Non intubated video-assisted thoracoscopic lung resections (NI-VATS) in COVID times.

The emergence of epidemic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan, China causing Coronavirus Disease 2019 (COVID-19) and its rapid expansion around the world, leading to a global pandemic of dimensions not observed at least since the "Spanish influenza" pandemic in 1917-18, has had great consequences at all levels, including social, health and economic spheres. This pandemic situation forces us, as health care workers, to redefine our medical and surgical actions to adapt them to this new reality. It is important, when the rules of the game change, to rethink and to reevaluate if the balance between risk and benefit have moved to a different point of equilibrium, and if our indications of certain surgical interventions need to be redefined. In this article we try to answer the doubts that arise about the suitability of the NI-VATS technique and assess whether its use in these new pandemic circumstances might add advantages, especially in relation to minimize the risks of virus contagion between patients and all healthcare personnel during the surgical procedure, as well as the known advantages described in many articles the last ten years.

[Malignant hyperthermia in a pig anesthesized with desflurane]. / Hipertermia maligna en un cerdo anestesiado con desflurano.

A large-white pig that had not been genetically selected to develop malignant hyperthermia (MH) during anesthesia nevertheless suffered an episode of severe MH after repeated exposure to increasing concentrations of desflurane. MH is a hypermetabolic alteration that may develop in susceptible patients who have inhaled certain drugs or agents that act as triggers. Early identification and appropriate treatment are essential to reduce the likelihood of death associated with this severe alteration. We report a case of late-developing MH triggered by low concentrations of inhaled desflurane.

Hipertermia maligna en un cerdo anestesiado con desflurano / Malignant hyperthermia in a pig anesthestized with desflurane

Un cerdo de la raza Large-White, no seleccionado genéticamente para desarrollar hipertermia maligna (HM) durante la anestesia, presentó un episodio de hipertermia maligna grave tras la exposición repetida a concentraciones crecientes con desflurano.La hipertermia maligna es una alteración hipermetabólica que se puede presentar en pacientes susceptibles a los que se le administran ciertos fármacos o agentes inhalatorios que actúan como agentes desencadenantes. La identificación precoz y el tratamiento adecuado son imprescindibles para disminuir la mortalidad asociada a tan grave alteración.Este caso de hipertermia maligna desencadenado por desflurano se caracterizó por una presentación tardía y por desarrollarse con una concentración mínima de agente inhalatorio (AU)

[Preloading with 500 ml of Hartmann's solution lessens the incidence and severity of hypotension and reduces the need for ephedrine after epidural anesthesia in ambulatory patients]. / La prehidratación con 500 ml de solución de Hartmann disminuye la incidencia e intensidad de la hipotensión y reduce las necesidades de efedrina tras anestesia epidural en pacientes ambulatorios.

INTRODUCTION: Fluid preloading to prevent hypotension after epidural anesthesia has been widely questioned, although few studies have been performed in outpatients. OBJECTIVE: To evaluate the incidence and severity of hypotension, and the need for vasoactive agents after epidural anesthesia in outpatients who did or did not receive fluid preloading. PATIENTS AND METHODS: Forty patients under 55 years of age (ASA I and II) undergoing general surgery on an outpatient basis were assigned randomly to two groups of 20 according to whether they were to receive loading with Hartmann's solution or not before epidural anesthesia. All received a similar epidural dose of 2% mepivacaine. Hypotension was defined as a decrease of 20% in systolic or mean blood pressure in comparison with baseline, or absolute pressures of < 90 and 60 mmHg, respectively. Hypotension was treated with 5 mg boluses of ephedrine. RESULTS: Fourteen patients in the non-preloading group and 5 in the preloading group developed hypotension (p < 0.05). Hypotensive episodes were fewer in patients receiving preloading fluids (0.5 +/- 1.2 versus 2.0 +/- 2.4; p < 0.05). The ephedrine dose required was higher in non-preloaded patients than in preloaded ones (10.0 +/- 12.2 versus 2.6 +/- 6.3 mg; p < 0.05). Time until presentation of hypotension was longer for non-preloaded patients. CONCLUSIONS: For patients undergoing outpatient surgery, fluid preloading with 500 ml of Hartman's solution decreases both the incidence and severity of hypotension, as well as the need for vasoactive drugs after epidural anesthesia.

[Prolonged neuromuscular block after a single dose of vecuronium in a patient with undiagnosed polyneuropathy and steroid myopathy]. / Bloqueo neuromuscular prolongado tras dosis única de vecuronio en un paciente con polineuropatía y miopatía esteroide no diagnosticadas.

We report the case of a patient who had been receiving long-term corticoid therapy with undiagnosed polyneuropathy and steroid-related myopathy before experiencing prolonged neuromuscular blockade (lasting longer than 4 hours) after administration of a single dose of 0.08 mg/kg of vecuronium. Neuromuscular function was monitored by accelerometry with four-stimuli series. Many of the circumstances present in this case -such as prior administration of succinylcholine, the use of an inhaled anesthetic, kidney insufficiency and cyclosporin therapy- have been associated with increased duration of blockade induced by neuromuscular blockers, although durations reported have been shorter than that experienced by our patient. After electromyography and muscle biopsy, polyneuropathy and steroid-related myopathy were diagnosed. We conclude that neuromuscular blockers should be administered with extreme caution to patients with polyneuropathy and those undergoing long-term corticoid therapy, in order to prevent prolonged neuromuscular blockade.

Compartment syndrome with severe rhabdomyolysis in the postoperative period following major vascular surgery.

We report a case of compartment syndrome with marked rhabdomyolysis in the immediate postoperative period following major vascular surgery. Early and aggressive treatment, based on intravenous fluids, sodium bicarbonate, mannitol and fasciotomy, resulted in satisfactory management of the patient and prevented the onset of severe complications, such as acute renal failure in a patient who presented several factors that predisposed him to this disorder.