RESUMEN
El neumotórax espontáneo en el embarazo es una causa extremadamente rara de disnea con menos de 100 casos reportados en la literatura. Una nulípara de 28 años con 39+4 semanas de gestación, acudió al Servicio de Urgencias por disnea intensa y dolor torácico pleurítico. La radiografía de tórax reveló un gran neumotórax izquierdo, con el pulmón colapsado. Se colocó un drenaje torácico y la reexpansión pulmonar fue incompleta. Por sospecha de macrosomía fetal, se realizó una cesárea bajo anestesia epidural. El posparto transcurrió sin incidentes. Aunque sea una condición muy rara, el neumotórax espontáneo debe descartarse en todas las mujeres embarazadas que presenten una disnea súbita y dolor torácico. Un elevado índice de sospecha es imprescindible para un abordaje oportuno de esta patología, evitando así complicaciones materno-fetales. Para un correcto diagnóstico y tratamiento, se requieren recomendaciones más sólidas y un enfoque multidisciplinario.(AU)
Spontaneous pneumothorax in pregnancy is an extremely rare cause of dyspnea with less than 100 cases reported in the literature. A 28-year-old primigravida at 39+4 weeks of gestation presented to the emergency department with sudden onset of dyspnea and pleuritic chest pain. A chest radiograph revealed a large, left-sided pneumothorax with a collapsed lung. A chest tube was placed with incomplete re-expansion of the lung. A cesarean section under epidural anesthesia was performed for suspected macrosomia. The postpartum was uneventful. Despite its rarity, spontaneous pneumothorax should be excluded in every pregnant woman presenting with sudden onset of dyspnea and chest pain. A heightened index of suspicion is essential for prompt management of this condition, avoiding adverse fetal and maternal outcomes. For a correct diagnosis and management, more solid recommendations and a multidisciplinary approach are needed.(AU)
Asunto(s)
Humanos , Femenino , Adulto , Embarazo , Neumotórax , Disnea , Pacientes Internos , Examen Físico , Evaluación de Síntomas , Dolor en el Pecho , Servicio de Urgencia en Hospital , Diagnóstico , Resultado del Tratamiento , Anestesiología , Anestesia , Reanimación Cardiopulmonar , Mujeres EmbarazadasRESUMEN
Spontaneous pneumothorax in pregnancy is an extremely rare cause of dyspnea with less than 100 cases reported in the literature. A 28-year-old primigravida at 39+4 weeks of gestation presented to the emergency department with sudden onset of dyspnea and pleuritic chest pain. A chest radiograph revealed a large, left-sided pneumothorax with a collapsed lung. A chest tube was placed with incomplete re-expansion of the lung. A cesarean section under epidural anesthesia was performed for suspected macrosomia. The postpartum was uneventful. Despite its rarity, spontaneous pneumothorax should be excluded in every pregnant woman presenting with sudden onset of dyspnea and chest pain. A heightened index of suspicion is essential for prompt management of this condition, avoiding adverse fetal and maternal outcomes. For a correct diagnosis and management, more solid recommendations and a multidisciplinary approach are needed.
Asunto(s)
Neumotórax , Complicaciones del Embarazo , Atelectasia Pulmonar , Adulto , Cesárea/efectos adversos , Dolor en el Pecho/etiología , Disnea/etiología , Femenino , Humanos , Neumotórax/etiología , Embarazo , Atelectasia Pulmonar/complicacionesRESUMEN
El bloqueo en el plano del músculo erector del espinal ha sido recientemente descrito, y parece ser una técnica de analgesia regional muy prometedora. Reportamos el primer bloqueo continuo en el plano del músculo erector del espinal realizado en un paciente pediátrico sometido a cirugía torácica. Se trata de un niño de 15 meses con un teratoma paracardiaco programado para resección tumoral por toracotomía. Después de la inducción de anestesia general se practicó un bloqueo continuo en el plano del músculo erector del espinal a nivel de T5 con ropivacaína 0,2%. Tras la cirugía se inició una perfusión torácica interfascia de ropivacaína 0,1% y analgesia multimodal. El paciente toleró bien el procedimiento sin complicaciones. Parece que esta es una buena alternativa a la epidural torácica y el bloqueo paravertebral, dada la simple reproducibilidad y la mayor seguridad potencial de esta técnica
Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery. A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0.1% along with multimodal rescue analgesia was initiated. The patient tolerated the procedure well with no complications. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique
Asunto(s)
Humanos , Masculino , Lactante , Bloqueo Nervioso/métodos , Nervios Espinales , Anestesia de Conducción/métodos , Teratoma/cirugía , Neoplasias Cardíacas/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Toracotomía/métodos , Resultado del TratamientoRESUMEN
Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery. A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0.1% along with multimodal rescue analgesia was initiated. The patient tolerated the procedure well with no complications. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique.