"Low-field" intraoperative MRI: a new scenario, a new adaptation.

AIM: To describe the adaptation of Cruces University Hospital to the use of intraoperative magnetic resonance imaging (ioMRI), and how the acquisition and use of this technology would impact the day-to-day running of the neurosurgical suite. MATERIALS AND METHODS: With the approval of the ethics committee, an observational, prospective study was performed from June 2012 to April 2014, which included 109 neurosurgical procedures with the assistance of ioMRI. These were performed using the Polestar N-30 system (PSN30; Medtronic Navigation, Louisville, CO), which was integrated into the operating room. RESULTS: A total of 159 procedures were included: 109 cranial surgeries assisted with ioMRI and 50 control cases (no ioMRI use). There were no statistical significant differences when anaesthetic time (p=0.587) and surgical time (p=0.792) were compared; however, an important difference was shown in duration of patient positioning (p<0.0009) and total duration of the procedure (p<0.0009) between both groups. CONCLUSIONS: The introduction of ioMRI is necessary for most neurosurgical suites; however, a few things need to be taken into consideration when adapting to it. Increase procedure time, the use of specific MRI-safe devices, as well as a checklist for each patient to minimise risks, should be taken into consideration.

Use of BIS VISTA™ bilateral monitor for diagnosis of intraoperative seizures, a case report / Utilidad del monitor BIS-bilateral en el diagnóstico de crisis intraoperatorias, descripción de un caso

Changes in BIS (bispectral index) VISTA™ bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described (AU)

Describimos los cambios que se produjeron en el monitor BIS vista bilateral durante dos episodios de crisis generalizada uno de ellos convulsivo, el otro no convulsivo, así como la presencia de crisis focales durante la exéresis de un meningioma frontal izquierdo (AU)

Algunos comentarios a la carta «Controversia en cuanto al uso del icatibant como profilaxis en el angioedema» / Some comments to the letter «Controversy to use icatibant for prophylaxis in angioedema»

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Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report.

Changes in BIS (bispectral index) VISTA bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described.

Uso profiláctico de icatibant en un caso de angioedema hereditario tipo III. (Revisión de la literatura sobre manejo perioperatorio en pacientes con angioedema hereditario tipo III) / Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)

El angioedema hereditario tipo iii es una forma de angioedema familiar poco frecuente, descrito como entidad patológica recientemente. El alto riesgo de exacerbación del angioedema hereditario en relación con la cirugía, incluso con procedimientos dentales, y la alta mortalidad en esta enfermedad cuando el edema de vía aérea es causado por las maniobras de intubación orotraqueal, obligan a establecer un tratamiento profiláctico cuando dichas maniobras son necesarias. Describimos el uso por primera vez de icatibant (Firazyr®) como profilaxis eficaz del desarrollo de edema de vía aérea asociado a intubación orotraqueal en este tipo de pacientes. Dada la inexistencia de publicaciones en relación con el manejo anestésico de estos pacientes, hemos realizado una revisión sistemática de esta enfermedad y de su posible relación con los procedimientos anestésicos, y usamos nuestro caso como base de esta revisión (AU)

Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr®), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted (AU)

[Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)]. / Uso profiláctico de icatibant en un caso de angioedema hereditario tipo III. (Revisión de la literatura sobre manejo perioperatorio en pacientes con angioedema hereditario tipo III).

Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr(®)), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted.

[Perioperative considerations in vagal nerve stimulator implantation]. / Aspectos perioperatorios de la implantación de un estimulador vagal.

Vagal nerve stimulation has become an a important tool in the treatment of refractory epilepsy, which continues to be the main indication for this technique. Other therapeutic indications are emerging, however, and vagal nerve stimulation has now been approved for major depression. Additional possible uses under study include morbid obesity, Alzheimer disease, chronic pain syndromes, and certain neuropsychologic disorders. This review considers perioperative aspects relevant to using this therapeutic procedure with a view to facilitating better and more integrated management of its application.

Aspectos perioperatorios de la implantación de un estimulador vagal / Perioperative considerations in vagal nerve stimulator implantation

La estimulación vagal se ha convertido en una modalidad importante en el tratamiento de la epilepsia refractaria, que sigue siendo su indicación principal. Sus indicaciones terapéuticas se han visto ampliadas, siendo aprobado para el tratamiento de la depresión mayor. En la actualidad siguen en estudio otras posibles indicaciones como la obesidad mórbida, la enfermedad de Alzheimer, síndromes de dolor crónico y algunos trastornos neuropsiquiátricos. En este artículo se revisan los aspectos perioperatorios de este procedimiento terapéutico, lo cual permitirá un mejor y más integral manejo del mismo(AU)

Vagal nerve stimulation has become an a important tool in the treatment of refractory epilepsy, which continues to be the main indication for this technique. Other therapeutic indications are emerging, however, and vagal nerve stimulation has now been approved for major depression. Additional possible uses under study include morbid obesity, Alzheimer disease, chronic pain syndromes, and certain neuropsychologic disorders. This review considers perioperative aspects relevant to using this therapeutic procedure with a view to facilitating better and more integrated management of its application(AU)