Hemorragia masiva tras fístula arterio-esofágica por una arteria subclavia aberrante desconocida / Massive hemorrhage after arterioesophageal fistula from an unknown aberrant subclavian artery

La arteria subclavia derecha aberrante tiene una incidencia de un 0,5-1% en la población, con una localización generalmente retroesofágica. Puede llevar a la formación de una fístula arterio-esofágica en pacientes con factores de riesgo predisponentes por dispositivos colocados en posición esofágica o traqueal, al ser particularmente susceptible a la compresión extrínseca y a la necrosis por presión.Presentamos el caso de un paciente con una fístula traqueo-esofágica posquirúrgica, que desarrolló un sangrado masivo por una fístula arterio-esofágica secundaria a una arteria subclavia derecha aberrante desconocida. Para el manejo hemostático se realizaron maniobras alternativas, como la colocación de una sonda urinaria tipo Foley en el punto de sangrado y la posterior colocación de un balón de Sengstaken-Blakemore en posición craneal.Dada la gravedad del cuadro y el posible retraso diagnóstico, parece adecuado considerar la realización de un angio-TC preoperatorio en pacientes con factores de riesgo sometidos a estos procedimientos.(AU)

The aberrant right subclavian artery has an incidence of 0.5-1% in the population, generally with retroesophageal location. It can lead to the formation of an arterio-esophageal fistula in patients with predisposing risk factors due to devices placed in esophageal or tracheal position, as it is particularly susceptible to extrinsic compression and pressure necrosis.We present the case of a patient with a postsurgical tracheoesophageal fistula, who developed massive bleeding due to an arterioesophageal fistula secondary to an unknown aberrant right subclavian artery. For hemostatic management, alternative maneuvers were performed, such as the placement of a Foley-type urinary catheter at the point of bleeding and the subsequent placement of a Sengstaken-Blakemore balloon in cranial position.Given the severity of the condition and the possible diagnostic delay, it seems appropriate to consider performing a preoperative CT angiography in patients with risk factors who undergo these procedures.(AU)

Massive hemorrhage after arterioesophageal fistula from an unknown aberrant subclavian artery.

The aberrant right subclavian artery has an incidence of 0.5%-1% in the population, generally with retroesophageal location. It can lead to the formation of an arterio-esophageal fistula in patients with predisposing risk factors due to devices placed in esophageal or tracheal position, as it is particularly susceptible to extrinsic compression and pressure necrosis. We present the case of a patient with a postsurgical tracheoesophageal fistula, who developed massive bleeding due to an arterioesophageal fistula secondary to an unknown aberrant right subclavian artery. For hemostatic management, alternative maneuvers were performed, such as the placement of a Foley-type urinary catheter at the point of bleeding and the subsequent placement of a Sengstaken-Blakemore balloon in cranial position. Given the severity of the condition and the possible diagnostic delay, it seems appropriate to consider performing a preoperative CT angiography in patients with risk factors who undergo these procedures.

The TotaltrackTM video laryngeal mask: an evaluation in 300 patients.

The TotaltrackTM is a new video laryngeal mask, which combines a supraglottic airway with a videolaryngoscope. We evaluated the performance of this device in an observational study in 300 adult patients. The Totaltrack was inserted at the first attempt and the glottis seen in all cases. In 249 patients (83%; 95%CI 78.7-87.3%) the glottis was seen at the first attempt. Adequate ventilation and tracheal intubation were achieved in all patients. The median time to visualisation of vocal cords, to confirmation of ventilation and to successful tracheal intubation was 5 s, 13 s and 24 s, respectively. Nineteen patients (6.3%; 95%CI 3.55-9.05%) suffered minor complications, such as mucosal lesion or blood staining. The Totaltrack appears effective for airway management.

Uso del Totaltrack VLM en una vía aérea difícil imprevista en una cesárea urgente / Use of the Totaltrack VLM in unexpected difficult airway in urgent caesarean section

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Uso del TotalTrack VLM para intubación endotraqueal urgente en vía aérea difícil prevista con obstrucción por lesiones ocupantes de espacio y distancia interdental reducida / Use of the TotalTrack VLM for emergent endotracheal intubation in predicted difficult airway with obstruction by expanding space-occupying lesions and reduced interincisor opening

La afección cervical aguda puede determinar un serio compromiso de la vía aérea como consecuencia de la distorsión anatómica secundaria a la obstrucción o desviación de la vía aérea superior, escenarios en los que cualquier dispositivo puede fracasar. El paso de un fibrobroncoscopio para exponer la glotis puede ser muy difícil, y la traqueotomía puede ser imposible o arriesgada en casos avanzados. Presentamos el uso del TotalTrack VLM en cirugía urgente para asegurar la vía aérea en 2 pacientes no cooperadores con vía aérea difícil debido a una angina de Ludwig y a un hematoma cervical, respectivamente, ambos acompañados de trismus (AU)

Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus (AU)

Use of the TotalTrack VLM for emergent endotracheal intubation in predicted difficult airway with obstruction by expanding space-occupying lesions and reduced interincisor opening. / Uso del TotalTrack VLM para intubación endotraqueal urgente en vía aérea difícil prevista con obstrucción por lesiones ocupantes de espacio y distancia interdental reducida.

Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus.

Síndrome de Rett: doble catéter epidural para control del dolor postoperatorio tras cirugía de escoliosis. Revisión de la bibliografía / Rett syndrome: double epidural catheter for the control of postoperative pain after scoliosis surgery. A literature review

El síndrome de Rett es una enfermedad neurológica grave e incapacitante por un defecto estructural en el brazo corto del cromosoma X (Xq28). Afecta a mujeres y consta de múltiples discapacidades neurológicas progresivas que se manifiestan desde edades tempranas causando invalidez y dependencia de por vida. La escoliosis aparece en más del 50% de los pacientes, con necesidad de corrección quirúrgica en casos de graves angulaciones. Es imprescindible una evaluación preanestésica cuidadosa con el fin de identificar los factores de riesgo y así disminuir la morbimortalidad asociada con el procedimiento quirúrgico. Presentamos el caso de una paciente afectada por este síndrome y escoliosis, programada para la realización de una artrodesis vertebral toracolumbar mediante instrumentación con anestesia general, que transcurrió sin incidentes. Evaluamos las connotaciones específicas de este síndrome, sus potenciales complicaciones y su manejo desde un punto de vista anestésico; remarcando el control del dolor postoperatorio conseguido mediante un doble catéter epidural con infusión de anestésicos locales y fentanilo tras la cirugía(AU)

Rett syndrome is a severe and incapacitating neurological disease caused by a structural defect in the short arm of the X chromosome (Xq28). It affects females and consists of multiple and progressive neurological impairments that start from a young age, leading to lifelong disability and dependency. Scoliosis appears in more than 50% of patients and requires surgical correction in cases where the curvature is severe. Pre-anaesthetic assessment is essential in order to identify the risk factors and thus reduce the morbidity and mortality associated with the surgical procedure. We present the case of a patient affected by this syndrome and scoliosis, who was scheduled to have an instrumented thoracolumbar spine arthrodesis with general anaesthesia, which passed without incident. We evaluate the specific details of this syndrome, its potential complications, and its management from an anaesthetic point of view, emphasising the control of postoperative pain using a double epidural catheter with an infusion of local anaesthetics and fentanyl(AU)

[Rett syndrome: double epidural catheter for the control of postoperative pain after scoliosis surgery. A literature review]. / Síndrome de Rett: doble catéter epidural para control del dolor postoperatorio tras cirugía de escoliosis. Revisión de la bibliografía.

Rett syndrome is a severe and incapacitating neurological disease caused by a structural defect in the short arm of the X chromosome (Xq28). It affects females and consists of multiple and progressive neurological impairments that start from a young age, leading to lifelong disability and dependency. Scoliosis appears in more than 50% of patients and requires surgical correction in cases where the curvature is severe. Pre-anaesthetic assessment is essential in order to identify the risk factors and thus reduce the morbidity and mortality associated with the surgical procedure. We present the case of a patient affected by this syndrome and scoliosis, who was scheduled to have an instrumented thoracolumbar spine arthrodesis with general anaesthesia, which passed without incident. We evaluate the specific details of this syndrome, its potential complications, and its management from an anaesthetic point of view, emphasising the control of postoperative pain using a double epidural catheter with an infusion of local anaesthetics and fentanyl.

Dermatitis de contacto por sensibilización a alérgenos del caucho y aplicación de apósito plástico en aerosol / No disponible

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[Conradi-Hünermann Chondrodysplasia punctata: anaesthetic implications]. / Condrodisplasia punctata de Conradi-Hünermann: implicaciones anestésicas.

Chondrodysplasia punctata syndrome is a group of rare congenital diseases that give rise to malformations, mainly skeletal, linked to the premature calcification of structures. There is little in the literature in the field of Anaesthesiology on this despite there being some clinical manifestations, particularly the possibility of difficult airway, which may be of importance during the peri-operative period. During the first years of life, the patients affected are often subjected to repeated surgery to correct their malformations. We describe the anaesthetic treatment during orthopaedic surgery of a paediatric patient with Conradi-Hünermann type chondrodysplasia punctata, highlighting the managementof the airway using a laryngeal mask in combination with balanced general anaesthesia with remifentanil. We also present a review of the characteristics of the different entities of these syndromes, with special emphasis on the aspects most relevant to the anaesthesiologist.

Condrodisplasia punctata de Conradi-Hünermann: implicaciones anestésicas / Conradi-Hünermann Chondrodysplasia punctata: anaesthetic implications

EL síndrome de condrodisplasia punctata es un grupo de enfermedades congénitas raras que dan lugar a malformaciones, fundamentalmente esqueléticas, vinculadas con la calcificación prematura de estructuras. Existe escasa bibliografía en el ámbito de la anestesiología, pese a que algunas de sus manifestaciones clínicas, especialmente la posibilidad de una vía aérea difícil, pueden tener relevancia durante el perioperatorio. Los pacientes afectos, durante los primeros años de vida, se verán frecuentemente sometidos a cirugías frecuentes para corrección de sus malformaciones. Presentamos el tratamiento anestésico durante una intervención quirúrgica ortopédica de un paciente pediátrico afecto de una condrodisplasia punctata tipo Conradi-Hünnermann. Se destaca el tratamiento de la vía aérea mediante una mascarilla laríngea en combinación con una anestesia general balanceada con remifentanilo. Asimismo presentamos una síntesis de las características de diversas entidades de estos síndromes, con especial énfasis en los aspectos más relevantes para el anestesiólogo(AU)

Chondrodysplasia punctata syndrome is a group of rare congenital diseases that give rise to malformations, mainly skeletal, linked to the premature calcification of structures. There is little in the literature in the field of Anaesthesiology on this despite there being some clinical manifestations, particularly the possibility of difficult airway, which may be of importance during the peri-operative period. During the first years of life, the patients affected are often subjected to repeated surgery to correct their malformations. We describe the anaesthetic treatment during orthopaedic surgery of a paediatric patient with Conradi-Hünermann type chondrodysplasia punctata, highlighting the management of the airway using a laryngeal mask in combination with balanced general anaesthesia with remifentanil. We also present a review of the characteristics of the different entities of these syndromes, with special emphasis on the aspects most relevant to the anaesthesiologist(AU)

Dolor pélvico en la embarazada. Disfunción de la sínfisis púbica. Revisión de la literatura / Pelvic pain in pregnancy. Pubic symphysis dysfunction. Literature review

La diástasis de la sínfisis púbica en la mujer embarazada es una entidad frecuente e infravalorada, que se relaciona con importante repercusión sobre la morbilidad maternal y con alta prevalencia de dolor crónico pélvico en las mujeres. La impotencia funcional que llega a ocasionar y el importante dolor con el que se relaciona, implica la utilización de un grupo de alternativas terapéuticas, que van desde el reposo en cama, hasta una compleja corrección quirúrgica que refuerza la importancia y la necesidad de un correcto abordaje de la patología. Nuestro objetivo será, a partir de varios casos remitidos a la Unidad de Tratamiento del Dolor de nuestro centro, el realizar una revisión de esta patología, con una aproximación a las pacientes, revisando las alternativas terapéuticas con las que contamos para este tipo de cuadros y su repercusión sobre la calidad de vida del binomio materno-fetal y cronificación del dolor (AU)

Pubic symphysis diastasis in pregnancy is a frequent and underestimated problem that has important repercussions on maternal morbidity and high prevalence of chronic pelvic pain in women. The functional impotence that it causes and the associated severe pain, entails the use of a number of therapeutic alternatives, ranging from bed rest to complex corrective surgery, reinforcing the importance and necessity of a correct approach to this pathology. Our aim is, after studying many cases referred to the Pain Treatment Unit at our centre, to carry out a review of this pathology, contacting patients, reviewing the therapeutic alternatives available for these types of conditions and their repercussions on the quality of life of the maternal-foetal binomial and chronic pain (AU)

Anestesia general con mascarilla laríngea y remifentanilo para osteosíntesis remodelante y correctora de pie neuropático en un caso de enfermedad de Charcot-Marie-Tooth tipo I / General anesthesia with a laryngeal mask and remifentanil for remodelling osteosynthesis to correct neuropathic foot in Charcot- Marie-Tooth disease type I

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