[Idiopathic brachial neuritis following general anesthesia]. / Neuritis braquial idiopática tras una anestesia general.

A 25-year-old woman complained of intense pain in her left shoulder several hours after augmentation mammaplasty under general anesthetic; pain was followed by marked sensory and motor deficit in the same arm. A diagnosis of idiopathic brachial neuritis was made after the main causes of intraoperative nerve damage had been ruled out. The shoulder pain resolved after 3 weeks but the sensory and motor deficit remained unchanged. An electrophysiological study performed at 4 weeks revealed abnormalities suggestive of edema or inflammation and an absence of signs of denervation. These findings and the favorable clinical course confirmed the diagnosis of idiopathic brachial neuritis. After 3 months, only mild weakness and numbness in the deltoid region persisted. Although most postoperative neuropathies are iatrogenic, idiopathic brachial neuritis should be included in the differential diagnosis when no evident cause is found. This syndrome is rare but may appear spontaneously after any type of surgery or anesthetic technique; the prognosis is good. Diagnosis, which can be based on symptoms, imaging and electrophysiological studies, is important both for clinical management and for establishing medical and legal liability.

Neuritis braquial idiopática tras una anestesia general / Idiopathic brachial neuritis following general anesthesia

Mujer de 25 años que, horas después de una anestesiageneral para mamoplastia de aumento, presentó dolorintenso en el hombro izquierdo seguido de un marcadodéficit motor y sensitivo en la misma extremidad. Trasdescartar las principales causas de daño neurológicointraoperatorio, se hizo un diagnóstico de presunción deneuritis braquial idiopática. A las 3 semanas de postoperatorioel dolor del hombro había cedido pero no habíacambios en la afectación motora y sensitiva. A la cuartasemana se realizó un estudio electrofisiológico que evidencióalteraciones compatibles con edema o inflamacióny ausencia de signos de denervación. Estos resultadosy la evolución clínica favorable confirmaron eldiagnóstico de neuritis braquial idiopática. A los 3 mesessólo persistía debilidad y anestesia leves en el área deltoidea.El origen de la mayoría de neuropatías postquirúrgicases yatrogénico. Sin embargo, cuando no se halleuna causa evidente debe incluirse la neuritis braquialidiopática en el diagnóstico diferencial. Se trata de unsíndrome raro de buen pronóstico que puede aparecerespontáneamente en el periodo postoperatorio con independenciadel tipo de cirugía y de la técnica anestésica.La sintomatología, las pruebas de imagen y el estudioelectrofisiológico nos permitirán confirmar el diagnóstico.Esto resulta importante tanto desde el punto de vistaclínico como a la hora de establecer posibles responsabilidadesmedicolegales (au)

A 25-year-old woman complained of intense pain in herleft shoulder several hours after augmentationmammaplasty under general anesthetic; pain was followedby marked sensory and motor deficit in the same arm. Adiagnosis of idiopathic brachial neuritis was made afterthe main causes of intraoperative nerve damage had beenruled out. The shoulder pain resolved after 3 weeks but thesensory and motor deficit remained unchanged. Anelectrophysiological study performed at 4 weeks revealedabnormalities suggestive of edema or inflammation and anabsence of signs of denervation. These findings and thefavorable clinical course confirmed the diagnosis ofidiopathic brachial neuritis. After 3 months, only mildweakness and numbness in the deltoid region persisted.Although most postoperative neuropathies are iatrogenic,idiopathic brachial neuritis should be included in thedifferential diagnosis when no evident cause is found. Thissyndrome is rare but may appear spontaneously after anytype of surgery or anesthetic technique; the prognosis isgood. Diagnosis, which can be based on symptoms,imaging and electrophysiological studies, is importantboth for clinical management and for establishing medicaland legal liability (AU)

Anestésicos locales en Cirugía Plástica y Estética / Local anesthetics in Plastic and Aesthetic Surgery

Un gran número de intervenciones de cirugía plástica se practican con técnicas de anestesia local. Los anestésicos locales (AL) son fármacos fiables y seguros aunque su uso no está exento de riesgos. El objetivo del presente estudio es describir de manera somera las principales características farmacológicas de los AL (destacando aquellos aspectos que pueden resultar más interesantes para el cirujano plástico) con el fin de optimizar sus indicaciones y prevenir las aparición de complicaciones. Los AL más utilizados son de tipo amida. El conocimiento de su mecanismo de acción así como de algunas de sus propiedades (duración, efecto vasoconstrictor, toxicidad) es indispensable a la hora de elegir el AL idóneo para cada procedimiento. También resulta importante saber qué factores no farmacológicos influyen en la acción delos AL (dosis administrada, lugar de inyección y medidas antiálgicas de inyección) para optimizar su uso; en este mismo sentido, la adición de aditivos (bicarbonato y vasoconstrictores) puede colaborara disminuir la latencia y la toxicidad así como a mejorar la duración y la calidad del efecto. El uso de adrenalina en partes (..) (AU)

A large number of Plastic Surgery procedures are performed using local anesthesia techniques. Local anesthetics (LA) are safe and reliable drugs although its use is not free of risks. The goal of this work is to describe concisely the main pharmacologycal features of LA (emphasizing the major interest characteristics for plastic surgeons) in order to improve their usage and prevent complications. Amides are the most frequently used LA. Acorrect understanding of their pharmacokinetics (duration, vasoconstricting effect, toxicity) is essential to choose a suitable LA for each procedure. It is also important to know what non-pharmacologic factors influence anesthetic activity (dosage of LA administered, site of injection, measures to reduce injection pain); in this respect, the use of additives (sodium bicarbonate and vasoconstrictors) may decrease the time for anesthesia onset and toxicity and improve the depth and duration of anesthesia. Adrenaline usage in anatomical areas with end arteries (..) (AU)

Distonía aguda secundaria a tratamiento con betahistina / Acute dystonia secondary to tratment with betahistine

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Acute painful diabetic neuropathy following severe weight loss.

A 34-year-old man, recently diagnosed as diabetic, presented an acute painful neuropathy. He reported a profound weight loss during the months preceding onset. There were no motor symptoms, and only mild neurological signs were observed on examination. Improvement was related to a good glycemic control and weight gain. Acute painful diabetic neuropathy is a condition that may affect diabetic patients shortly after development of the disease. The pathogenetic roles played by different factors are reviewed.