Distribución espacial de los Genotipos de Echinococcus granulosus sensu lato por hospedero en el continente americano. Revisión sistemática / Spatial distribution of Echinococcus granulosus sensu lato genotypes in the american continent

BACKGROUND: Knowledge of the distribution cystic is required for its territorial control. Aim: To describe the spatial distribution of Echinococcus granulosus sensu lato genotypes by host in the American continent. MATERRIAL AND METHODS: A systematic review of studies from the American continent, related to genotypes of the E. granulosus s.l complex were included, including any host species, without restriction of language or year of publication. Sensitive searches were performed based on sensitive searches from PubMed, EMBASE, ScienceDirect, SCOPUS and WoS; SciELO and BIREME-BVS and Trip Database. MeSH and free terms were used, including articles up to December 2020. Cartography was carried out with the Arc Map 10® program, using a world geodetic system. Result variables sought were genotype, host, geographic location, year of publication, number of samples, genes used for genotyping. RESULTS: From 1123 retrieved studies retrieved, 53 met the inclusion and exclusion criteria. The studies analyzed represent 3,397 samples from humans and animals. Thirty six percent of articles were published in the five-year period 2016-2020. Reports were mainly from Argentina (27.9%), Brazil (20.6%) and Chile (13.2%). The most reported genotypes globally were G1-G3 (47.3%), G7 (15.3%), G5 (14.6%) and G6 (13.3%). A predominance of G1-G3 and G6 genotypes was verified in South America, G8 and G10 in North America, and "epidemiological silence" in Central America and the Caribbean. Conclusions: Spatial analysis allows defining the relationship of territories and cases with their own characteristics, which can help to plan control interventions.

PROTEOMIC PROFILE OF ECHINOCOCCUS GRANULOSUS: A SYSTEMATIC REVIEW.

Cystic echinococcosis is a zoonotic disease caused by the larval stage of Echinococcus granulosus. This affliction is an endemic worldwide condition that represents a neglected parasitic disease with important socioeconomic repercussions. Proteomic characterization of larval and adult stages of E. granulosus, as well as the association between expression profiles and host interactions, is relevant for a better understanding of parasite biology, and eventually for drug design and vaccine development. This study aimed to develop a synthesis of the evidence available related to proteomics of E. granulosus. A systematic review was carried out to collect data concerning the proteomics of E. granulosus, without language or host restriction, published between 1980 and 2019. A systematic search was carried out in the Trip Database, BIREME-BVS, SciELO, Web of Science, PubMed, EMBASE, SCOPUS, EBSCO host, and LILACS, using MeSH terms, free words, and Boolean connectors, and adapting strategies to each source of information. Additionally, a manual cross-reference search was performed. Variables studied were the year of publication, geographic origin of the study, number of samples, hosts, parasitic organs, proteomic techniques, and parasite proteins verified. Nine-hundred and thirty-six related articles were identified: 17 fulfilled selection criteria, including slightly more than 188 samples. Most articles were published between 2014 and 2019 (64.7%) and were from Brazil and China (35.3% each). In reference to confirmed hosts in the primary articles, cattle (41.2%) and humans (23.5%) were the most frequently reported. Concerning proteomic techniques applied in the primary articles, LC-MS/MS was the most used (41.1%), and 890 proteins were reported by the primary articles. As the results of our search suggest, the information related to E. granulosus proteomics is scarce, heterogeneous, and scattered throughout several articles that include a diversity of tissues, samples, intermediate hosts, and proteomic techniques. Consequently, the level of evidence generated by our search is type 4.

[Spatial distribution of Echinococcus granulosus sensu lato genotypes in the american continent]. / Distribución espacial de los Genotipos de Echinococcus granulosus sensu lato por hospedero en el continente americano. Revisión sistemática.

BACKGROUND: Knowledge of the distribution cystic is required for its territorial control. AIM: To describe the spatial distribution of Echinococcus granulosus sensu lato genotypes by host in the American continent. MATERIAL AND METHODS: A systematic review of studies from the American continent, related to genotypes of the E. granulosus s.l complex were included, including any host species, without restriction of language or year of publication. Sensitive searches were performed based on sensitive searches from PubMed, EMBASE, ScienceDirect, SCOPUS and WoS; SciELO and BIREME-BVS and Trip Database. MeSH and free terms were used, including articles up to December 2020. Cartography was carried out with the Arc Map 10® program, using a world geodetic system. Result variables sought were genotype, host, geographic location, year of publication, number of samples, genes used for genotyping. RESULTS: From 1123 retrieved studies retrieved, 53 met the inclusion and exclusion criteria. The studies analyzed represent 3,397 samples from humans and animals. Thirty six percent of articles were published in the five-year period 2016-2020. Reports were mainly from Argentina (27.9%), Brazil (20.6%) and Chile (13.2%). The most reported genotypes globally were G1-G3 (47.3%), G7 (15.3%), G5 (14.6%) and G6 (13.3%). A predominance of G1-G3 and G6 genotypes was verified in South America, G8 and G10 in North America, and "epidemiological silence" in Central America and the Caribbean. CONCLUSIONS: Spatial analysis allows defining the relationship of territories and cases with their own characteristics, which can help to plan control interventions.

Echinococcus granulosus sensu lato Genotypes in Different Hosts Worldwide: A Systematic Review.

INTRODUCTION: The aim of this study was to develop a synthesis of the evidence available regarding verified E. granulosus sensu lato (s.l.) genotypes in different species worldwide. MATERIAL AND METHODS: A systematic review was performed including studies concerning genotypes of E. granulosus s.l. without language or genotyped method restriction, published between 1990 and 2020. A systematic search was carried out in Trip Database, BIREME, SciELO, LILACS, IBECS, PAHO-WHO, EMBASE, PubMed, Scopus, and WoS. Variables of interest were year of publication, country, number of samples, and hosts; genotypes, molecular marker, haplotypes and molecular biology techniques used. Descriptive statistics were applied. RESULTS: 2411 articles were analyzed, however 135 met the selection criteria, representing 8643 liver and lung samples. Of the samples selected 24% were human, the remaining samples pertained to non-human animal hosts; cattle and sheep prevailed with 28.6% and 26.6% of the studied samples, respectively. The reported evidence is mainly from Iran, Turkey, Argentina, China and Chile; with 50, 11, 6, 6 and 5 studies, respectively, published between 1992 and 2020 [most frequently during 2015-2020 (76/135 studies; 56.3%)]. The mitochondrial gene cox1 was generally sequenced and informative (91.8%). Genotypes most frequently identified were E. granulosus sensu stricto (s.s.) (83.2%). CONCLUSIONS: Based on this overall evidence, it can be concluded that publications related to genotypes of E. granulosus s.l. are heterogeneous. E. granulosus ss accounts for the vast majority of the global burden of E. granulosus s.l. worldwide. Further studies including larger number of cases and adequate internal validity are required to specify the distribution of genotypes in various host species. TRIAL REGISTRATION: PROSPERO CRD42018099827.

The hemodynamic effects of diazepam versus dexmedetomidine in the treatment of alcohol withdrawal syndrome: A randomized clinical trial / Efectos hemodinámicos del diazepam versus la dexmedetomidina en el tratamiento del síndrome de abstinencia del alcohol: ensayo clínico aleatorizado

Background: Dexmedetomidine (DEX) is an alpha-2 adrenergic drug used for short sedation and as an alternative to diazepam (DZP) in the treatment of alcohol withdrawal syndrome (AWS).PurposeThis study aims to compare the hemodynamic effect of DZP versus DEX on heart rate (HR) and blood pressure in patients with AWS.MethodsProspective randomized clinical trial that includes 40 patients with AWS from Mérida, Yucatán, México.ResultsForty patients were randomly divided into two groups: one group DZP (n=20) patients received diazepam (doses 5–20mg IV) and the other group (n=20) received DEX (dexmedetomidine infusion .2–.7mcg/kg/min). We obtained statistical significance in sedation with the DEX group in the degree of traumatic brain injury I/II (p=.003). The DEX group remained haemodynamically stable in the first 24h, the mean HR (73.85±8.39) was significant comparing both groups (p=.002). In the comparison of the figures for the DEX group with the DZP (143.85±2.30–137.95±5.62) the SBP was significant with a (p=.0001). Furthermore, DEX treatment was shorter.ConclusionAlthough DEX is not indicated for the routine treatment of AWS, this study proposes a positive effect on HR, SBP and fewer days of treatment compared to the standard DZP treatment for AWS. (AU)

Antecedentes: La dexmedetomidina (DEX) es un fármaco alfa-2 adrenérgico, utilizado para la sedación corta y como alternativa al diazepam (DZP) en el tratamiento por síndrome de abstinencia por alcohol.ObjetivosComparar el efecto hemodinámico del DZP versus la DEX en la frecuencia cardíaca (FC) y la presión arterial en pacientes con síndrome de abstinencia del alcohol.MétodosEnsayo clínico aleatorizado prospectivo en 40 pacientes con síndrome de abstinencia de alcohol, del Hospital General Agustín O’Horán Mérida, Yucatán, México.ResultadosCuarenta pacientes fueron divididos aleatoriamente en 2 grupos: grupo DZP (n=20) recibió DZP n=20 (dosis: 5-20mg IV) y el otro grupo (n=20) recibió DEX (infusión de DEX: 0,2-0,7μg/kg/min). Obtuvimos significancia estadística en la sedación con el grupo de DEX en el grado de trauma craneoencefálico I/II (p=0,003). El grupo de DEX se mantuvo hemodinámicamente estable en las primeras 24h, la media FC (73; 85±8,39) fue significativa comparando ambos grupos (p=0,002). Las cifras de PAS para el grupo DEX comparada con DZP (143; 85±2; 30-137, 95±5,62) fue significativa con a (p=0,0001). Además, el tratamiento con DEX fue de menor duración.ConclusiónAunque DEX no está indicado para el tratamiento de rutina de AWS, este estudio propone un efecto positivo hemodinámicamente sobre la FC, la PAS y menos días de tratamiento en comparación con el tratamiento estándar de DZP para el tratamiento del síndrome de abstinencia del alcohol. (AU)

The hemodynamic effects of diazepam versus dexmedetomidine in the treatment of alcohol withdrawal syndrome: A randomized clinical trial.

BACKGROUND: Dexmedetomidine (DEX) is an alpha-2 adrenergic drug used for short sedation and as an alternative to diazepam (DZP) in the treatment of alcohol withdrawal syndrome (AWS). PURPOSE: This study aims to compare the hemodynamic effect of DZP versus DEX on heart rate (HR) and blood pressure in patients with AWS. METHODS: Prospective randomized clinical trial that includes 40 patients with AWS from Mérida, Yucatán, México. RESULTS: Forty patients were randomly divided into two groups: one group DZP (n=20) patients received diazepam (doses 5-20mg IV) and the other group (n=20) received DEX (dexmedetomidine infusion .2-.7mcg/kg/min). We obtained statistical significance in sedation with the DEX group in the degree of traumatic brain injury I/II (p=.003). The DEX group remained haemodynamically stable in the first 24h, the mean HR (73.85±8.39) was significant comparing both groups (p=.002). In the comparison of the figures for the DEX group with the DZP (143.85±2.30-137.95±5.62) the SBP was significant with a (p=.0001). Furthermore, DEX treatment was shorter. CONCLUSION: Although DEX is not indicated for the routine treatment of AWS, this study proposes a positive effect on HR, SBP and fewer days of treatment compared to the standard DZP treatment for AWS. Clinical Trials.gov ID: NCT03877120-https://clinicaltrials.gov/ct2/show/NCT03877120.

Genotipos de Echinococcus granulosus en hidatidosis humana alrededor del mundo: revisión sistemática / Echinococcus granulosus genotypes verified in human hydatid disease around the world: systematic review

Resumen Introducción: La evidencia sobre las características genotípicas de la infección por Echinococcus granulosus en humanos es escasa. Objetivo: Desarrollar un resumen de la evidencia disponible respecto a genotipos de E. granulosus verificados en hidatidosis humana en el mundo. Material y Métodos: Revisión sistemática. Se incluyeron artículos relacionados con genotipos de E. granulosus, en humanos, sin restricción de lenguaje ni método de secuenciación; publicados entre 1990-2019. Se realizó una búsqueda sistemática en WoS, EMBASE, MEDLINE, SCOPUS, Trip Database, BIREME, SciELO, LILACS, IBECS y OPS-OMS. Las variables en estudio fueron: año de publicación, país de origen, número de muestras, órganos parasitados, marcador molecular utilizado y genotipo identificado. Se aplicó estadística descriptiva. Resultados: Se identificaron 701 artículos relacionados; 62 cumplieron los criterios de selección, representando 1.511 muestras. La evidencia existente fue publicada entre 1994 y 2019 y proviene principalmente de Irán (45,2%). El método de secuenciación más utilizado fue amplificación por reacción de polimerasa en cadena más secuenciación tipo Sanger con genotipificación del gen cox1 (79,0%). Los genotipos identificados con mayor frecuencia fueron G1 (49,1%) y el complejo G1/G3 (32,2%). Conclusión: Las publicaciones relacionadas con genotipos de E. granulosus en humanos son escasas y heterogéneas. Eg G1 representa la mayor parte de la carga global mundial.

Abstract Background: The evidence regarding genotypic characteristics of Echinococcus granulosus infection in humans worldwide is scarce. Aim: To develop a synthesis of the available evidence regarding genotypes of E. granulosus verified in humans worldwide. Methods: Systematic review. Articles related with genotypes of E. granulosus, in humans, without language neither genotyped method restriction, published between 1990-2019 were included. A systematic in WoS, EMBASE, MEDLINE, SCOPUS, Trip Database, BIREME, SciELO, LILACS, IBECS, and PAHO-WHO was carried out. In study variables were year of publication, country, number of samples, host and parasite organs, genotype identified, molecular marker and genes. Descriptive statistics were applied. Results: 701 related articles were identified; 62 fulfilled selection criteria, representing 1,511 samples. The existing evidence was published between 1994 and 2019; and mainly comes from Iran (45.2%). The most commonly used sequencing method was PCR amplification and Sanger type sequencing with partial or total genotyping of the cox1 gene. Genotyped method most frequently used was cox1 (79,0%). Genotypes most frequently identified were G1 and G1/G3 complex (49.1% and 32.2%). Conclusions: Publications related to genotypes of Eg in humans are scarce, heterogeneous, and presenting differing results. Eg G1/G3 accounts for most of the global burden worldwide.

Colitis amebiana necrosante, presentación de un caso / Necrotizing amebian colitis, case report

Resumen Introducción: La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) han definido la amebiasis como la infección por Entamoeba histolytica, independientemente de los síntomas. La colitis amebiana necrosante es una forma rara de amebiasis que se asocia con una alta morbilidad y mortalidad. Caso clínico: Presentamos a un paciente femenino de 68 años, con antecedentes de diabetes mellitus tipo 2, con colitis amebiana necrosante con múltiples perforaciones, que fue sometida a una hemicolectomía derecha con íleo-transverso anastomosis. Conclusiones: Se necesitan intervenciones efectivas para prevenir la colitis amebiana y terapias adicionales para tratar la colitis amebiana fulminante y mejorar los resultados.

Abstract Background: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. Case Report: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. Conclusions: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

Echinococcus Granulosus Haplotypes in the Scientific Literature.

Echinococcus granulosus (Eg) is a parasite causing an incidental infection in humans. The disease can be observed as a hydatid cyst in the liver and lungs and is found in dogs and wolves as definitive hosts. It is considered a neglected infectious disease which has rarely been studied in Mexico1.

[Necrotizing amebian colitis, case report]. / Colitis amebiana necrosante, presentación de un caso.

BACKGROUND: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. CASE REPORT: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. CONCLUSIONS: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

[Echinococcus granulosus genotypes verified in human hydatid disease around the world. Systematic review]. / Genotipos de Echinococcus granulosus en hidatidosis humana alrededor del mundo. Revisión sistemática.

BACKGROUND: The evidence regarding genotypic characteristics of Echinococcus granulosus infection in humans worldwide is scarce. AIM: To develop a synthesis of the available evidence regarding genotypes of E. granulosus verified in humans worldwide. METHODS: Systematic review. Articles related with genotypes of E. granulosus, in humans, without language neither genotyped method restriction, published between 1990-2019 were included. A systematic in WoS, EMBASE, MEDLINE, SCOPUS, Trip Database, BIREME, SciELO, LILACS, IBECS, and PAHO-WHO was carried out. In study variables were year of publication, country, number of samples, host and parasite organs, genotype identified, molecular marker and genes. Descriptive statistics were applied. RESULTS: 701 related articles were identified; 62 fulfilled selection criteria, representing 1,511 samples. The existing evidence was published between 1994 and 2019; and mainly comes from Iran (45.2%). The most commonly used sequencing method was PCR amplification and Sanger type sequencing with partial or total genotyping of the cox1 gene. Genotyped method most frequently used was cox1 (79,0%). Genotypes most frequently identified were G1 and G1/G3 complex (49.1% and 32.2%). CONCLUSIONS: Publications related to genotypes of Eg in humans are scarce, heterogeneous, and presenting differing results. Eg G1/G3 accounts for most of the global burden worldwide.

Trasplante renal en bloque: a propósito de un caso / En bloc kidney transplantation: case report

En México la enfermedad renal crónica en la población pediátrica es un grave problema de salud pública. Las alternativas terapéuticas en niños con enfermedad renal crónica (ERC) son la diálisis y el trasplante renal (TxR), siendo esta última, la mejor opción terapéutica actual en niños con estadios terminal de la función renal. El objetivo de este manuscrito, fue reportar nuestra experiencia en el tratamiento perioperatorio de pacientes pediátricos sometidos a trasplante renal en bloque. Paciente de sexo femenino, 12 años de edad, originaria de Veracruz, México. Portadora de ERC estadio IV de KDOQI, secundaria a glomerulopatía. Fue programada para TxR en bloque de donante cadavérico pediátrico; el que se realizó bajo anestesia general balanceada, con ventilación mecánica controlada, isquemia fría de 17 hs, isquemia caliente de 30 min y un tiempo quirúrgico de 5 hs y 10 min. El tiempo anestésico total, fue de 6 hs. La paciente fue trasladada a la Unidad de Terapia Intensiva Pediátrica, con adecuada aceptación del injerto renal. Durante los siguientes siete meses, el curso clínico ha sido satisfactorio, con estudios ecotomográficos renales normales. En esta paciente la glomerulonefritis, le ocasionó que debutara a muy corta edad con una enfermedad renal crónica con terapia sustitutiva de hemodiálisis. El trasplante renal en bloque realizado, fue exitoso debido al manejo multidisciplinario que participa en el programa de trasplante renal

In Mexico, chronic kidney disease is a major public health problem in pediatric patients. The therapeutic options for chronic kidney disease (CKD) in children are dialysis and kidney transplant (KT); the latter constitutes the current treatment of choice for children suffering from end-stage renal disease. The aim of this study was to describe our experience of perioperative treatment of pediatric patients undergoing en bloc kidney transplant. Female patient, 12 years old, from Veracruz, Mexico, suffering from stage 4 CKD according to KDOQI criteria, secondary to glomerulonephritis. An en bloc kidney transplantarion from a pediatric deceased donor was performed; balanced general anesthesia with mechanical ventilation was used. Cold ischemia time was 17 hours and warm ischemia time was 30 minutes. The surgery lasted 5 hours and 10 minutes and the total anesthesia time was 6 hours. The patient was taken to the pediatric intensive care unit and showed an adequate renal graft acceptance. During the following seven months the clinical course was satisfactory and kidney echotomography showed normal results. Glomerulonephritis made this patient undergo hemodialysis replacement therapy due to CKD at a very early age. The en bloc kidney transplantation performed was successful thanks to the multidisciplinary management involved in the Kidney Transplant Program

[Clinical, serological and polymerase chain reaction follow-up of a family with brucellosis]. / Seguimiento clínico, serológico y mediante la reacción de polimerasa en cadena de una familia con brucelosis.

INTRODUCTION: Human brucellosis diagnosis is based on isolation of Brucella spp. from blood or tissue cultures with a positivity rate of 40-70% and serology techniques are used as complementary tools; recently molecular biology diagnostic techniques have been developed intending to optimize the etiological confirmation. AIM: The main objective of this work was to compare the polymerase chain reaction (PCR), against serological diagnostic tests during the clinical follow-up of a family presenting brucellosis. METHODS: Seven family members who lived in the urban area of Mexico City, were monitored using the Rose Bengal test, the agglutination test as well as agglutination with 2 mecapto ethanol, blood cultures and serum PCR for a period of 27 months. The suspected source of infection was fresh goat cheese from a known endemic zone. RESULTS: Brucella melitensis was isolated from the blood cultures of two patients. All of the patients were positive in serological and PCR tests at the beginning of this follow-up. At the end of the study, three patients responded well to the treatment and showed negative results in the serological and PCR tests. While two patients with diabetes mellitus type 2, showed positive results in the serological and PCR tests as well as persistent symptoms. CONCLUSION: Clinical follow-up of patients with brucellosis is of great importance, to properly evaluate the given treatment. In this sense the PCR is a great supporting tool in diagnostic testing.

Seguimiento clínico, serológico y mediante la reacción de polimerasa en cadena de una familia con brucelosis / Clinical, serological and polymerase chain reaction follow-up of a family with brucellosis

Introduction: Human brucellosis diagnosis is based on isolation of Brucella spp. from blood or tissue cultures with a positivity rate of 40-70% and serology techniques are used as complementary tools; recently molecular biology diagnostic techniques have been developed intending to optimize the etiological confirmation. Aim: The main objective of this work was to compare the polymerase chain reaction (PCR), against serological diagnostic tests during the clinical follow-up of a family presenting brucellosis. Methods: Seven family members who lived in the urban area of Mexico City, were monitored using the Rose Bengal test, the agglutination test as well as agglutination with 2 mecapto ethanol, blood cultures and serum PCR for a period of 27 months. The suspected source of infection was fresh goat cheese from a known endemic zone. Results: Brucella melitensis was isolated from the blood cultures of two patients. All of the patients were positive in serological and PCR tests at the beginning of this follow-up. At the end of the study, three patients responded well to the treatment and showed negative results in the serological and PCR tests. While two patients with diabetes mellitus type 2, showed positive results in the serological and PCR tests as well as persistent symptoms. Conclusion: Clinical follow-up of patients with brucellosis is of great importance, to properly evaluate the given treatment. In this sense the PCR is a great supporting tool in diagnostic testing.

Introducción: El diagnóstico de brucelosis humana es difícil pues los cultivos de sangre y tejidos tienen un rendimiento limitado (40-70%) y usualmente se recurre a la serología como recurso complementario; últimamente se han desarrollado técnicas de biología molecular que intentan optimizar la confirmación etiológica. Objetivo: Comparar la reacción de la polimerasa en cadena (RPC) con las pruebas de diagnóstico serológicas en el seguimiento clínico de una familia con brucelosis. Métodos: Siete integrantes de una familia con brucelosis que habitaban la zona urbana de Ciudad de México fueron monitoreados mediante aglutinación con antígeno Rosa de Bengala, prueba de aglutinación, aglutinación en presencia de 2 mercapto-etanol, hemocultivos y RPC en suero durante 27 meses. La probable fuente de infección de los pacientes fue el consumo de queso fresco de cabra originario de una zona endémica. Resultados: Brucella melitensis se obtuvo del hemocultivo de dos pacientes. Todos los pacientes fueron positivos a las pruebas serológicas y al RPC al inicio del seguimiento. Tres pacientes respondieron bien al tratamiento y mostraron resultados negativos en serología y RPC al final del estudio. Mientras que en dos pacientes con diabetes mellitus tipo 2 la sintomatología fue persistente, serología positiva y RPC positivos al finalizar el estudio. Conclusión: El seguimiento clínico de pacientes con brucelosis es muy importante para valorar el tratamiento, en este sentido la RPC es una herramienta que puede apoyar a otras pruebas de diagnóstico.

Consideraciones anestésicas para cirugía ortognática: reporte de un caso clínico / Anesthetic considerations for orthognathic surgery: Clinical case report

Objetivo: Selección de fármacos anestésicos ideales en cirugía maxilofacial. Material y métodos: Varón de 22 años, 75 kg de peso y 171cm de altura. No premedicado. Parámetros vitales prequirúrgicos: PA120/70; FC72×min; SPO(2)96%; temperatura 36,5°C; ECG 5 derivaciones ritmo sinusal, y capnografía. Preoxigenación por 5min mediante mascarilla facial. Se realiza prueba de olfateo corroborando buena ventilación, se coloca hisopo impregnado de oximetazolina spray 0,05%. Se inicia la administración de dexmedetomidina (concentración de solución 0,8μg/ml) en infusión continua por vía intravenosa a 0,05μg/kg/h con una escala Ramsay 2, se inicia inducción con fentanil 3μg/g, propofol 2mg/kg, rocuronio 0,6mg/kg. Se introduce por narina derecha tubo endotraqueal Murphy N.° 7, lubricado con lidocaína 10% spray, a través de la nasofaringe. Comenzando la cirugía se la ajusta dosis de dexmedetomidina a 0,1μg/kg/h. Durante el acto anestésico-quirúrgico se mantiene con PA entre 84/55 y 90/53mmHg, FC con cifras entre 58-76 por minuto. Resultados: La selección de los fármacos anestésicos permitió lograr la estabilidad hemodinámica y bienestar en el despertar del paciente. Conclusión: La anestesia para cirugía ortognática en la actualidad por su evolución hace necesario combinar diferentes técnicas anestésicas para poder proporcionar a los pacientes tranquilidad, seguridad, bienestar y analgesia postoperatoria.

Objective: Selection of ideal anesthetic drugs in maxillofacial surgery. Material and methods: A 22-year-old male patient weighing 75 kg and 171cm in height, with no premedication. Pre-operative vital parameters were BP 120/70, HR 72× min, SpO2 96%, temperature 36.5 ◦C, sinus rhythm on 5-lead EKG, capnograpy. The patient was subjected to 5 min of pre-oxygenation through a facial mask. The sniff test was performed, good ventilation was confirmed and a Q-tip impregnated in 0.05% oxymetazoline was applied. An intravenous continuous infusion of dexmedetomidine (solution concentration of 0.8 cg/ml) was initiated at a rate of 0.05 mcg/kg/h with a score of 2 on the Ramsay scale. Induction was initiated with fentanyl 3 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg. A No. 7 Murphy endotracheal tube lubricated with a 10% lidocaine spray was introduced through the right nostril down to the nasopharynx. At the start of surgery, the dose of dexmedetomidine was increased to 0.1 mcg/kg/h. Intra-operatively, BP was maintained between 84/55mmHg and 90/53mmHg, and HR between 58 and 76 per minute. Results: The selection of anesthetic drugs allowed for hemodynamic stability and comfort on awakening. Conclusion: Anesthesia for orthognathic surgery, as it has evolved today, requires combining different anesthetic techniques in order to ensure that the patient remains calm, comfortable and reassured, with adequate post-operative analgesia.