Childbirth with epidural analgesia in a pregnant woman with hypokalemic periodic paralysis.

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.

Parto con analgesia epidural en una gestante con parálisis periódica hipocaliémica / Childbirth with epidural analgesia in a pregnant woman with hypokalemic periodic paralysis

La parálisis hipocaliémica periódica familiar (PHPF) es una rara entidad genética que causa episodios de debilidad muscular con hipopotasemia precipitados por fármacos, estrés, alteraciones metabólicas, hipotermia o infecciones. En este artículo se describe el caso de una gestante de 38 años con PHPF en periodo activo de parto con evolución favorable con analgesia epidural. La PHPF en la gestante requiere un manejo multidisciplinar entre anestesia, ginecología y pediatría. Está indicado mantener la normotermia, prevenir la hiperventilación, monitorizar los iones en sangre, evitar las soluciones glucosadas y las medicaciones que produzcan descensos de la calcemia, aportando suplementos de potasio cuando se precise. Se prefieren las técnicas locorregionales a la anestesia general, siendo conveniente la analgesia epidural precoz en el parto para reducir el riesgo de crisis precipitadas por el dolor. En la anestesia general conviene evitar fármacos precipitantes de la hipertermia maligna y utilizar BNMND de acción corta con monitorización neuromuscular.(AU)

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.(AU)

Childbirth with epidural analgesia in a pregnant woman with hypokalemic periodic paralysis. / Parto con analgesia epidural en una gestante con parálisis periódica hipocaliémica.

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.

Tratamiento anestésico en el síndrome de Kearns-Sayre. Descripción de un caso / Anesthetic management of Kearns-Sayre syndrome. Case report

El síndrome de Kearns-Sayre constituye una miopatía mitocondrial que cursa con oftalmoplejia, retinopatía pigmentaria y alteraciones de la conducción cardiaca. Presentamos el caso de un paciente de 50 años de edad con síndrome de Kearns-Sayre intervenido de una fractura de fémur con anestesia subaracnoidea.(AU)

Kearns-Sayre syndrome is a mitochondrial myopathy characterized by ophthalmoplegia, pigmentary retinopathy and cardiac conduction abnormalities. This article describes the clinical management of a 50-year-old patient with Kearns-Sayre syndrome who underwent subarachnoid anesthesia for a traumatic femoral fracture surgery.(AU)

Anesthetic management of Kearns-Sayre syndrome. Case report. / Tratamiento anestésico en el síndrome de Kearns-Sayre. Descripción de un caso.

Kearns-Sayre syndrome is a mitochondrial myopathy characterized by ophthalmoplegia, pigmentary retinopathy and cardiac conduction abnormalities. This article describes the clinical management of a 50-year-old patient with Kearns-Sayre syndrome who underwent subarachnoid anesthesia for a traumatic femoral fracture surgery.

Neuropatía crural tras histerectomía abdominal: informe de un caso / Crural neuropathy after abdominal hysterectomy: A case report

Se presenta el caso de una mujer de 46 años de edad sin antecedentes de interés quien, tras una intervención de histerectomía abdominal con anestesia raquídea, presentó en el postoperatorio hipoestesia en la cara anterior del muslo, paresia cuadricipital y abolición del reflejo rotuliano, sin otras manifestaciones asociadas. Inicialmente dicho cuadro clínico fue achacado a la técnica anestésica. Sin embargo, las exploraciones complementarias posteriores llevadas a cabo con tomografía computarizada, resonancia magnética y electromiografía descartaron que la técnica anestésica fuera la responsable del cuadro clínico que presentaba la paciente, que fue diagnosticada de neuropatía femoral secundaria a la técnica quirúrgica realizada. Como resultado, la evolución del cuadro clínico fue satisfactoria. Dicha clínica cedió al cabo de 6 meses de tratamiento rehabilitador y de la administración oral de complejo vitamínico B. Como conclusión, cabe decir que: la cirugía en la parte baja del abdomen también puede producir lesiones en el nervio femoral, complicación que a veces se asume como consecuencia de las técnicas de anestesia raquídea

We present the case of a 46-year-old woman with no prior history of interest, who presented anteromedial thigh hypoesthesia, quadriceps paresis and no patellar reflex, with no other associated symptoms, after undergoing an abdominal hysterectomy. The symptoms were initially attributed to the anaesthesia. However, subsequent supplementary examinations, including a computed tomography scan, magnetic resonance imaging and an electromyogram ruled out anaesthesia as the cause of the patient's symptoms, who was diagnosed with femoral neuropathy secondary to the surgery performed. The patient's clinical progression was satisfactory, with abatement of symptoms after 6months of rehabilitation treatment and the oral administration of vitamin B complex. As a conclusion, lower abdominal surgery can also damage the femoral nerve, which is sometimes assumed to be caused by spinal anaesthesia

Implication of general anaesthetic and sedation techniques in temporomandibular joint disorders - a systematic review.

The purpose of this study was to conduct a systematic review of the literature on temporomandibular joint damage directly related to general anaesthesia and sedation. We searched MEDLINE, SCOPUS and the COCHRANE Library for titles and abstracts containing terms related to the subject. The search delimiters were analytical and descriptive studies with abstracts in Spanish, German, English or French, with no time limit. The search was updated in January 2015. Of the 398 articles found, 89 were duplicates and only 28 were of interest. Of these, 23 (82.14%) were case and case series reports, 4 (14.28%) were longitudinal studies and 1 (3.57%) was a cross-sectional study. General anaesthesia and sedation are risk factors for temporomandibular joint damage because of the drop in muscle tone caused by the drugs employed and because of airway management manoeuvres involving the joint. Joint complications have been described with spontaneous ventilation as well as with ventilation assisted by a face or laryngeal mask and with intubation. They are more frequent in women and/or patients with previous temporomandibular problems. Proper assessment is required both before and after anaesthesia or sedation in order to foresee and avoid or minimize temporomandibular complications. The data should be treated with caution, as the evidence of case and case series reports is not of a high standard and the small number of analytical studies is not entirely comparable. General anaesthesia and sedation techniques can influence the onset of temporomandibular joint disorders. More studies are needed to provide better clinical evidence.