Manejo anestésico de la tiroidectomía endoscópica transoral. Reporte de un caso / Anaesthetic management of transoral endoscopic thyroidectomy. A case report

La tiroidectomía endoscópica transoral por abordaje vestibular (TOETVA) constituye un procedimiento novedoso y mínimamente invasivo, libre de cicatrices visibles y que presenta resultados alentadores en cuanto a la rápida recuperación y menor dolor posoperatorio. Consiste en realizar la tiroidectomía a través de su orificio natural, empleando tres puertos en el área oral vestibular y llevando a cabo una disección cuidadosa hasta la muesca esternal y los bordes de ambos músculos esternocleidomastoideos. El objetivo es describir las diferentes implicaciones anestésicas que conlleva esta técnica quirúrgica, dado que la evidencia publicada hasta la fecha en la literatura es muy limitada. Se considera esencial la monitorización del nervio laríngeo recurrente mediante tubo endotraqueal con electromiografía para garantizar su identificación e integridad, así como la utilización de otros monitores como el TOF-watch o el índice biespectral para asegurar una adecuada profundidad anestésica y un óptimo nivel de relajación muscular.(AU)

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel and minimally invasive procedure, free of visible scars and showing encouraging results in terms of rapid recovery and less postoperative pain. It consists of performing the thyroidectomy through its natural orifice, using three ports in the oral vestibular area and carrying out a careful dissection to the sternal notch and the edges of both sternocleidomastoid muscles. The objective of this article is to describe the different anesthetic implications that this surgical technique entails, given that the evidence published to date in the literature is very limited. It is considered essential to control the recurrent laryngeal nerve using an endotracheal tube with electromyography to ensure its identification and integrity, as well as the use of other monitors such as the TOF watch or the bispectral index to ensure adequate anesthetic depth and an optimal level of muscle relaxation.(AU)

Anaesthetic management of transoral endoscopic thyroidectomy. A case report. / Manejo anestésico de la tiroidectomía endoscópica transoral. Reporte de un caso.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel and minimally invasive procedure, free of visible scars and showing encouraging results in terms of rapid recovery and less postoperative pain. It consists of performing the thyroidectomy through its natural orifice, using three ports in the oral vestibular area and carrying out a careful dissection to the sternal notch and the edges of both sternocleidomastoid muscles. The objective of this article is to describe the different anesthetic implications that this surgical technique entails, given that the evidence published to date in the literature is very limited. It is considered essential to control the recurrent laryngeal nerve using an endotracheal tube with electromyography to ensure its identification and integrity, as well as the use of other monitors such as the TOF watch or the bispectral index to ensure adequate anesthetic depth and an optimal level of muscle relaxation.

Fístulas aortoesofágica y aortobronquial secundarias a reparación endovascular de aneurisma de aorta torácica / Aorto-oesophageal and aorto-bronchial fistulae secondary to endovascular repair of a thoracic aortic aneurysm

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[Giant omphalocele correction in a patient with pentalogy of Cantrell]. / Corrección de onfalocele gigante en un paciente con pentalogía de Cantrell.

Pentalogy of Cantrell is a rare congenital malformation characterised by a large defect in the lower region of the sternum, diaphragm, and lower abdominal region. It is also characterised by the migration of organs, and its prognosis depends on the presence of cardiac malformations. We present the case of an 18 year-old male subjected to a scheduled giant omphalocele correction. Invasive monitoring, including cardiac output, was used to avoid episodes of instability due to the increase in abdominal pressure and the increase in venous return (as had happened on two previous operations). The prognosis depends on multiple factors, with good haemodynamic and respiratory control being the most important. Mortality is high despite the advances in monitoring.

Corrección de onfalocele gigante en un paciente con pentalogía de Cantrell / Giant omphalocele correction in a patient with pentalogy of Cantrell

La pentalogía de Cantrell es una rara malformación congénita caracterizada por un amplio defecto de la región inferior del esternón, el diafragma y la región anterior abdominal. Se caracteriza por la migración de órganos y su pronóstico depende de la presencia de malformaciones cardiacas. Presentamos el caso de un varón de 18 años sometido a corrección programada de un onfalocele gigante. Se empleó monitorización invasiva y del gasto cardiaco para evitar (como había sucedido en dos intervenciones previas) episodios de inestabilidad por aumento de la presión intraabdominal y disminución del retorno venoso. El pronóstico depende de múltiples factores; lo más importante es el buen control hemodinámico y respiratorio. A pesar de la monitorización avanzada, la mortalidad es muy alta(AU)

Pentalogy of Cantrell is a rare congenital malformation characterised by a large defect in the lower region of the sternum, diaphragm, and lower abdominal region. It is also characterised by the migration of organs, and its prognosis depends on the presence of cardiac malformations. We present the case of an 18 year-old male subjected to a scheduled giant omphalocele correction. Invasive monitoring, including cardiac output, was used to avoid episodes of instability due to the increase in abdominal pressure and the increase in venous return (as had happened on two previous operations). The prognosis depends on multiple factors, with good haemodynamic and respiratory control being the most important. Mortality is high despite the advances in monitoring(AU)