Intubación con fibra óptica en un niño con dificultad de la vía no prevista previamente, debido a hipertrofia de amígdala lingual / Fiberoptic intubation in a child with previous unexpected difficult airway due to lingual tonsil hypertrophy

Las amígdalas linguales son componentes normales de la orofaringe, situadas en la base de la lengua, que a veces pueden agrandarse debido a inflamación. Esto puede ser causa de vía aérea difícil no prevista, considerando que muchos pacientes son asintomáticos y que esta masa supra-glótica no es detectada habitualmente durante la valoración rutinaria preoperatoria de la vía aérea. Se describe de manera común en adultos, pero existen pocos informes sobre pacientes pediátricos. Describimos el caso de un niño de 12 años, con diagnóstico de tumor cerebral cerebeloso, programado para resección quirúrgica. La primera cirugía se pospuso debido a complicaciones respiratorias como resultado de vía aérea difícil a causa de hipertrofia de la amígdala lingual. Se reprogramó la cirugía, estableciéndose un plan para el tratamiento de la vía aérea: intubación con fibra óptica con ventilación espontánea. Considerando que se trata de un problema que no puede identificarse mediante una exploración regular de la vía aérea, debemos tomar conciencia acerca de los modos más efectivos de manejar esta situación, cuando surja

Lingual tonsils are normal components of the oropharynx localized at the base of the tongue, which sometimes can become enlarged by inflammation. This may be a cause of unexpected difficult airway, considering most patients are asymptomatic and this supraglottic mass is not usually detected during a routine preoperative airway assessment. Commonly described in adults, there are limited reports in pediatric patients. We describe a case of a 12 years old boy diagnosed with a cerebellar brain tumor that was scheduled for a resection. The first surgery was postponed because of respiratory complications as a result of unexpected difficult airway due to lingual tonsil hypertrophy. His surgery was rescheduled and a plan for airway management was laid out: fibroscopic intubation with spontaneous ventilation. Considering this is a problem that cannot be identified by regular airway examination, we should be aware of the most effective ways to manage the situation as it arises

Avaliação da produtividade, dos custos e da satisfação dos usuários do setor odontológico de um hospital militar / Evaluation of productivity, costs and users' satisfaction of the dental service from a military hospital

Introduction: the evaluation of health services can be considered as a manner to promote the continuous improvement of attention, providing the user with a service of better quality. Being the Hospital of Military Police of Santa Maria (HBM/SM) a public service offered to the corporation, it should also be evaluated, so that measures can institute to its expansion. Objective: to analyze the service provided and the public's satisfaction attended by the HBM/ SM. Methods: three hundred and seventy monthly production maps were evaluated from 2010 to 2016 in order to verify the dental procedures performed and the patients treated. The satisfaction surveys answered by users were also appraised. The monthly expenses were determined by adding: salaries, dental material, emergency expenses, depreciation and estimated fixed costs. The working hours for dentists were calculated annually according to the working arrangements of each professional. Results: the total cost was R$ 6.866.119,03 being performed 103.075 dental procedures, resulting in an average cost of R$ 66,61 per procedure. The monthly average of dental procedures (preventive and curative) was 1.207,74 ± 328,49. Dependents represent 48.03% of the users and the military staff, 44.87%. The vast majority of users considered the dental service excellent or good in relation to the different aspects evaluated. The average number of procedures/hour exceeded SUS goal (3 procedures/hour) to achieve maximum economic efficiency in 5 of the 7 years evaluated. Conclusion: even being more economically advantageous to maintain a proper dental care center for the corporation's members and their dependents, economic measures can be adopted, such as renegotiation of outsourcing contracts, direct contracting of professional or implementation of the Temporary Military Health Program.

Introdução: sendo o Setor Odontológico do Hospital da Brigada Militar de Santa Maria um serviço público oferecido para corporação, este deve ser avaliado para que se instituam medidas de ampliação. Objetivo: analisar o serviço prestado e a satisfação do público atendido pelo referido setor. Metodologia: foram avaliados 370 mapas mensais de produção de 2010 a 2016, nos quais constam os procedimentos odontológicos realizados e os pacientes atendidos, e as pesquisas de satisfação respondidas pelos usuários. Os gastos mensais foram determinados somando-se salários, material odontológico, despesas emergenciais, depreciação e custos fixos estimados. As horas de trabalho dos dentistas foram calculadas de acordo com o regime de trabalho de cada um. Resultados: o custo total foi de R$ 6.866.119,03, sendo realizados 103.075 procedimentos odontológicos, resultando num custo médio por procedimento de R$ 66,61. A média mensal de procedimentos odontológicos foi de 1.207,74 ± 328,49. A grande maioria dos usuários considerou o serviço ótimo ou bom em relação aos diferentes aspectos avaliados. A média de procedimentos/hora superou a meta do SUS, de 3 procedimentos/hora para atingir máxima economicidade, em 5 dos 7 anos avaliados. Conclusão: mesmo sendo mais vantajoso economicamente manter um centro de atendimento odontológico próprio para os integrantes da corporação, pode-se propor medidas de economicidade a serem adotadas, como renegociação dos contratos terceirizados, contratação direta dos profissionais ou implementação do Programa de Militares Estaduais de Saúde Temporários.

Bloqueo continuo en el plano del músculo erector del espinal para analgesia en cirugía torácica pediátrica: informe de un caso / Continuous erector spinae plane block for analgesia in pediatric thoracic surgery: A case report

El bloqueo en el plano del músculo erector del espinal ha sido recientemente descrito, y parece ser una técnica de analgesia regional muy prometedora. Reportamos el primer bloqueo continuo en el plano del músculo erector del espinal realizado en un paciente pediátrico sometido a cirugía torácica. Se trata de un niño de 15 meses con un teratoma paracardiaco programado para resección tumoral por toracotomía. Después de la inducción de anestesia general se practicó un bloqueo continuo en el plano del músculo erector del espinal a nivel de T5 con ropivacaína 0,2%. Tras la cirugía se inició una perfusión torácica interfascia de ropivacaína 0,1% y analgesia multimodal. El paciente toleró bien el procedimiento sin complicaciones. Parece que esta es una buena alternativa a la epidural torácica y el bloqueo paravertebral, dada la simple reproducibilidad y la mayor seguridad potencial de esta técnica

Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery. A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0.1% along with multimodal rescue analgesia was initiated. The patient tolerated the procedure well with no complications. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique