Total intravenous anesthesia for aortic aneurysm replacement surgery in a patient with limb-girdle dystrophy / Anestesia total intravenosa para sustitución de aorta ascendente por aneurisma en paciente con distrofia muscular de cinturas

We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained (AU)

Presentamos el tratamiento anestésico con anestesia total intravenosa de un varón de 61 años diagnosticado de distrofia muscular de cinturas para sustitución de aorta ascendente por aneurisma aórtico. La distrofia muscular de cinturas es un grupo genéticamente heterogéneo de distrofias musculares que afecta predominantemente la cintura escapular y pélvica. Aunque el riesgo de hipertermia maligna no parece estar aumentado en estos pacientes en comparación con la población general, la exposición a anestésicos inhalatorios y succinilcolina probablemente deba evitarse ya que existe una predisposición a la hiperpotasemia y rabdomiólisis. Utilizamos anestesia intravenosa total con propofol y remifentanilo, además de bloqueanttes musculares durante el procedimiento quirúrgico, para reducir el consumo de oxígeno y minimizar las dosis de propofol y remifentanilo. La combinación de una estrategia anestésica cuidadosa, monitorización de bloqueo neuromuscular y profundidad anestésica se describen a continuación (AU)

[Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft]. / Rotura de aneurisma ilíaco durante el precondicionamiento con levosimendán previo a cirugía de revascularización coronaria.

We present the case of a 77 year-old patient scheduled for coronary artery bypass. During the infusion of levosimendan as preconditioning for surgery, a rupture of right common iliac artery occurred. Surgery was delayed and an urgent aorto-bifemoral bypass was performed. We believe that the rupture of the artery was triggered by an increase in transmural pressure due to the inotropic effects of levosimendan in a dilated diseased vessel. To our knowledge, there are no cases of aneurysm rupture as a complication during levosimendan infusion, but the coincidence of events in time strongly suggests some kind of causal relationship.

Total intravenous anesthesia for aortic aneurysm replacement surgery in a patient with limb-girdle dystrophy.

We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained.

[Evaluation of 2 invasive techniques for treating myofascial pain]. / Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial.

OBJECTIVE: To assess the efficacy of 2 invasive techniques for treating myofascial pain: trigger point acupuncture and 1% lidocaine infiltration of trigger points. MATERIAL AND METHODS: Patients who met the inclusion criteria were randomized to 2 groups for evaluation at our pain clinic over a period of 7 months. Each patient had 4 treatment sessions. Response was evaluated on a visual analog scale (VAS) and by means of the Lattinen test. RESULTS: Twenty-one patients were enrolled. Eleven underwent acupuncture and 10 received lidocaine infiltrations. When post-treatment pain was assessed, the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45 (2.05) in the acupuncture group and from 4.8 (2.03) to 2.2 (1.91) in the lidocaine group. Lattinen test scores also fell, from 10.63 (2.69) to 8.54 (3.14) in the acupuncture group and from 10.9 (1.59) to 8.60 (2.63) in the lidocaine group. There were no statistically significant differences between the 2 treatment groups. CONCLUSION: Both acupuncture and lidocaine infiltration of trigger points were effective in reducing pain intensity after treatment and in improving quality of life. One method could not be shown to be better than the other for treating myofascial pain.

Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial / Evaluation of 2 invasive techniques for treating myofascial pain

OBJETIVO: Evaluar la eficacia de dos técnicas invasivasen el tratamiento del dolor miofascial: punción depuntos gatillo con aguja de acupuntura e infiltración delos mismos con lidocaína al 1%.MATERIAL Y MÉTODOS: Se distribuyó a los pacientesaleatoriamente en ambos grupos, de los evaluados duranteun periodo de 7 meses en la Unidad del Dolor y quecumplían los criterios de inclusión. Se practicaron cuatrosesiones por paciente, evaluando la respuesta mediante laEscala Visual Analógica (EVA) y el test de Lattinen.RESULTADOS: Se incluyeron 21 pacientes. Once fueronpinchados con aguja de acupuntura y 10 se infiltraroncon lidocaína. Se objetivó una disminución en la puntuaciónen la EVA al final de ambos tratamientos. Los valoresfueron 5,50 ± 2,08 disminuyendo a 2,45 ± 2,05 en elgrupo acupuntura, y 4,8 ± 2,03 disminuyendo a 2,20 ±1,91 en el grupo lidocaína. También se redujo la puntuaciónen el test de Lattinen de 10,63 ± 2,69 a 8,54 ± 3,14con aguja de acupuntura y de 10,9 ± 1,59 a 8,60 ± 2,63con lidocaína. No hubo diferencias estadísticamente significativaen ambas escalas (visual analógica y test deLattinen) entre ambas técnicas.CONCLUSIÓN: Tanto la punción con aguja de acupunturacomo la infiltración con lidocaína demostraron sereficaces en la disminución de la intensidad del dolor alfinal del tratamiento, así como en su influencia en lacalidad de vida, no pudiendo determinar en este grupode pacientes que un método sea superior a otro en el tratamientodel dolor miofascial(AU)

OBJETIVE: To assess the efficacy of 2 invasivetechniques for treating myofascial pain: trigger pointacupuncture and 1% lidocaine infiltration of triggerpoints.MATERIAL AND METHODS: Patients who met theinclusion criteria were randomized to 2 groups forevaluation at our pain clinic over a period of 7 months.Each patient had 4 treatment sessions. Response wasevaluated on a visual analog scale (VAS) and by meansof the Lattinen test.RESULTS: Twenty-one patients were enrolled. Elevenunderwent acupuncture and 10 received lidocaineinfiltrations. When post-treatment pain was assessed,the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45(2.05) in the acupuncture group and from 4.8 (2.03) to2.2 (1.91) in the lidocaine group. Lattinen test scoresalso fell, from 10.63 (2.69) to 8.54 (3.14) in theacupuncture group and from 10.9 (1.59) to 8.60 (2.63) inthe lidocaine group. There were no statisticallysignificant differences between the 2 treatment groups.CONCLUSION: Both acupuncture and lidocaineinfiltration of trigger points were effective in reducingpain intensity after treatment and in improving qualityof life. One method could not be shown to be better thanthe other for treating myofascial pain(AU)

Endocarditis precoz sobre catéter endovenoso central / No disponible

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