[Detection of a cerebral ischaemia episode during surgery by monitoring the brain tissue oxygen pressure]. / Detección intraoperatoria de un episodio de isquemia cerebral mediante la monitorización de la presión tisular de oxígeno cerebral.

The detection and treatment of cerebral ischaemia and tissue hypoxia for the prevention of secondary injury are the basic objectives during anaesthesia for neurosurgical procedures. The monitoring of the tissue oxygen pressure is direct and can enable potentially harmful situations to be detected in real time. Although it was initially used in neurocritical patients, its use has extended to surgical patients. We present the case of a patient subjected to surgical resection of a dural arteriovenous fistula in which the brain tissue oxygen pressure around the area of the lesion was monitored. The finding of an episode of cerebral tissue hypoxia during closure of the craniotomy determined the treatment of the patient. We highlight the possible use of this neuromonitoring for the rapid detection of regional cerebral hypoxia events in the peri-operative period of vascular neurosurgery, procedures that have a significant risk of, mainly ischaemic, hypoxia episodes.

[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.

Detección intraoperatoria de un episodio de isquemia cerebral mediante la monitorización de la presión tisular de oxígeno cerebral / Detection of a cerebral ischaemia episode during surgery by monitoring the brain tissue oxygen pressure

La detección y el tratamiento de la isquemia y la hipoxia tisular cerebrales para la prevención de la lesión secundaria son objetivos fundamentales durante la anestesia para procedimientos neuroquirúrgicos. La monitorización de la presión tisular de oxígeno es un monitor directo que puede permitir detectar situaciones potencialmente lesivas en tiempo real. Aunque se empleó inicialmente en pacientes neurocríticos, su uso se ha extendido a pacientes quirúrgicos. Presentamos el caso de un paciente sometido a cirugía de resección de una fístula arteriovenosa dural al que se le monitorizó la presión tisular de oxígeno cerebral en el área perilesional. El hallazgo de un episodio de hipoxia tisular cerebral durante el cierre de la craneotomía, determinó el tratamiento del paciente. Destacamos la posible utilidad de esta neuromonitorización para la detección rápida de eventos hipóxicos cerebrales regionales en el perioperatorio de neurocirugía vascular, procedimientos que presentan un riesgo significativo de episodios hipóxicos fundamentalmente isquémicos(AU)

The detection and treatment of cerebral ischaemia and tissue hypoxia for the prevention of secondary injury are the basic objectives during anaesthesia for neurosurgical procedures. The monitoring of the tissue oxygen pressure is direct and can enable potentially harmful situations to be detected in real time. Although it was initially used in neurocritical patients, its use has extended to surgical patients. We present the case of a patient subjected to surgical resection of a dural arteriovenous fistula in which the brain tissue oxygen pressure around the area of the lesion was monitored. The finding of an episode of cerebral tissue hypoxia during closure of the craniotomy determined the treatment of the patient. We highlight the possible use of this neuromonitoring for the rapid detection of regional cerebral hypoxia events in the peri-operative period of vascular neurosurgery, procedures that have a significant risk of, mainly ischaemic, hypoxia episodes(AU)

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)