[Single-port video-assisted thoracic surgery in an awake patient]. / Cirugía torácica asistida por vídeo uniportal en paciente despierto.

Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery.

Timectomía toracoscópica con insuflación de dióxido de carbono / Thoracoscopic thymectomy with carbon dioxide insufflation in the mediastinum

Presentamos el caso de un varón de 71 años diagnosticado de timoma. Se interviene al paciente mediante timectomía con visión mediante toracoscopia e insuflación del mediastino con dióxido de carbono. Durante el procedimiento, en ventilación unipulmonar, el paciente sufre un deterioro respiratorio importante. Se observa el colapso del pulmón debido al paso del dióxido de carbono del mediastino al tórax contralateral por la apertura de la pleura. Se decide volver a la ventilación bipulmonar, con mejoría de la oxigenación en gasometría arterial, presiones en la vía respiratoria y estabilización de pCO2 y pH. Se pudo mantener el abordaje y la técnica con dióxido de carbono, puesto que no afectó al campo quirúrgico. Esta técnica presenta complicaciones importantes asociadas, y en caso de realizarse estaría indicado hacerlo en ventilación bipulmonar (AU)

The case is presented of a 71 year-old male, diagnosed with a thymoma. A thoracoscopic thymectomy was performed using the carbon dioxide insufflation technique in the mediastinum. During the procedure, while performing one-lung ventilation, the patient's respiration worsened. The contralateral lung had collapsed, as carbon dioxide was travelling from the mediastinum to the thorax through the opened pleura. Two-lung ventilation was decided upon, which clearly improved oxygenation in the arterial gases and airway pressures. Both pH and pCO2 stabilized. The surgical approach and the carbon dioxide technique were continued because 2-lung ventilation did not affect the surgical procedure. This technique has many serious complications and it should always be performed using 2-lung ventilation (AU)

[Thoracoscopic thymectomy with carbon dioxide insufflation in the mediastinum]. / Timectomía toracoscópica con insuflación de dióxido de carbono.

The case is presented of a 71 year-old male, diagnosed with a thymoma. A thoracoscopic thymectomy was performed using the carbon dioxide insufflation technique in the mediastinum. During the procedure, while performing one-lung ventilation, the patient's respiration worsened. The contralateral lung had collapsed, as carbon dioxide was travelling from the mediastinum to the thorax through the opened pleura. Two-lung ventilation was decided upon, which clearly improved oxygenation in the arterial gases and airway pressures. Both pH and pCO2 stabilized. The surgical approach and the carbon dioxide technique were continued because 2-lung ventilation did not affect the surgical procedure. This technique has many serious complications and it should always be performed using 2-lung ventilation.

Respuesta metabólica inmunológica e inflamatoria a la agresión anestésico quirúrgica / No disponible

En su conjunto, la respuesta inmune pretende: destruir los elementos extraños o no reparables del organismo; delimitar y aislar el foco inflamatorio, reparar las lesiones promoviendo la cicatrización y la neovascularización, activar los mecanismos generales que aporten células y nutrientes (activación neuroendocrina y metabólica); y evitar la generalización del proceso, induciendo una cierta inmunodepresión sistémica contrarreguladora. En el presente trabajo se hace una revisión sobre los aspectos fisiopatológicos derivados de la respuesta metabólica, inmunológica e inflamatoria a la agresión quirúrgica(AU)

On the Whole, the immune response seeks: to destroy the foreing or not repairable elements of the organism; to limit and to isolate the focus of the inflamation; to repair the lesion by advancyng the cicatrization and the neovascularización; to activate the general mechanisms that bring cells and nutrients (neuroendocrina and metabolic activation); and to avoid the generalization of the process inducing a certain systemic contraregulatory inmunodepression In the present work a review is maid of the physiopatologyc aspects derived from the metabolic, immunological and inflammatory response to the surgical aggression(AU)

Aspectos clínicos del estrés quirúrgico / No disponible

La agresión quirúrgica provoca una respuesta endocrinometabólica, siendo el dolor postoperatorio uno de los factores implicados en la producción de dicha respuesta, consecuencia de la activación del sistema simpático y estimulación del eje endocrino hipotálamo-hipofisario-adrenal (HHA). El anestesiólogo puede modificar estas respuestas endocrinas y metabólicas al utilizar los distintos fármacos o técnicas anestésicas durante el acto quirúrgico. En un intento de frenar los efectos de la secreción de catecolaminas, debida al estrés quirúrgico, se han utilizado fármacos como los bloqueantes beta adrenérgicos, con el fin de evitar complicaciones como la isquemia miocárdica perioperatoria. Los resultados han demostrado que los betabloqueantes no disminuyen la respuesta neuroendocrina al estrés, pero sí disminuyen los requerimientos analgésicos, se produce una recuperación de la anestesia más rápida y una mejoría en la estabilidad hemodinámica. En el presente trabajo se hace una revisión sobre los aspectos clínicos derivados de la respuesta neuroendocrina, metabólica, inmunológica e inflamatoria a la agresión quirúrgica(AU)

The surgical aggression provokes an endocrinometabolic response, with the postoperatory pain beeing one of the factors involved in the production of the above mentioned response, consequence of the activation of the simpathetic nervous system and stimulation of the endocrine hypothalamus - hipofisario-adrenal axis (HHA). The anaesthtetist can modify these endocrine and metabolic responses on by using the different drugs or anesthesic techniques during the surgical operation. In an attempt to the limit the effects of the catecolamines secretion due to the surgical stress, the medicaments such as adrenergic betablockers have been iused, in order to avoid complications such perioperatory myocardic ischemia. The results have demonstrated that betablockers do not reduce the neuroendocrine response to the stress, but do reduce the analgesic requirements, tand a faster recovery from the anesthesia is produced, and an improvement in the hemodinámic stability In the present work a review is made on the clinical aspects derived from the neuroendocrine, metabolic, immunological and inflammatory response to the surgical aggression(AU)