Craneotomía en el paciente consciente. Consideraciones en situaciones especiales / Awake craniotomy. Considerations in special situations

La craneotomía con el paciente despierto es un procedimiento ancestral, que vuelve a estar de actualidad. Confinada durante mucho tiempo a la cirugía de la epilepsia, sus indicaciones se han ampliado, siendo una técnica ampliamente reconocida para la resección de lesiones próximas a regiones corticales fundamentales, y en neurocirugía funcional. Es un procedimiento seguro, que además de proporcionar excelentes resultados, ahorra dinero y recursos. El anestesiólogo ha de estar familiarizado con los fundamentos de la neuroanestesia, conocer la técnica concreta de infiltración, así como los protocolos de sedación, y manejarse cómodamente con la vía aérea. El objetivo principal es que el paciente colabore en los momentos en que el cirujano lo precise (anestesia basada en la analgesia). Esta revisión pretende sintetizar lo publicado hasta la fecha, pues cada vez son más los procedimientos de esta naturaleza que se van a realizar, sobre todo en la población pediátrica(AU)

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population(AU)

[Awake craniotomy. Considerations in special situations]. / Craneotomía en el paciente consciente. Consideraciones en situaciones especiales.

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.

[Analysis of the causes for increases in the length of stay in the Recovery Unit of La Paz Maternity Hospital in 2008]. / Análisis de las causas de prolongación de la estancia en la Unidad de Reanimación del Hospital Maternal La Paz en el año 2008.

OBJECTIVE: To establish the spectrum of diseases in the obstetric patient that involves an increase in the length of stay in the Recovery Unit of a specialist Maternity Hospital. To analyse the severity of these conditions as regards the means required for their resolu-tion, as well as to identify the factors that influence on post-operative morbidity in the obstetric patient. MATERIAL AND METHODS: All the case histories of all the patients admitted to the Maternity Hospital Recovery Unit during the year 2008 were reviewed. Those who required a lon-ger stay than usual were selected, which included, those with more than 6hours after a caesarean, and all admissions made during pregnancy, or after dilation and curettage or partum. RESULTS: Out of a total of 10419 births delivered in 2008, 3000 obstetric patients were ad-mitted to the Maternity Hospital Recovery Unit, of which 285 (9.5%) required critical care. The most frequent cause of increased length of stay was obstetric haemorrhage, followed by hypertensive states of pregnancy. No patients died in this Unit in the year 2008. CONCLUSIONS: The number of patients who had an increased length of stay in the Mater-nity Hospital Recovery Unit is similar to the percentage of patients who are admitted to Intensive Care Units in countries such as Canada or the United Kingdom, but our Unit had a lower death rate in the year evaluated. The main causes are obstetric haemorrhage and hypertensive states of pregnancy, thus patients with risk factors for developing these complications must be observed closely and monitored.

Análisis de las causas de prolongación de la estancia en la Unidad de Reanimación del Hospital Maternal La Paz en el año 2008 / Analysis of the causes for increases in the length of stay in the Recovery Unit of La Paz Maternity Hospital in 2008

Objetivo: Establecer el espectro de enfermedades de la paciente obstétrica que implican la estancia prolongada en la unidad de reanimación de un hospital maternal monográfico; analizar la gravedad de dichas alteraciones en función de las medidas requeridas para su resolución, así como identificar los factores que influyen en la morbilidad del postoperatorio de la paciente obstétrica. Material y métodos: Se revisan todas las historias clínicas de todas pacientes que ingresaron en la Unidad de Reanimación del Hospital Universitario Maternal La Paz durante el año 2008, y se selecciona a las que requirieron un ingreso más largo de lo habitual, es decir, más de 6 h tras una cesárea y todo ingreso que se produjera durante la gestación o tras un legrado o el parto. Resultados: De un total de 10.419 nacimientos que se produjeron en 2008, 3.000 pacientes obstétricas pasaron por la Unidad de Reanimación del Hospital Maternal, de las que 285 (9,5%) necesitaron cuidados críticos. La causa más frecuente de la estancia prolongada fue la hemorragia obstétrica, seguida de los estados hipertensivos del embarazo. Ninguna paciente obstétrica falleció en esta unidad en 2008. Conclusiones: La cifra de pacientes que tuvieron que prolongar su estancia en la Reanimación del Hospital Maternal es similar al porcentaje de pacientes graves obstétricas que ingresan en unidades de cuidados intensivos de países como Canadá o Reino Unido, pero con una mortalidad menor en nuestro servicio en el año evaluado. Las principales causas son la hemorragia obstétrica y los estados hipertensivos del embarazo. Por ello, se debe vigilar y monitorizar a las pacientes con factores de riesgo de sufrir estas complicaciones(AU)

Objective: To establish the spectrum of diseases in the obstetric patient that involves an increase in the length of stay in the Recovery Unit of a specialist Maternity Hospital. To analyse the severity of these conditions as regards the means required for their resolution, as well as to identify the factors that influence on post-operative morbidity in the obstetric patient. Material and methods: All the case histories of all the patients admitted to the Maternity Hospital Recovery Unit during the year 2008 were reviewed. Those who required a longer stay than usual were selected, which included, those with more than 6 hours after a caesarean, and all admissions made during pregnancy, or after dilation and curettage or partum. Results: Out of a total of 10 419 births delivered in 2008, 3000 obstetric patients were admitted to the Maternity Hospital Recovery Unit, of which 285 (9.5%) required critical care. The most frequent cause of increased length of stay was obstetric haemorrhage, followed by hypertensive states of pregnancy. No patients died in this Unit in the year 2008. Conclusions: The number of patients who had an increased length of stay in the Maternity Hospital Recovery Unit is similar to the percentage of patients who are admitted to Intensive Care Units in countries such as Canada or the United Kingdom, but our Unit had a lower death rate in the year evaluated. The main causes are obstetric haemorrhage and hypertensive states of pregnancy, thus patients with risk factors for developing these complications must be observed closely and monitored(AU)