[New anaesthetic technique in diode laser treatment of retinopathy of prematurity]. / Nueva técnica anestésica en el tratamiento con láser diodo de la retinopatía del prematuro.

INTRODUCTION: Anaesthesia in premature infants can have many complications. Although the application of diode laser is less painful than cryotherapy, there has to be adequate immobilization of the patient to provide a correct focus of the spot. At Hospital Infantil de Zaragoza, the same standard anaesthetic technique has been applied since 1999, obtaining sedation with inhaled anaesthetic agents combined with topical anaesthesia. We analyse the results obtained on the application of this technique. MATERIAL AND METHOD: The study included 72 consecutive premature infants treated with diode laser for retinopathy of prematurity (ROP), using an anaesthetic technique combining inhalatory sedation and topical anaesthesia. The personal data of each patient was collected (gestational age, birth weight, postconceptional age at the time of initial treatment, associated systemic disorders) together with information related to the surgical intervention (duration, intraoperative and postoperative complications). RESULTS: Intraoperative complications occurred in 12 cases (16.66%). These were self-limited in 9 cases and only 3 cases required orotracheal intubation (4.16%). Postoperative complications occurred in 4 cases (5.55%) during the 48 h following treatment. No statistically significant relationship was found between the presence of intraoperative complications and the mean gestational age and birth weight, and the presence of apnoea, intraventricular haemorrhage or a permeable ductus. A statistically significant relationship was found between the presence of postoperative complications and significant intraventricular haemorrhage. CONCLUSIONS: This anaesthetic technique combining inhalatory gases and topical anaesthesia is safe, with few complications and comfortable for the surgeon.

Nueva técnica anestésica en el tratamiento con láser diodo de la retinopatía del prematuro / New anaesthetic technique in diode laser treatment of retinopathy of prematurity

Introducción: La anestesia en prematuros es susceptible de tener múltiples complicaciones. Aunque la aplicación del láser diodo es menos dolorosa que la crioterapia, se debe conseguir una correcta inmovilización del paciente para un enfoque y una aplicación adecuados del mismo. Desde 1999 está protocolizada en el Hospital Infantil de Zaragoza una técnica anestésica que utiliza sedación con agentes inhalatorios asociada a anestesia tópica. Analizamos los resultados obtenidos en la utilización de dicha técnica. Material y método: Se incluyen 72 prematuros consecutivos tratados con láser por retinopatía del prematuro (ROP) utilizando la técnica anestésica de sedación inhalatoria y anestesia tópica. Se han recogido datos de los pacientes (edad gestacional, peso al nacer, edad posconcepcional en el momento del tratamiento inicial, patología sistémica asociada) y del acto quirúrgico (tiempo de duración y complicaciones intraoperatorias y postoperatorias). Resultados: Se produjeron complicaciones intraoperatorias en 12 casos (16,66 %). En 9 casos fueron autolimitadas y sólo 3 precisaron intubación orotraqueal (4,16 %). En 4 casos (5,55 %) se produjeron complicaciones postoperatorias en las 48 h posteriores al tratamiento. No se encontró relación estadísticamente significativa entre la presencia de complicaciones intraoperatorias y la media de edad gestacional y peso al nacer o la presencia de apneas, hemorragia intraventricular o ductus permeable. Se encontró relación estadísticamente significativa entre la presencia de complicaciones postoperatorias y la presencia de hemorragia intraventricular significativa. Conclusiones: La técnica anestésica con gases inhalatorios asociada a anestesia tópica es segura, con escasa proporción de complicaciones y cómoda para el cirujano (AU)

Introduction: Anaesthesia in premature infants can have many complications. Although the application of diode laser is less painful than cryotherapy, there has to be adequate immobilization of the patient to provide a correct focus of the spot. At Hospital Infantil de Zaragoza, the same standard anaesthestic technique has been applied since 1999, obtaining sedation with inhaled anaesthetic agents combined with topical anaesthesia. We analyse the results obtained on the application of this technique. Material and method: The study included 72 consecutive premature infants treated with diode laser for retinopathy of prematurity (ROP), using an anaesthestic technique combining inhalatory sedation and topical anaesthesia. The personal data of each patient was collected (gestational age, birth weight, postconceptional age at the time of initial treatment, associated systemic disorders) together with information related to the surgical intervention (duration, intraoperative and postoperative complications). Results: Intraoperative complications occurred in 12 cases (16.66 %). These were self-limited in 9 cases and only 3 cases required orotracheal intubation (4.16 %). Postoperative complications occurred in 4 cases (5.55 %) during the 48 h following treatment. No statistically significant relationship was found between the presence of intraoperative complications and the mean gestational age and birth weight, and the presence of apnoea, intraventricular haemorrhage or a permeable ductus. A statistically significant relationship was found between the presence of postoperative complications and significant intraventricular haemorrhage. Conclusions: This anaesthestic technique combining inhalatory gases and topical anaesthesia is safe, with few complications and comfortable for the surgeon (AU)

Síndrome HELLP diagnosticado por dolor epigástrico leve-moderado en el tercer trimestre de la gestación / HELLP syndrome diagnosis based on mild-to-moderate epigastric pain in the third trimester of pregnancy

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Hipotensión perioperatoria grave tras nefrectomía con suprarrenalectomía / Severe perioperative hypotension after nephrectomy with adrenalectomy

A una mujer de 70 años, obesa e hipertensa en tratamiento con inhibidores de la enzima convertidora de angiotensina (IECA) y clortalidona, pero sin antecedentes de tratamiento corticoideo ni enfermedad del eje hipotálamohipófiso-suprarrenal, se le realizó una nefrectomía más suprarrenalectomía bajo anestesia combinada: general y peridural. Presentó una hipotensión arterial grave con oliguria intraoperatoria, que continuó en el postoperatorio junto al desarrollo de anuria, acidosis metabólica, hiponatremia e hiperpotasemia. Aunque inicialmente el cuadro se atribuyó al tratamiento previo con IECA más diuréticos junto a la anestesia combinada, la refractariedad a la administración de cristaloides, coloides e inotrópicos catecolamínicos, con respuesta parcial a la efedrina y el desarrollo de anuria, acidosis metabólica, hiponatremia e hiperpotasemia, nos hizo pensar en la concurrencia de una crisis addisoniana. Tras extraer muestras para determinar cortisol y ACTH, se inició el tratamiento con hidrocortisona. La respuesta al tratamiento junto al cortisol descendido confirmaron el diagnóstico de insuficiencia suprarrenal. En los pacientes sometidos a una nefrectomía más suprarrenalectomía por hipernefroma, se ha observado que la suprarrenal contralateral compensa la secreción endógena del cortisol, por esto no se recomienda tratamiento sustitutivo. Por otra parte, se han descrito crisis addisonianas perioperatorias en pacientes sometidos a cirugías con estrés quirúrgico importante. También se han visto hipotensiones graves en los pacientes tratados crónicamente con IECA tras la inducción de la anestesia general y tras la anestesia epidural con anestésicos locales. En este caso la conjunción de todos estos factores dificultó el diagnóstico y la rápida instauración del tratamiento adecuado (AU)

[Severe perioperative hypotension after nephrectomy with adrenalectomy]. / Hipotensión perioperatoria grave tras nefrectomía con suprarrenalectomía.

A 70-year-old obese, hypertensive woman taking angiotensin converting enzyme (ACE) inhibitors and chlorthalidone but with no history of corticosteroid treatment or hypothalamus-hypophyseal-adrenal disease, underwent nephrectomy and adrenalectomy under combined general and epidural anesthesia. Severe hypotension with oliguria developed during surgery and persisted during postoperative recovery, with anuria, metabolic acidosis, hyponatremia and hyperpotassemia. Although the symptoms were initially attributed to prior treatment with ACE inhibitors and diuretics together with combined anesthesia, the patient's lack of response to crystalloid, colloid and inotropic catecholamine therapy in the context of anuria, metabolic acidosis, hyponatremia and hyperpotassemia led us to consider a diagnosis of Addisonian crisis. Blood samples were taken to determine adrenocorticotropic hormone levels, and hydrocortisone treatment was started. The patient responded to treatment and cortisol levels fell, confirming the diagnosis of adrenal insufficiency. Compensatory endrocrine secretion of cortisol by the contralateral adrenal gland has been observed in patients undergoing nephrectomy and adrenalectomy for excision of a hypernephroma, and replacement therapy is therefore not recommended. Perioperative Addisonian crises have also been described in patients suffering great surgical stress, and severe hypotension has been observed in patients on long-term treatment with ACE inhibitors after induction of general anesthesia and after epidural anesthesia with local anesthetics. The combination of these factors made rapid diagnosis and start of appropriate therapy difficult.

Anestesia general en una gestante con ataxia de friedreich / General anesthesia in a pregnant patient with Friedreich ataxia

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