Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge.

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

Rotura de bronquio principal izquierdo por tubo de doble luz en paciente con antecedentes de radioterapia / Rupture of left main bronchus due to a left double-lumen tube in patient with a history of radiotherapy

La lesión de vía aérea causada por tubos de doble luz es una complicación infrecuente pero potencialmente muy grave. Describimos el caso de una paciente que presentó una rotura bronquial durante la ventilación unipulmonar con un tubo de doble luz izquierdo, complicándose con una parada cardíaca secundaria de la que se recuperó sin secuelas. Causas intrínsecas de la paciente, como el antecedente de radioterapia externa, y un posible sobreinflado del neumotaponamiento pudieron contribuir al desarrollo de esta complicación. La posible lesión de vía aérea debe ser considerada por todos los profesionales que empleen tubos de doble luz durante el cuidado de sus pacientes (AU)

Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients (AU)

Pharmacologic preventive strategies for takotsubo stress cardiomyopathy. What does evidence tell us? / Estrategias farmacológicas de prevención contra la miocardiopatía de takotsubo. ¿Qué nos aportan las pruebas?

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[Rupture of left main bronchus due to a left double-lumen tube in patient with a history of radiotherapy]. / Rotura de bronquio principal izquierdo por tubo de doble luz en paciente con antecedentes de radioterapia.

Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients.

Fractura abierta de apófisis cervical transversa producida por herida por asta de toro / Open fracture of a cervical transverse process as a result of a bull-horn wound

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Allergy to low dose sugammadex.

We describe the case of a fit 17-year-old man who developed a severe allergic reaction to a low clinical dose of sugammadex (3.2 mg kg(-1) , 200 mg intravenously), 1 min after its administration. This was manifest by an intense erythema over the anterior part of the thorax, severe lip and palpebral oedema and bilateral wheeze. On later investigation, the patient had a positive skin prick test to sugammadex (5-mm diameter response, with a negative saline control and positive histamine control of 5 mm) and no response to any other drug tested. Other diagnostic tests supported a diagnosis of allergic reaction to sugammadex.

Síndrome coronario agudo secundario a shock anafilático por amoxicilina clavulánico / No disponible

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[Fracture and embolization of implantable subclavian venous catheter fragments due to costoclavicular compression: pinch-off syndrome]. / Sección y embolización de catéter permanente por síndrome de pinzamiento costoclavicular (pinch-off).

The fracture of an implantable subclavian venous access device and the subsequent embolization of a catheter fragment is a known complication that is usually associated with a set of clinical and radiologic signs of costoclavicular compression. This scenario is also known as pinch-off syndrome. We describe 2 cases of venous port fracture which led us to review the efficacy of follow-up procedures used in our hospital. As a result, we added instructions for radiologic and clinical verification of catheter placement, taking into consideration the dynamic nature of compression. We also established protocols for coordinating the involvement of different services.

Sección y embolización de catéter permanente por síndrome de pinzamiento costoclavicular (pinch-off) / Fracture and embolization of implantable subclavian venous catheter fragments due to costoclavicular compression: pinch-off syndrome

Una de las complicaciones de los dispositivos venososimplantables subclavios es la rotura y posterior embolizaciónde un fragmento de catéter, que habitualmente seasocia a signos clínicos y radiológicos de pinzamientocostoclavicular, también llamado síndrome de “pinchoff”.Describimos dos casos de rotura ocurridas en nuestrohospital que nos llevaron a revisar la eficacia delseguimiento aplicado. Se añadieron instrucciones para lacomprobación radiológica y clínica del catéter, teniendoen cuenta el carácter dinámico del pinzamiento y se establecieronprotocolos de coordinación entre los serviciosimplicados)(AU)

The fracture of an implantable subclavian venousaccess device and the subsequent embolization of acatheter fragment is a known complication that is usuallyassociated with a set of clinical and radiologic signs ofcostoclavicular compression. This scenario is also knownas pinch-off syndrome. We describe 2 cases of venousport fracture which led us to review the efficacy offollow-up procedures used in our hospital. As a result, weadded instructions for radiologic and clinical verificationof catheter placement, taking into consideration thedynamic nature of compression. We also establishedprotocols for coordinating the involvement of differentservices(AU)

[Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision]. / Espondilodiscitis infecciosa y absceso epidural después de una punción subaracnoidea para escisión de sinus pilonidal.

Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.

Espondilodiscitis infecciosa y absceso epidural después de una punción subaracnoidea para escisión de sinus pilonidal / Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision

Las infecciones vertebrales tras punción subaracnoidea son excepcionales y a menudo están insuficientemente documentadas. Su incidencia no supera la de los abscesos epidurales espontáneos, lo que debería obligarnos a ser prudentes antes de afirmar la relación causal entre punción y absceso. Tras analizar 10 casos publicados observamos que sólo en la mitad de ellos se aportan datos sobre las condiciones de asepsia de las punciones y únicamente en dos pacientes parece haber una infección previa. En tres casos los abscesos aparecen tras punciones técnicamente sencillas, mientras que en la mitad de ellos ni siquiera se menciona este evento. Debe considerarse esta complicación ante un paciente con dolor de espalda y fiebre, aunque no aparezcan déficit neurológicos, e incluso tras punción subaracnoidea sencilla. Es importante solicitar urgentemente una resonancia magnética, con el fin de establecer con premura un tratamiento adecuado, puesto que el diagnóstico y tratamiento precoces han demostrado su eficacia para mejorar la supervivencia y disminuir el porcentaje de pacientes con secuelas neurológicas

Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established

Respuesta de supresión (BSR) en entropía por hipotermia moderada en un paciente con transfusión masiva / Burst suppression entropy response to moderate hypothermia in a patient receiving a massive transfusion

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