Complicaciones relacionadas al manejo anestésico de pacientes pediátricos con osteogénesis imperfecta sometidos a procedimientos ortopédicos / Complications related to the anesthetic management of pediatric patients with osteogenesis imperfecta undergoing orthopedic procedures

Resumen: Introducción: la osteogénesis imperfecta es un trastorno sistémico del tejido conectivo, se caracteriza por una densidad ósea menor y variabilidad de la fragilidad ósea. Material y métodos: se realizó un estudio retrospectivo, observacional, descriptivo de casos consecutivos, cuyo objetivo principal fue determinar las complicaciones relacionadas al procedimiento anestésico en pacientes pediátricos con diagnóstico de osteogénesis imperfecta sometidos a procedimientos ortopédicos en el Hospital Infantil de México «Federico Gómez¼ mediante la revisión de expedientes clínicos. Se incluyeron pacientes con diagnóstico de osteogénesis imperfecta, menores de 18 años, sometidos a cirugía ortopédica electiva. Se utilizaron medidas de tendencia central y dispersión así como pruebas de hipótesis diversas. Resultados: se incluyeron 86 registros anestésicos. La mayoría del tipo III de osteogénesis imperfecta. La anestesia general balanceada fue la técnica más frecuente con intubación orotraqueal. De las complicaciones reportadas hubo intubación difícil en dos casos (2.3%). En seis casos (6.9%) se consideró ventilación difícil. Otra de las complicaciones reportadas fue el sangrado, encontrando un sangrado mayor al previsto en 33 casos (38.4%). Conclusiones: la anestesia requerida en los pacientes con osteogénesis imperfecta se llevó a cabo con un mínimo de complicaciones.

Abstract: Introduction: osteogenesis imperfecta is a systemic disorder of connective tissue, characterized by decreased bone density and variability of bone fragility. Material and methods: a retrospective, observational, descriptive study of consecutive cases was carried out, whose main objective was to determine the complications related to the anesthetic procedure in pediatric patients with a diagnosis of osteogenesis imperfecta undergoing orthopedic procedures at the «Federico Gómez¼ Children's Hospital of Mexico, through the review of clinical records. Patients diagnosed with osteogenesis imperfecta, under 18 years of age, undergoing elective orthopedic surgery, were included. Measures of central tendency and dispersion were used, as well as tests of various hypotheses. Results: 86 anesthetic records were included. Most of the type III of osteogenesis imperfecta. Balanced general anesthesia was the most frequent technique with orotracheal intubation. Of the reported complications, difficult intubation was found in two cases (2.3%). In six cases (6.9%) ventilation was considered difficult. Another of the complications reported was bleeding, finding bleeding greater than expected in 33 cases (38.4%). Conclusions: the anesthesia required in patients with osteogenesis imperfecta was carried out with a minimum of complications.

Complications of bronchial thermoplasty using laryngeal mask: case series / Complicaciones de la termoplastia bronquial usando máscara laríngea: serie de casos

Abstract Severe asthma affects more than 250 million people and represents high healthcare costs. Bronchial thermoplasty is a relatively new technique in interventional pulmonology for managing this condition. The procedure is done under general anesthesia and the patients are mostly ASA II and III; therefore, the anesthesia plan must be safe. The purpose of the article is to describe the anesthetic technique used (general anesthesia and laryngeal mask) and the immediate and early complications of the procedure. Four patients were included, each undergoing three sessions. The complications during and immediately after the procedure, as well as the early complications (up to seven days post-procedure) that could have required hospital management were discussed. In three of the sessions at least one acute bronchospasm event presented, but only one patient required hospital admission for more than 24 hours. Experience suggests that thermoplasty may be safely conducted under general anesthesia and laryngeal mask.

Resumen El asma grave afecta a más de 250 millones de personas y genera altos costos en el sistema de salud. La termoplastia bronquial es una técnica relativamente novedosa de la neumología intervencionista para el manejo de esta condición. Este procedimiento se realiza bajo anestesia general, y los pacientes son en su mayoría ASA II y III, por lo que el plan anestésico debe ser seguro. El objetivo del artículo es describir la técnica anestésica utilizada (anestesia general y máscara laríngea) y las complicaciones inmediatas y tempranas del procedimiento. Se incluyeron cuatro pacientes, cada uno de los cuales fue sometido a tres sesiones. Se describieron las complicaciones durante e inmediatamente después del procedimiento y las complicaciones tempranas (hasta siete días posprocedimiento), que hubieran requerido manejo hospitalario. En tres de las sesiones se presentó al menos un evento agudo de broncoespasmo y solo un paciente requirió hospitalización mayor a 24 horas. La experiencia sugiere que la termoplastia puede ser llevada a cabo de manera segura bajo anestesia general y mascara laríngea.

Anesthetic complications in children with mucopolysaccharidosis / Complicaciones anestésicas en niños con mucopolisacaridosis

Abstract: Introduction: A high percentage of mucopolysaccharidosis patients require surgery at some point. Common features like respiratory limitations and cardiovascular disease pose a high anesthetic risk. We describe the prevalence of anesthetic complications in our institution. Material and methods: Patients' medical history and reported surgery data from 18 eligible records were reviewed from a total of 29 mucopolysaccharidosis diagnosed children registered between the years 1999 to 2019 at a hospital in Mexico. Results: Median age was 11 years. 12 patients were type I, two type II, three type IV, and one type VI. Intravenous premedication was administered in 69.5% and induction was intravenous in 91.3% of the surgical procedures. Orotracheal intubation was the first attempted anesthetic method in 47.8% and a laryngeal mask in another 47.8%. Bronchospasm was the most frequent complication in 17.4% followed by difficult intubation in 13.1%. Conclusions: Bronchospasm was the most prevalent complication. A higher Cormack-Lehane grade was primarily related. The most prevalent concomitant risk factors were short neck and restrictive chest rendering airway management difficult in comparison to the general population.

Resumen: Introducción: Un alto porcentaje de pacientes con mucopolisacaridosis requieren cirugía en algún momento. Algunas características comunes como alteraciones respiratorias y enfermedades cardiovasculares constituyen un alto riesgo anestésico. Describimos la prevalencia de las complicaciones anestésicas en nuestra institución. Material y métodos: Fueron revisados los antecedentes y los datos quirúrgicos de 18 pacientes elegibles, extraídos de un total de 29 expedientes de niños con mucopolisacaridosis registrados entre los años 1999 y 2019 en un hospital de México. Resultados: La mediana de edad fue de 11 años. Doce pacientes fueron de tipo I, dos tipo II, tres tipo IV y uno tipo VI. La premedicación intravenosa se administró en 69.5% y la inducción fue intravenosa en 91.3% de los procedimientos quirúrgicos. El primer método anestésico intentado fue la intubación orotraqueal en 47.8% y la máscara laríngea en 47.8%. El broncoespasmo fue la complicación más frecuente en 17.4%, seguida de una intubación difícil en 13.1%. Conclusiones: El broncoespasmo fue la complicación más observada relacionada, primordialmente, con un grado Cormack-Lehane más alto. Los factores de riesgo concomitantes más frecuentes fueron el cuello corto y las restricciones torácicas, lo que dificulta en mayor grado el manejo de las vías respiratorias en comparación con la población general.

Complications associated with three brachial plexus blocking techniques: Systematic review and meta-analysis.

BACKGROUND: Brachial plexus block has become one of the most widely-used anaesthetic techniques in the world for upper limb anaesthesia. There are three different brachial blocks techniques: supraclavicular, infraclavicular and axillary block. However, its execution is not exempt from possible clinical complications, and it is not clear which of these is associated with a lower complication rate and greater anaesthetic success. MATERIALS AND METHODS: Systematic review and meta-analysis following the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify controlled clinical trials reporting the three techniques. The main outcome was the incidence of anaesthetic complications, and the secondary ones were an anaesthetic success, time of performance and anaesthetic latency. RESULTS: 25 controlled clinical trials, with 2012 patient, were included. The methodological quality of the included studies is moderate to high. For the main outcome, the main complication reported was a vascular puncture, followed by transient neurological injury, symptomatic diaphragmatic paralysis and pneumothorax. No differences were found in complications associated with the three anaesthetic techniques. Additionally, no differences were found regarding anaesthetic success. CONCLUSIONS: Anesthetic complications associated with the three brachial block techniques are low, with no medium and long-term sequelae; however, none of the three techniques seems to be superior among them to reduce these complications. All three techniques are highly successful when performed using ultrasound imaging.

Manejo anestésico perioperatorio de glosoplastia reductora en paciente con síndrome de Beckwith-Wiedemann / Perioperative anesthetic management of reductive glossoplasty in a patient with Beckwith-Wiedemann syndrome

Introducción: El síndrome de Beckwith-Wiedemann (SBW) es un trastorno de crecimiento congénito. El manejo perioperatorio puede ser a veces complicado. Sus principales manifestaciones clínicas son macroglosia, que puede causar dificultades en el manejo de la vía aérea, prematuridad, hemihipertrofia, onfalocele, tumores embrionarios y episodios de hipoglucemia neonatal. Objetivo: Nuestro objetivo principal es describir el manejo perioperatorio de pacientes pediátricos con SBW sometidos a glosectomía y sus posibles complicaciones anestésicas. Métodos: Reporte de caso y revisión del tema. Resultados: Describimos el caso de una paciente de 11meses diagnosticada con SBW que se sometió a cirugía reductora de macroglosia. Se realizó una evaluación preoperatoria exhaustiva con la consideración de las posibles complicaciones anestésicas derivadas tanto de la macroglosia como de la prematuridad, y los posibles episodios de hipoglucemia. El procedimiento se realizó bajo anestesia general, siguiendo los algoritmos de intubación difícil de la vía aérea, sin incidencias, y se realizó una extubación segura en el quirófano. Durante el postoperatorio la paciente permaneció estable, presentó buena dinámica respiratoria, SatO2>96% y buen control glucémico, comenzando la dieta oral a las 4h después de la cirugía. Fue dada de alta a planta 24h después de la intervención. Conclusión: El manejo exitoso de pacientes con SBW requiere un enfoque multimodal, con planificación preoperatoria completa y conocimiento sobre posibles complicaciones en relación tanto con las vías respiratorias como con las sistémicas.(AU)

Introduction: Postoperative management of patients with the congenital growth disorder Beckwith-Wiedemann syndrome (BWS) can be complicated. The main clinical manifestations of the syndrome are macroglossia — which may hamper airway management —, prematurity, hemihypertrophy, omphalocele, embryonal tumours and episodes of neonatal hypoglycaemia. Objective: Our main objective is to describe the perioperative management and potential anaesthetic complications in paediatric patients with BWS undergoing glossectomy. Methods: Case report and literature review. Results: We describe the case of an 11-month-old patient diagnosed with BWS who underwent reduction glossoplasty. We performed a comprehensive preoperative evaluation, taking into account potential anaesthetic complications derived from both macroglossia and prematurity, and the risk of hypoglycaemia. The procedure was performed under general anaesthesia. Intubation — performed according to difficult airway management algorithms — was uneventful and the patient was successfully extubated in the operating room. The patient remained stable during the postoperative period, with good respiratory dynamics, SatO2>96% and good glycaemic control. Oral intake was started 4hours after surgery, and she was discharged to the ward at 24hours. Conclusion: BWS patients require a multimodal approach that includes detailed preoperative planning and knowledge of potential airway-related and systemic complications.(AU)

Perioperative anesthetic management of reductive glossoplasty in a patient with Beckwith-Wiedemann syndrome. / Manejo anestésico perioperatorio de glosoplastia reductora en paciente con síndrome de Beckwith-Wiedemann.

INTRODUCTION: Postoperative management of patients with the congenital growth disorder Beckwith-Wiedemann syndrome (BWS) can be complicated. The main clinical manifestations of the syndrome are macroglossia - which may hamper airway management -, prematurity, hemihypertrophy, omphalocele, embryonal tumours and episodes of neonatal hypoglycaemia. OBJECTIVE: Our main objective is to describe the perioperative management and potential anaesthetic complications in paediatric patients with BWS undergoing glossectomy. METHODS: Case report and literature review. RESULTS: We describe the case of an 11-month-old patient diagnosed with BWS who underwent reduction glossoplasty. We performed a comprehensive preoperative evaluation, taking into account potential anaesthetic complications derived from both macroglossia and prematurity, and the risk of hypoglycaemia. The procedure was performed under general anaesthesia. Intubation - performed according to difficult airway management algorithms - was uneventful and the patient was successfully extubated in the operating room. The patient remained stable during the postoperative period, with good respiratory dynamics, SatO2>96% and good glycaemic control. Oral intake was started 4hours after surgery, and she was discharged to the ward at 24hours. CONCLUSION: BWS patients require a multimodal approach that includes detailed preoperative planning and knowledge of potential airway-related and systemic complications.

Spinal Myoclonus: Is It An Anesthetic Mystery? / Mioclonía espinal: ¿un misterio anestésico? ¡Se acepta el reto!

The goal is to present a descriptive study related an unprecedent case of spinal myoclonus (SM) following subarachnoid anesthesia (SA). SM are sudden, brief, involuntary non-generalized spasms that can be an adverse effect of drug administration via neuraxial routes. Female, 67y, ASA II, proposed for hip replacement surgery, with normal preoperative exams. 7min after SA with 10mg of bupivacaine 0,5%, no motor blockade observed, and patient complained of unbearable pain in legs and perineum and bilateral, asymmetrical and arrhythmic myoclonic movements in the lower limbs. The latter solved after 48h of general anesthesia and rocuronium perfusion, amongst other therapeutics. Accordingly, intrathecal bupivacaine appears to be the SM most likely cause, regarding the absence of neurologic and electrolyte disorders, spinal cord direct trauma, drug exchange and normal perioperative examination, imaging and laboratory testing.It is mandatory to always take the patients' anaesthetic histories and recognize, treat and report rare anaesthetic complications.

Cambios fisiológicos y consideraciones anestésicas en cirugía robótica no cardíaca / Physiological changes and anaesthetic considerations in non-cardiac robotic surgery

Resumen: La cirugía robótica ofrece numerosas ventajas sobre la cirugía laparoscópica convencional y la cirugía abierta. El anestesiólogo debe conocer los cambios que suceden en el paciente al ser sometido a cirugía robótica en el campo de la ginecología, urología, cirugía general, torácica y transoral. Los cambios fisiológicos son múltiples e involucran todos los sistemas: cardiovascular, respiratorio, neurológico, digestivo, renal; por lo que es de suma importancia el conocimiento de éstos para evitar complicaciones durante el período perioperatorio. De igual manera, es importante conocer el protocolo de seguridad para el retiro de los brazos del robot al verse con la necesidad de convertir la cirugía a laparoscópica o abierta. Se resumen las principales consideraciones anestésicas así como los cuidados específicos que el anestesiólogo debe tener durante cirugía robótica no cardíaca.

Abstract: Robotic surgery offers numerous advantages over conventional laparoscopic or open surgery. The anesthesiologist must have full knowledge of the physiological changes that happen when the patient undergoes robotic surgery; it being gynecological, urological, general surgery, thoracic or trans-oral surgery. There are multiple changes during robotic surgery involving the cardiovascular, respiratory, neurologic, digestive and renal systems. It is of utter importance the full knowledge of these changes in order to avoid complications during and after surgery. Also, it is important to fully know the emergency protocol for undocking if need be, to convert to laparoscopic or open surgery. We have summarized the main anesthetic considerations as well as the key points of care anesthesiologists must have during non-cardiac robotic surgery.

Factores de riesgo asociados a complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia / Risk factors associated with anesthetic complications in chronic renal patients undergoing emergency surgery

INTRODUCTION: Chronic kidney disease is a clinical entity secondary to the common final pathway of multiple etiologies with risk factors common to other chronic diseases. OBJECTIVE: To identify the risk factors related to the appearance of anesthetic complications in chronic renal patients undergoing emergency surgery. METHOD: A prospective cohort study was performed in patients with chronic kidney disease undergoing emergency surgery. The exposed cohort consisted of 15 patients with chronic kidney disease who developed complications during the study period. RESULTS: Age over 40 years, patients with ischemic heart disease and hypertensive patients presented a higher risk of anesthetic complications. Obesity and bronchial asthma were no risk factors. It was demonstrated that when the time elapsed between hemodialysis and the operation was less than 2 hours, the risk of anesthetic complications increased, the stage of the disease and the associated drugs were not related to the appearance of complications. Patients who received general anesthesia had three times more risk of complications than those under regional anesthesia. CONCLUSIONS: Age, arterial hypertension, ischemic heart disease, heart failure and the use of general anesthesia are risk factors associated with complications.

INTRODUCCIÓN: La enfermedad renal crónica es una entidad clínica secundaria a la vía final común de múltiples etiologías con factores de riesgo comunes a otras enfermedades crónicas. OBJETIVO: Identificar los factores de riesgo relacionados con la aparición de complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia. MÉTODO: Se realizó un estudio de cohorte prospectivo en pacientes con enfermedad renal crónica intervenidos por cirugía general de urgencia. La cohorte expuesta estuvo constituida por 15 pacientes con enfermedad renal crónica que desarrollaron complicaciones en el período en estudio. RESULTADOS: La edad mayor o igual a 40 años, los pacientes con cardiopatía isquémica y los hipertensos presentaron mayor riesgo de complicaciones anestésicas, no así la obesidad al igual que el asma bronquial. Se demostró que cuando el tiempo transcurrido entre la hemodiálisis y la operación fue inferior a 2 horas se incrementó el riesgo de complicaciones anestésicas, el estadio de la enfermedad y los medicamentos asociados no estuvieron relacionados con la aparición de complicaciones. Los pacientes a los que se administró anestesia general tuvieron tres veces más riesgo de complicaciones que aquellos que fueron intervenidos con anestesia regional. CONCLUSIONES: La edad, la hipertensión arterial, la cardiopatía isquémica, la insuficiencia cardiaca y el empleo de anestesia general son factores de riesgo asociados a complicaciones, en los pacientes portadores de IRC, sometidos a cirugía de urgencia.

Evaluación de la incidencia de temblores en la sala de recuperación postanestésica / Evaluation of the incidence trembling in the recovery room postanesthtic / Avaliação da incidência de tremores na sala de recuperação posanestesica

Los temblores son una complicación frecuente, desagradable y que pueden relacionarse a un aumento de la morbilidad del período postoperatorio. El propósito de este estudio fue determinar la frecuencia de presentación de temblores en el postoperatorio inmediato. Pacientes y métodos: Se estudiaron 119 pacientes adultos, operados de coordinación una vez que ingresaron a la Sala de Recuperación Postanestésica (SRPA). Se consignó la presencia y severidad (grado I a IV) de temblores al ingreso y luego cada 15 minutos. Se trataron mediante medidas de recalentamiento externo, ondansetrón y meperidina, de manera escalonada cada 15 minutos. Resultados: hubo 24 (21.2 %) pacientes con temblores postoperatorios, 17/24 (71%) asociados a hipotermia. En 8 (33,3%) pacientes el temblor fue grado I, en 2 (8,3%) fueron grado II, y en 14 (58,3%) fueron grado III. En todos los casos cedieron con el tratamiento pautado y no más allá de los 45 minutos. Conclusiones: Los temblores fueron una complicación frecuente en la SRPA, asociados a hipotermia en la mayor parte de los casos, pero de duración limitada, y fácilmente tratables.

Trembling are frequent, unpleasant complication and can relate to increased morbidity postoperative period. The purpose of this study was to determine the frequency of occurrence of earthquakes in the immediate postoperative period. Patients and Methods: 119 adult patients operated coordination once entered the recovery room (PACU) were studied. the presence and severity (grade I to IV) of tremors at admission and then every 15 minutes was recorded. They were treated by external measures, ondansetron and meperidine overheating, staggered every 15 minutes. Avaliação da incidência de tremores na sala de recuperação posanestesica.

Tremores é uma complicação freqüente, desagradável e que pode relacionar-se a um aumento da morbilidade do período posoperatorio. O propósito deste estudo foi determinar a freqüência de manifestação de tremores no posoperatorio imediato. Pacientes e métodos: Estudaram-se 119 pacientes adultos, de cirurgias eletivas que chegaram à Sala de Recuperação Posanestesica (SRPA). Registraram-se a presença e severidade (grado I a IV) de tremores ao ingresso e cada 15 minutos. O tratamento foi: medidas de aquecimento externo, ondansetron e meperidina de maneira alternativa cada 15 minutos. Resultados. Teve 24 (21.2%) de pacientes com tremores posoperatorio, 17/24 (71%) associados à hipotermia. Em 8 (33,3%) pacientes o tremor foi grado I, em 2 (8,3%) foi grado II, em 14 (58,3%) grado III. Todos os casos acalmaram com o tratamento pautado nos primeiros 45 minutos. Conclusões. Os tremores foram uma complicação freqüente em SRPA, associado à hipotermia na maioria dos casos, com duração limitada e de fácil tratamento.

Anesthetic complications in a rehabilitation hospital: is the incidence related to the pre-anesthetic visit? / Complicação anestésica em hospital de reabilitação. A incidência tem relação com a consulta pré-anestésica? / Complicación anestésica en un hospital de rehabilitación. ¿La incidencia tiene relación con la consulta preanestésica?

Introduction: Approximately 234 million surgeries are done annually worldwide. There is a growing concern for the safety of the anesthetic act, and the pre-anesthetic consultation emerges as an important and widely recommended activity, used as a preventive measure for the emergence of a complication. Objectives: To describe the complications related to anesthesia, to identify the factors that contribute to its appearance and to reflect on ways to improve clinical practice. Methods: 700 patients, 175 cases and 525 controls, were evaluated over a period of 21 months. The data obtained through the pre-anesthetic consultation were evaluated descriptively and then tested with conditional univariate and multivariate logistic regression analysis. Results: 175 cases of anesthesia-related complications (2.74%) out of 6365 anesthetic acts were evaluated. Hypotension was the most common complication (40 patients, 22.8%), followed by vomiting (24 patients, 13.7%) and arrhythmia (24 patients, 13.7%). Among the complications, 55% were due to patient conditions, 26% accidental, 10% predictable and 9% iatrogenic. The complications were classified as mild in 106 (61%), moderate in 63 (36%) and severe in six (3%) patients. Conclusion: Patients with more impaired physical status (American Society of Anaesthesiology 3 and 4), with airway disease, tumor or parenchymal disease, diabetes or disorder of lipid metabolism, thyroid disease, former smokers and very prolonged anesthetic acts present a higher risk of anesthesia-related complications. Therefore, they should be actively investigated in the pre-anesthetic evaluation consultation. .

introdução: Cerca de 234 milhões de cirurgias são feitas anualmente no mundo. É cada vez maior o interesse pela segurança do ato anestésico e a consulta pré-anestésica surge como atividade importante e amplamente recomendada, usada como medida preventiva para o surgimento de uma complicação. Objetivos: Descrever as complicações relacionadas à anestesia, identificar os fatores que contribuem para o seu surgimento e refletir sobre formas de melhoria na prática clínica. Métodos: foram avaliados 700 pacientes, 175 casos e 525 controles, em um período de 21 meses. Os dados obtidos por meio da consulta pré-anestésica foram avaliados descritivamente e em seguida testados com regressão logística condicional univariada e multivariada. Resultados: Foram avaliados 175 casos de complicação relacionada à anestesia (2,74%) dentre 6.365 atos anestésicos. A hipotensão foi a complicação mais comum (40 casos, 22,8%), seguida do vômito (24%, 13,7%) e arritmia (24%, 13,7%). Das complicações, 55% foram devidas às condições do paciente, 26% acidentais, 10% previsíveis e 9% iatrogênicas. As complicações foram classificadas como leves em 106 pacientes (61%), moderadas em 63 (36%) e graves em seis (3%). Conclusão: Pacientes com estado físico mais debilitado (ASA 3 e 4), com doença de vias aéreas, tumor ou doença parenquimatosa, com diabetes ou transtorno do metabolismo lipídico, com doença de tireoide, ex-fumantes e as anestesias muito prolongadas apresentam maior risco de complicações relacionadas à anestesia e, por isso, devem ser investigados ativamente na consulta de avaliação pré-anestésica. .

Introducción: Cerca de 234 millones de cirugías se hacen anualmente en todo el mundo. Cada vez crece más el interés por la seguridad de la anestesia, y la consulta preanestésica surge como una actividad importante y ampliamente recomendada, usada como medida preventiva para el surgimiento de una complicación. Objetivos: Describir las complicaciones relacionadas con la anestesia, identificar los factores que contribuyen a su aparición y reflexionar sobre las formas de mejorar la práctica clínica. Métodos: Se evaluaron 700 pacientes, 175 casos y 525 controles, en un período de 21 meses. Los datos que se obtuvieron por medio de la consulta preanestésica se calcularon descriptivamente y enseguida fueron testados con la regresión logística condicional univariada y multivariada. Resultados: Fueron evaluados 175 casos de complicación relacionada con la anestesia (2,74%) entre 6.365 anestesias practicadas. La hipotensión fue la complicación más común (40 casos; 22,8%), seguida del vómito (24%; 13,7%) y de la arritmia (24%; 13,7%). De las complicaciones, un 55% de debieron a las condiciones del paciente, un 26% accidentales, un 10% previsibles y un 9% iatrogénicas. Las complicaciones fueron clasificadas como leves en 106 pacientes (61%), moderadas en 63 (36%) y graves en 6 (3%). Conclusión: Los pacientes con estado físico más debilitado (ASA 3 y 4), con enfermedad de vías aéreas, tumor o enfermedad parenquimatosa, con diabetes o trastorno del metabolismo lipídico, con enfermedad de la tiroides, exfumadores y las anestesias muy prolongadas presentan un mayor riesgo de complicaciones relacionadas con la anestesia y por eso deben ser investigados activamente en la consulta de evaluación preanestésica. .

Aracnoides trabecular, piamadre espinal humana y anestesia subaracnoidea / Trabecular arachnoid membrane, human spinal piamater and subarachnoid anesthesia

En los textos de anestesiología se aportan pocos detalles sobre la aracnoides trabecular y la piamadre espinal humana, a pesar de ser estructuras íntimamente relacionadas con los anestésicos locales administrados en una anestesia subaracnoidea. Complicaciones tales como el síndrome de cauda equina y el síndrome de irritación radicular transitorio posterior a la realización de bloqueos subaracnoideos, sumado a la alta permeabilidad que ha sido asociada con la piamadre, nos ha motivado a investigar sobre la ultraestructura de estas meninges. Método. Las muestras estudiadas se tomaron de cadáveres recientes y fueron examinadas por microscopía electrónica de transmisión y de barrido. Resultados. El trabeculado aracnoideo rodeaba a las raíces nerviosas, a la médula y a los vasos que se encontraban dentro del espacio subaracnoideo, limitando zonas. La piamadre estaba formada por un plano celular y por un compartimiento subpial. En el plano celular existían perforaciones naturales, especialmente en la región del cono medular y en las raíces nerviosas. Conclusiones. La inyección accidental de anestésicos locales dentro de las fundas que formaban el trabeculado aracnoideo podría justificar una dilución inadecuada de estas soluciones y el origen de síndromes neurotóxicos transitorios o permanentes. La alta permeabilidad de la piamadre podría deberse, en parte, a la existencia de perforaciones naturales, las cuales facilitarían un pasaje rápido de las sustancias introducidas en el líquido cefalorraquídeo hacia las raíces nerviosas y la médula espinal. En este caso, la membrana basal ubicada por debajo de las fibras colágenas del compartimiento subpial sería la única estructura limitante previa al tejido glio-neuronal de la médula.

Few details are to be found in anesthesiology texts concerning the trabecular arachnoid membrane and the human spinal pia mater in spite of being structures that are intimately related to local anesthetics administered in subarachnoid anesthesia. We were driven to investigate the ultrastructure of these meninges by complications such as the cauda equina syndrome and the transitory radicular irritation syndrome following subarachnoid blocks, added to the high permeability associated to the pia mater. Method. The samples analyzed were taken from recently deceased cadavers and were examined under transmission and scanning electron microscopy. Results. The arachnoid trabeculation surrounded the nerve roots, the spinal cord and the vessels within the subarachnoid space, limiting areas. The pia mater was formed by a cellular plane and by a sub-pial compartment. There were natural perforations in the cellular plane, particularly in the medullar cone region and the nerve roots. Conclusions. Accidental injection of local anesthetics into the sheaths formed by arachnoid trabeculation could be the cause of inadequate dilution of these solutions and the source of transitory or permanent neurotoxic syndromes. The high permeability of the pia mater could be partly due to the existence of natural perforations, which enable the quick passage of the substances introduced in the cerebrospinal fluid into the nerve roots and spinal cord. ln this case, the basal membrane located underneath the collagen fibers of the subpial compartment would be the only limiting structure before the glioneural tissue of the spinal cord.

Os textos de anestesiologia fornecem poucos detalhes sobre a aracnóide trabecular e a pia-máter espinhal humana, apesar delas serem estruturas intimamente relacionadas com os anestésicos locais administrados em uma anestesia subaracnóidea. Complicações tais como a síndrome de cauda eqüina e a síndrome de irritação radicular transitória posterior a bloqueios subaracnóideosas quais se soma a alta permeabilidade, que tem sido associada à pia-máter -levou-nos a pesquisar a ultraestrutura dessas meninges. Método. As amostras estudadas foram coletadas de cadáveres recentes e examinadas por microscopia eletrónica de transmissão e de varredura. Resultados. A trabeculação aracnóidea rodea va as raízes nervosas, a medula e os vasos no interior do espaço subaracnóide, limitando zonas. A pia-máter estava formada por um plano celular e um espaço subpial. No plano celular existiam perfurações naturais, especialmente na regiáo do cone medular e nas raízes nervosas. Conclusóes. A injeção acidental de anestésicos locais no interior das coberturas que formavam a trabeculação aracnoidea poderia justificar uma diluição inadequada das soluções e a origem de síndromes neurotóxicas transitórias ou permanentes. A causa da alta permeabilidade da pia-máter seria, em parte, a existencia de perfurações naturais que facilitariam a rápida passagem das substancias introduzidas no líquido cefalorraquiano para as raizes nervosas e a medula espinhal. Neste caso, a membrana basal localizada abaixo das fibras colágenas do espaço subpial seria a única estrutura limitante anterior ao tecido glio-neuronal da medula.