Influencia de la elevación de la cabeza sobre la presiónintracraneal, presión de perfusión cerebral y saturación de oxígenocerebral regional en pacientes con hemorragia cerebral / Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and regional cerebral oxygen saturation in patients with cerebral hemorrhage

OBJETIVO: Estudiar los efectos de la posición semisentadacon la cabecera a 30 y 45 grados sobre la dinámicacerebral y oxigenación cerebral regional en pacientes conhemorragia cerebral.PACIENTES Y MÉTODOS: Estudio prospectivo sobre 10pacientes con hemorragia cerebral, sometidos a sedoanalgesiay ventilación mecánica. Se recogieron los valores dePIC, presión arterial media (PAM), presión de perfusióncerebral (PPC) y oximetría cerebral regional por infrarrojos(SrO2) con la cabeza en posición horizontal (0º) y elevada30º y 45º, tras un periodo de estabilización de 5 minutos.RESULTADOS: La PIC disminuyó significativamente enlas posiciones de 30º y 45º con respecto a los valores enposición horizontal (disminuyeron 2,8 ± 1,4 mmHg y4,4 ± 1,4 mmHg, respectivamente). La PPC descendió ligeramentea 30º de elevación de la cabeza (3,5 ± 3,1 mmHg,p=0,048), siendo la reducción más importante a 45º(7,1 ± 4,8 mmHg, p < 0,01). Asimismo, la mayor reducciónde la PAM se registró con la cabeza elevada 45º(11,8 ± 4,6 mmHg, p < 0,001). La SrO2 se redujo al elevarla cabeza 30º y 45º, existiendo la mayor diferencia cuandola cabeza se elevó a 45º (7% ± 2% p < 0,001). Una correlaciónmoderada fue observada entre los valores de PPC ylos cambios de la SrO2 (r2 = 0,45, p < 0,001).CONCLUSIÓN: La elevación de la cabeza produce unadisminución significativa de la PIC y la PPC en pacientescon hemorragia cerebral. Asimismo, la elevación de lacabeza disminuye la SrO2, dependiendo los cambios de laSrO2 del grado de elevación de la cabeza (AU)

OBJECTIVE: To study the effects on cerebral dynamicsand regional oxygenation (rSO2) of the semi-sittingposition, with the head at either 30° or 45°, in surgery forcerebral hemorrhage.PATIENTS AND METHODS: We performed a prospectivestudy of 10 patients undergoing surgery for cerebralhemorrhage under sedation and analgesia and withmechanical ventilation. Intracranial pressure (ICP), meanarterial pressure (MAP), cerebral perfusion pressure(CPP), and rSO2 measured using near-infraredspectroscopy were recorded with the head in the supineposition (0°) and elevated to an angle of 30° and then 45°,following a stabilization period of 5 minutes.RESULTS: Mean (SD) ICP values were significantlylower in both semi-sitting positions than in the supineposition: 2.8 (1.4) mm Hg lower at 30° and 4.4 (1.4) mmHg lower at 45°. Mean CPP values were fell slightly whenthe head was elevated to 30° (3.5 [3.1] mm Hg, P=.048); agreater reduction was achieved when the head waselevated 45° (7.1 [4.8] mm Hg, P<.01). The greatestreduction in mean MAP values also occurred with thehead elevated to 45° (11.8 [4.6] mm Hg, P<.001). MeanrSO2 values fell when the head was elevated to 30° and45°; the greatest reduction occurred when the head waselevated to 45° (7% [2%], P<.001). There was a moderatecorrelation between CPP values and changes in rSO2(r2=0.45, P<.001).CONCLUSION: Head elevation significantly reducesICP and CPP in patients with cerebral hemorrhage.Head elevation also reduces rSO2, to a greater or lesserextent depending on the degree to which the head iselevated (AU)

Implicaciones anestésicas en una paciente con Síndrome de Donohue / Managing anesthesia for a woman with Donohue syndrome

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Non-surgical management of intracranial subdural hematoma complicating spinal anesthesia.

We report the case of a 29 year-old woman who presented a symptomatic intracranial subdural hematoma developing shortly after spinal anesthesia. The patient was fully conscious at clinical onset, and thus we treated her conservatively with an epidural autologous blood patch and close neurological observation. Given the clinical improvement the possibility of surgery was discauded in agreement with the neurosurgical team. Most cases of subdural hematoma appearing after spinal anesthesia are treated with surgery. In the present case the subdural hemorrhage was detected at our hospital 20 days after the anesthetic procedure, and given the excellent state of consciousness, we choosed a conservative management.

Non-surgical management of intracranial subdural hematoma complicating spinal anesthesia

El hematoma subdural (SDH) es una complicación evolutiva rara, documentada y de riesgo vital en los cuadros de cefalea post punción subdural (PDPH). Presentamos un caso de esta rara complicación resuelto con un parche de sangre autóloga epidural y tratamiento conservador, sin precisar evacuación quirúrgica

The subdural hematoma (SDH) is a systematic, documented and vital risk in post boxes subdural puncture (PDPH) evolutionary headache rare complication. We present a case of this rare complication resolved with a patch of autologous epidural and conservative treatment, without requiring surgical evacuation

Cateterización accidental de catéter de Swan-Ganz en cava inferior. Monitorización radiológica / Accidental catheterization of the inferior vena cava with a Swan-Ganz catheter: radiologic monitoring

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