old woman was scheduled for laparoscopic removal of an ovarian tumor. Intravenous metamizol was administered and when pneumoperitoneum was performed she developed severe hypotension and bronchospasm. Anaphylactic reaction was suspected, all drugs were suspended, and 2 doses of intravenous adrenalin (0.2 and 1 mg) were injected followed by continuous perfusion. Because response was slow and given the unknown origin of the tumor, the possibility of a carcinoid crisis was considered. When an intravenous bolus dose of octreotide was administered, pressure recovered, patient was extubated and could be transferred asymptomatic to the recovery ward. Tests later ruled out carcinoid syndrome, whereas tryptase levels in blood extracted during surgery and allergy tests confirmed an anaphylactic reaction to metamizol. Carcinoid crisis can be difficult to distinguish from anaphylactic reaction because the clinical pictures are similar. Anesthetic management of carcinoid crisis has been facilitated by administration of octreotide. Less is known about the use of octreotide to treat hypotension in patients with autonomic neuropathy based mainly on the drug's ability to produce splanchnic vasoconstriction. This is probably the reason why octreotide resolved our patient's shock in a context of systemic vasodilation caused by the anaphylactic reaction.