[Anesthetic management of coagulation factor V deficiency]. / Manejo anestésico en el déficit de factor V de la coagulación.

Factor V deficiency, or Owren's disease, is a rare inherited recessive autonomic disorder that is congenital. The bleeding in patients with this disease depends on plasma levels of factor V. Anesthetic management is similar to that used for patients with other coagulation disorders. On the one hand, it is useful to initiate infusion of plasma if purified concentrates are not available. On the other hand, it is important to monitor hemostasis carefully so that bleeding during postoperative recovery can be prevented. Plasma and antifibrinolytic drugs such as tranexamic acid should continue to be administered in the first few days after surgery. We report the case of a man with homozygotic factor V deficiency who underwent surgery for colon cancer. This article reviews the main aspects of anesthetic management of this coagulation disorder.

Estudio comparativo de la respuesta metabólica e inmunológica de la morfina administrada vía subaracnoidea frente a morfina endovenosa para el control del dolor postoperatorio en prostatectomía radical / Metabolic and immune response to spinal vs intravenous morphine for analgesia after radical prostatectomy

OBJETIVO: Estudiar las diferencias en la respuesta endocrino-metabólica e inmunológica asociadas al uso endovenoso o subaracnoideo de la morfina utilizada como analgésico postoperatorio en cirugía de prostatectomía radical. MATERIAL Y MÉTODOS: Estudio prospectivo de 60 pacientes incluidos aleatoriamente en dos grupos: Grupo A(n=30): analgesia postoperatoria con morfina endovenosa. Grupo B (n=30): analgesia postoperatoria con morfina subaracnoidea. Para el estudio de la respuesta inmunológica celular se analizó la evolución de las poblaciones leucocitarias y subpoblaciones linfocitarias en sangre periférica y a nivel del drenaje quirúrgico. Como marcadores de la respuesta metabólica e inmunológica humoral se midieron los niveles de cortisol, ACTH, GH, glucosa e inmunoglobulinas en sangre periférica. RESULTADOS: Ambos grupos presentaron linfopenia en sangre periférica. El grupo tratado con morfina subaracnoidea presentó recuentos de linfocitos CD4 significativamente más bajos en sangre periférica, p<0,05. A nivel local no se encontraron diferencias en la respuesta leucocitaria de ambos grupos. Se encontraron diferencias significativas, p<0,05, en el número de células NK y CD4 a nivel local y el encontrado en sangre periférica. En ambos grupos se encontró inmunosupresión de la respuesta humoral, siendo significativamente mayor, p<0,05 en el grupo tratado con morfina subaracnoidea. La respuesta metabólica fue superior en el grupo tratado con morfina endovenosa. CONCLUSIÓN: El grupo tratado con morfina subaracnoidea presentó una respuesta endocrino-metabólica menor. Aunque la respuesta celular a nivel local fue similar en ambos grupos, la respuesta encontrada a nivel periférico fue distinta, pudiendo ser reflejo de diferentes vías centrales de modulación de la respuesta inflamatoria a estrés

OBJETIVE: To study differences between the endocrine– metabolic and immune cell responses to spinal or intravenous administration of morphine for analgesia after radical prostatectomy. MATERIAL AND METHODS: Prospective study of 60 patients randomized to 2 groups: in group A (n=30) morphine for postoperative analgesia was infused intravenously and in group B (n=30) morphine was infused into the spinal canal. Changes in leukocyte populations and lymphocyte subpopulations in peripheral blood and blood from surgical drains (local) were analyzed to study immune cell response to morphine administration. Cortisol, corticotropin, growth hormone, glucose, and immunoglobulin levels in peripheral blood were measured as indicators of metabolic and humoral immune responses. RESULTS: Both groups developed lymphopenia in peripheral blood. The group treated with spinal morphine had significantly lower CD4+ cell counts in peripheral blood P<0.05. No differences were found in the local leukocyte response in either group. Significant differences were found in natural killer and CD4+ cell counts both locally and in peripheral blood P<0.05. There was humoral immune response suppression in both groups; however, it was more marked in the group treated with spinal morphine and the difference was significant P<0.05. The metabolic response was greater in the group treated with intravenous morphine. CONCLUSION: Patients who received morphine by spinal infusion had a less marked endocrine-metabolic response. Although local cell responses were similar in the 2 groups, the response in peripheral blood was different, possibly reflecting different mechanisms of central modulation of the inflammatory response to stress

[Anesthetic management in mastocytosis]. / Manejo anestésico en la mastocitosis.

Mastocytosis is a heterogeneous grouping of entities characterized by proliferation of mast cells in one or more organs or tissues. The skin is the most frequently affected organ, followed by bone marrow. The relevance of this disease to anesthesia lies in the fact that many drugs used can trigger massive release of chemical mediators of mast cells. We report the case of a patient diagnosed with cutaneous mastocytosis who underwent testicular biopsy with intradural anesthesia. We review the fundamental aspects of the disease and the principles of anesthetic management.

Manejo anestésico en la mastocitosis / Anesthetic management in mastocytosis

La mastocitosis es un conjunto heterogéneo de enfermedades caracterizadas por la proliferación de mastocitos en uno o más órganos o tejidos. Después de la piel el órgano más afectado es la médula ósea. La importancia anestésica de la enfermedad radica en que muchos de los fármacos empleados pueden ser causa de una liberación masiva de mediadores químicos mastocitarios. Presentamos el caso de un paciente diagnosticado de mastocitosis cutánea al que se realizó una biopsia testicular bajo anestesia intradural, revisando los aspectos fundamenta- les de la enfermedad así como las bases de la actuación anestésica en estos pacientes

Mastocytosis is a heterogeneous grouping of entities characterized by proliferation of mast cells in one or more organs or tissues. The skin is the most frequently affected organ, followed by bone marrow. The relevance of this disease to anesthesia lies in the fact that many drugs used can trigger massive release of chemical mediators of mast cells. We report the case of a patient diagnosed with cutaneous mastocytosis who underwent testicular biopsy with intradural anesthesia. We review the fundamental aspects of the disease and the principles of anesthetic management

[Metabolic and immune response to spinal vs intravenous morphine for analgesia after radical prostatectomy]. / Estudio comparativo de la respuesta metabólica e inmunológica de la morfina administrada vía subaracnoidea frente a morfina endovenosa para el control del dolor postoperatorio en prostatectomía radical.

OBJECTIVE: To study differences between the endocrine-metabolic and immune cell responses to spinal or intravenous administration of morphine for analgesia after radical prostatectomy. MATERIAL AND METHODS: Prospective study of 60 patients randomized to 2 groups: in group A (n=30) morphine for postoperative analgesia was infused intravenously and in group B (n=30) morphine was infused into the spinal canal. Changes in leukocyte populations and lymphocyte subpopulations in peripheral blood and blood from surgical drains (local) were analyzed to study immune cell response to morphine administration. Cortisol, corticotropin, growth hormone, glucose, and immunoglobulin levels in peripheral blood were measured as indicators of metabolic and humoral immune responses. RESULTS: Both groups developed lymphopenia in peripheral blood. The group treated with spinal morphine had significantly lower CD4+ cell counts in peripheral blood P<0.05. No differences were found in the local leukocyte response in either group. Significant differences were found in natural killer and CD4+ cell counts both locally and in peripheral blood P<0.05. There was humoral immune response suppression in both groups; however, it was more marked in the group treated with spinal morphine and the difference was significant P<0.05. The metabolic response was greater in the group treated with intravenous morphine. CONCLUSION: Patients who received morphine by spinal infusion had a less marked endocrine-metabolic response. Although local cell responses were similar in the 2 groups, the response in peripheral blood was different, possibly reflecting different mechanisms of central modulation of the inflammatory response to stress.

[Thoracic impedance cardiography in a case of anomalous drainage of the superior vena cava into the coronary sinus]. / Cardiografía por impedancia toráicica en un caso de drenaje anómalo de vena cava superior en seno coronario.

Thoracic impedance cardiography is a noninvasive hemodynamic monitoring technique based on the physical principal of impedance, which can be defined as resistance to electrical flow. We report the case of a man who underwent orthotopic heart transplantation, during which the superior vena cava was found to drain into the coronary sinus. Impedance cardiography was used because hemodynamics could not be monitored invasively with a Swan-Ganz catheter. We describe the main applications of impedance cardiography and the characteristics of this rare vascular anomaly.

[Anesthesia in Sebastian syndrome: a new hereditary macrothrombocytopenia]. / Anestesia en el síndrome de Sebastian: una nueva macrotrombocitopenia hereditaria.

The macrothrombocytopenias make up a heterogeneous group of disease involving thrombocytopenia and giant platelets; other clinical or laboratory findings, such as hereditary nephritis, sensorineural hearing loss, leukocyte inclusions, and cataracts, may also be present. The tendency to bleeding is highly variable and is due to decreased expression of the GP1b-V-IX complex on the surface of platelets, leading to altered platelet-vessel wall and platelet-platelet interactions. The 5 autosomal dominant giant-platelet disorders that are associated with macrothrombocytopenia are May-Hegglin anormaly, Epstein, Fechtner, and Sebastian syndromes, and Alport-like syndrome with macrothrombocytopenia. The mutation responsible is in gene 9 (MYH9) coding for the nonmuscle myosin heavy chain IIA that has been identified in the long arm of chromosome 22 (22q12.3-q13.2). The most recently described macrothrombocytopenia is Sebastian syndrome, consisting of thrombocytopenia with giant platelets and leukocyte inclusions. We report the case of a woman with Sebastian syndrome scheduled for abdominoperineal resection for rectal carcinoma. Preoperative studies revealed isolated thrombocytopenia (35,000 platelets/microL) and a mean platelet volumen of 13 fL. Preoperative prophylactic platelet transfusion was carried out with no adverse events. After a postoperative transfusion of packed red cells, needed because of abundant bleeding, clinical course continued to be satisfactory. The anesthetic implications of this syndrome are not well known because few cases have been reported in the literature, and none was found that describes anesthetic management. Nevertheless, thrombocytopenia and the tendency to bleeding present challenges to the anesthesiologist.

Anestesia en el síndrome de Sebastian: una nueva macrotrombocitopenia hereditaria / Anesthesia in Sebastian syndrome, a new hereditary macrothrombocytopenia

Las macrotrombocitopenias son un grupo heterogéneo de enfermedades con trombocitopenia y plaquetas gigantes que pueden incluir otros hallazgos como nefritis hereditaria, sordera neurosensorial, inclusiones leucocitarias y cataratas. Su tendencia al sangrado es muy variable, por una disminución de los niveles de la expresión del complejo GPIb-V-IX en la superficie de las plaquetas que implica una alteración de la adhesión y de la agregación plaquetaria. Los cinco desórdenes plaquetarios, autosómicos dominantes que asocian macrotrombocitopenia son los síndromes de May-Hegglin, Epstein, Alport-like con macrotrombocitopenia, Fechtner y Sebastian. La mutación genética causante se localiza en el gen 9 (MYH9) para la cadena pesada de la miosina no muscular IIA, NMMHC-IIA, que se ha identificado en el brazo largo del cromosoma 22 (22q12.3-q13.2). La macrotrombocitopenia más recientemente descrita es el síndrome de Sebastian, que consiste en una trombocitopenia con plaquetas gigantes e inclusiones leucocitarias. Describimos el caso de una paciente con síndrome de Sebastian programada para amputación abdominoperineal por neoplasia de recto. En el preoperatorio se objetivó una trombocitopenia aislada (35.000 plaquetas/µl) con volumen plaquetario medio de 13 fl. Se realizó transfusión profiláctica de plaquetas antes de la intervención que transcurrió sin incidencias. En el postoperatorio requirió la transfusión de concentrados de hematíes por sangrado abundante y la evolución fue favorable. Las implicaciones anestésicas son poco conocidas, por el escaso número de casos descritos y no se ha encontrado bibliografía sobre su manejo anestésico, pero la trombocitopenia y la tendencia al sangrado son un reto para el anestesiólogo (AU)

Fibrobroncoscopia a través de mascarilla laríngea en un paciente con síndrome de goldenhar / Fiberoptic bronchoscopy by laryngeal mask in a patient with Goldehar's syndrome

No disponible

[The utility of digital infiltration of mepivacaine and ketorolac in postoperative analgesia of the unilateral hallux valgus]. / Utilidad de la infiltración digital con mepivacaína y ketorolaco en la analgesia postoperatoria del hallux valgus unilateral.

OBJECTIVES: To determine whether locally injected ketorolac provides analgesia additional to that of mepivacaine, and also to prevent, diminish or delay the peripheral hypersensitivity response of postoperative pain. PATIENTS AND METHODS: Prospective, randomized, double-blind study of 72 patients scheduled for surgery to correct unilateral hallux valgus. Group 1 (n = 24) received median infiltration at the first metatarsus of 5 ml of 2% mepivacaine and 1 ml (30 mg) of ketorolac. Group 2 (n = 21) received local infiltration of 5 ml of 2% mepivacaine and 1 ml of saline solution. Group 3, the control group (n = 27) received the same solution as did group 2, plus 30 mg of ketorolac intravenously. The postoperative analgesia prescribed was 10 mg of ketorolac orally every 8 hours. Pain was measured on a visual analog scale (VAS) 0, 1, 4, 8 and 24 hours after surgery. Time elapsed until the appearance of pain, number of ketorolac pills consumed and overall patient satisfaction were recorded. RESULTS: There were no differences in anthropometric characteristics. Time until pain appeared was significantly longer in group 1 than in groups 2 and 3 (14.66 +/- 7.19, 5.90 +/- 2.27 and 8.70 +/- 5.02 hours, respectively). The VAS scores were significantly lower in group 1 after the fourth postoperative hour. Analgesic consumption was significantly lower in group 1. CONCLUSIONS: Infiltration of 30 mg of ketorolac along with mepivacaine delays the appearance of postoperative pain and diminishes it in the first 24 hours after surgery to correct hallux valgus, in comparison with infiltration of mepivacaine alone plus intravenous ketorolac.

[Failure of empirical treatment with ceftriaxone in motor neuron disease]. / Fracaso del tratamiento empírico con ceftriaxona en la enfermedad de la motoneurona.

We describe two patients with lateral amyotrophic sclerosis who, after informed consent, received empirical treatment with intravenous cephtriaxone at a dose of 2 g/24 hours for three weeks, with no positive results. The pharmacokinetics of this cephalosporin is analyzed, along with the relationship between motor neuron disease, neuroborreliosis and immunoreactivity to Borrelia burgdorferi.