[Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura]. / Manejo anestésico en gestante afecta de púrpura trombocitopénica idiopática.

Idiopathic thrombocytopenic purpura is an autoimmune disorder characterized by a low platelet count. Onset usually occurs during adolescence with episodes of cutaneous and mucosal bleeding. Thrombocytopenia during pregnancy is associated with many diseases, of which idiopathic thrombocytopenic purpura is the most common in the first trimester. The need for treatment will depend on the platelet count and whether there is bleeding. At the end of pregnancy, however, whether delivery is vaginal or by cesarean, more aggressive therapeutic measures are required. Anesthetic management in this type of patient will be determined by coagulation status and platelet count, and local or regional anesthesia may be contraindicated. We report the case of a pregnant woman with idiopathic thrombocytopenic purpura who was admitted to the emergency department of our hospital with suspected preeclampsia.

Manejo anestético en gestante afecta de púrpura trombocitopénica idiopática / Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura

La púrpura trombocitopénica idiopática (PTI) es untrastorno autoinmune, caracterizado por plaquetopenia,que suele debutar durante la adolescencia y que cursa enforma de brotes con episodios de sangrado cutáneomucoso.Existen muchas patologías asociadas a trombocitopeniadurante la gestación, siendo la PTI la más frecuentedurante el primer trimestre del embarazo. Lanecesidad de tratamiento dependerá del recuento de plaquetasy de la presencia de clínica hemorrágica. Sinembargo, cuando finaliza la gestación (tanto vía vaginalcomo cesárea) hay que tomar medidas terapéuticas másagresivas. El manejo anestésico de este tipo de pacientesvendrá determinado por el estado de la coagulación y elrecuento plaquetar, puediendo estar contraindicada unaanestesia locorregional. Presentamos el caso de una gestanteafecta de PTI que acudió al servicio de urgenciasde nuestro centro por sospecha de preeclampsia(AU)

Idiopathic thrombocytopenic purpura is anautoimmune disorder characterized by a low plateletcount. Onset usually occurs during adolescence withepisodes of cutaneous and mucosal bleeding.Thrombocytopenia during pregnancy is associated withmany diseases, of which idiopathic thrombocytopenicpurpura is the most common in the first trimester. Theneed for treatment will depend on the platelet count andwhether there is bleeding. At the end of pregnancy,however, whether delivery is vaginal or by cesarean, moreaggressive therapeutic measures are required. Anestheticmanagement in this type of patient will be determined bycoagulation status and platelet count, and local or regionalanesthesia may be contraindicated. We report the case ofa pregnant woman with idiopathic thrombocytopenicpurpura who was admitted to the emergency departmentof our hospital with suspected preeclampsia(AU)

[Airway management in a man with ankylosing spondylitis]. / Manejo de la vía aérea en un paciente con espondilitis anquilosante.

We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. Cervical column and atlantooccipital articulation mobility are reduced and in severe cases the cervical vertebrae become fixed in a flexed position. This portion of the spine is also the most susceptible to fracture, particularly in hyperextension, an event that could lead to damage to the cervical spinal cord during maneuvers to manage the airway. Patients with this condition may also have temporomandibular joint involvement, further complicating airway management. We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.

Manejo de la vía aérea en un paciente con espondilitis anquilosante / Airway management in a man with ankylosing spondylitis

Presentamos el caso clínico de manejo de vía aérea difícil en un paciente de 41 años afectado de espondilitis anquilosante programado para ser intervenido de prótesis total de cadera izquierda. Tras varios intentos fallidos para la realización de una técnica regional, se practicó una anestesia general y una intubación orotraqueal con fibrobroncoscopio. La progresión de una espondilitis anquilosante conlleva a la aparición de fibrosis, osificación y anquilosis de toda la columna vertebral y de las articulaciones sacroilíacas. La movilidad de la columna cervical y de la articulación atlantoccipital están limitadas y en casos severos el raquis cervical queda fijado en posición de flexión. Además la columna vertebral cervical es más susceptible de presentar fracturas, sobre todo en hiperextensión, lo que podría derivar en una lesión de la médula espinal cervical durante las manipulaciones de la vía aérea. Estos pacientes pueden tener también afectada la articulación temporomandibular dificultando aún más el acceso a la vía aérea. En este caso describimos el manejo de la vía aérea, en un paciente afectado de espondilitis anquilosante con fijación de toda columna, mediante intubación con fibrobroncoscopio con el paciente en ventilación espontánea, sedado con perfusión de remifentanilo como único agente anestésico, tras el fracaso de una anestesia intradural

We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. Cervical column and atlantooccipital articulation mobility are reduced and in severe cases the cervical vertebrae become fixed in a flexed position. This portion of the spine is also the most susceptible to fracture, particularly in hyperextension, an event that could lead to damage to the cervical spinal cord during maneuvers to manage the airway. Patients with this condition may also have temporomandibular joint involvement, further complicating airway management. We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia

[General practitioners' approach to relapsing multiple sclerosis]. / Approche des poussées de sclérose en plaques par les médecins généralistes.

Management of multiple sclerosis depends on close multidisciplinary collaboration but general practitioners play a particularly important role, especially in case of relapse, due to their close relationship with the patient. The purpose of this work was to conduct a survey of general practitioners' knowledge of relapsing multiple sclerosis and ascertain their main difficulties in patient management. One hundred seventy-seven practitioners answered a written questionnaire with two headings, diagnostic criteria for relapse and therapeutic approaches. Analysis of the results showed that this common event is under recognized. While 55.9 p.cent of the general practitioners stated they diagnosed relapse by themselves, only 2.8 p.cent knew its exact definition. Differential diagnosis accounted for a large number of mistakes. Our survey also underlined the use of certain therapeutic options (low-dose oral corticosteroid therapy) for which the effectiveness has not been demonstrated. It would be important to propose specific education on relapsing multiple sclerosis for general practitioners and improve cooperation with specialists. An integrated care network might be useful.