Masa cervical gigante en recién nacida pretérmino / Giant cervical mass in a premature neonate

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Complicaciones respiratorias perioperatorias en pacientes pediátricos con masas mediastínicas: A propósito de dos casos / Perioperative respiratory complications in pediatric patients with mediastinal masses: a report of 2 cases

La anestesia general en pacientes con masas mediastínicaspuede conducir a la aparición de complicacionescardiorrespiratorias que pongan en peligro la vida delpaciente.Presentamos los casos clínicos de dos pacientes pediátricoscon masas mediastínicas que presentaron gravescomplicaciones durante la anestesia general. El primero deellos, un paciente de 13 años con sospecha diagnostica delinfoma no Hodgkin de alto grado-células T, adenopatías yuna masa en mediastino anterior, presentó edema pulmonarpor presión negativa durante el transcurso de la anestesiageneral secundario a una obstrucción severa de la víaaérea superior en presencia de ventilación espontánea. Elsegundo, un paciente de 14 años diagnosticado de enfermedadde Rosai-Dorfman y con adenopatías paratraqueales,presentó un cuadro de obstrucción severa de la víaaérea en el postoperatorio inmediato.Los problemas anestésicos que pueden presentar estospacientes comprenden oclusión aguda de la vía aérea,síndrome de la vena cava superior, compresión cardiacao de la arteria pulmonar, edema agudo de pulmón ycolapso cardiopulmonar1-3. Se considera de elección unainducción anestésica inhalatoria y mantenimiento de laventilación espontánea, evitando el uso de relajantesneuromusculares

General anesthesia in patients with mediastinal massescan lead to life-threatening cardiorespiratory complications.We report the cases of 2 pediatric patients withmediastinal masses who developed serious complicationsduring general anesthesia. The first was a 13-year-oldboy with a suspected diagnosis of high-grade T-cellnon-Hodgkin lymphoma, lymph node disease, and ananterior mediastinal mass. He developed negative pressurepulmonary edema secondary to severe upper airwayobstruction in spontaneous ventilation. The second was a14-year-old boy with Rosai-Dorfman disease andparatracheal lymph node involvement. He developed severeairway obstruction in the early postoperative period.The anesthetic difficulties that arise in these casesinclude acute airway occlusion, superior vena cavasyndrome, pulmonary artery or cardiac compression,acute pulmonary edema, and cardiopulmonary collapse.The technique of choice is induction with inhaledanesthetics and maintenance of spontaneous ventilation.Neuromuscular relaxants are avoided

[Emergency axillary brachial plexus block in a patient allergic to atropine]. / Bloqueo axilar en paciente alérgico a atropina ante una cirugía de urgencia.

Peripheral nerve blocks can provide a valid alternative for anesthetizing patients with allergy to drugs such as atropine that are often used for general anesthesia. We report the case of a 7-year-old boy (physical status ASA II, weight 28 Kg). Relevant medical history included generalized skin rash and breathing difficulties due to bronchospasm after administration of atropine eyedrops. The boy had never undergone skin testing for allergy. With a diagnosis of distal metaphyseal fracture of the right radius, he was proposed for urgent closed reduction and osteosynthesis of the lesion. After premedication with midazolam, an axillary brachial plexus block with 0.4 mL x Kg(-1) of 1% mepivacaine was performed with the aid of a nerve stimulator. The intervention was uneventful and the patient was free of pain during and after the procedure. Axillary brachial plexus block anesthesia in this pediatric patient was easy to perform, safe, and effective. It provided satisfactory conditions for surgery and made it possible to avoid administering drugs with vagotonic effects that are often used for general anesthesia and require the use of atropine.

Bloqueo axilar en paciente alérgico a atropina ante una cirugía de urgencia / Emergency axillary brachial plexus block in a patient allergic to atropine

Los bloqueos nerviosos periféricos pueden ser unaalternativa anestésica válida en pacientes con alergia afármacos empleados con frecuencia en anestesia general,como la atropina.Presentamos el caso clínico de un paciente de 7 años y28 Kg de peso valorado con estado físico ASA II. Comoantecedentes personales destaca episodio de reacciónurticariforme generalizada y dificultad respiratoria porbroncospasmo en relación con la administración de uncolirio de atropina que nunca fue estudiado por el serviciode alergología. Con el diagnóstico de fractura suprametafisariade radio derecho se propuso para reducciónortopédica cerrada y fijación urgentes. Previa premedicacióncon midazolam, se realizó un bloqueo del plexobraquial a nivel axilar mediante neuroestimulación conmepivacaína 1%, 0,4 mL Kg-1. La intervención quirúrgicatranscurrió sin incidencias. El paciente permaneciósin dolor en los periodos intra y postoperatorio.En el paciente del caso clínico que presentamos el bloqueoaxilar ha constituido una técnica anestésica fácil derealizar, segura y eficaz que ha proporcionado unas condicionesadecuadas para la intervención quirúrgica evitandola administración de fármacos de efecto vagotónicoque con frecuencia se emplean en anestesia general yque requieren la utilización de atropina

Peripheral nerve blocks can provide a valid alternativefor anesthetizing patients with allergy to drugs suchas atropine that are often used for general anesthesia.We report the case of a 7-year-old boy (physical statusASA II, weight 28 Kg). Relevant medical history includedgeneralized skin rash and breathing difficulties dueto bronchospasm after administration of atropine eyedrops.The boy had never undergone skin testing forallergy. With a diagnosis of distal metaphyseal fractureof the right radius, he was proposed for urgent closedreduction and osteosynthesis of the lesion. After premedicationwith midazolam, an axillary brachial plexusblock with 0.4 mL·Kg-1 of 1% mepivacaine was performedwith the aid of a nerve stimulator. The interventionwas uneventful and the patient was free of pain duringand after the procedure.Axillary brachial plexus block anesthesia in thispediatric patient was easy to perform, safe, and effective.It provided satisfactory conditions for surgery andmade it possible to avoid administering drugs with vagotoniceffects that are often used for general anesthesiaand require the use of atropine

[Perioperative respiratory complications in pediatric patients with mediastinal masses: a report of 2 cases]. / Complicaciones respiratorias perioperatorias en pacientes pediátricos con masas mediastínicas: a propósito de dos casos.

General anesthesia in patients with mediastinal masses can lead to life-threatening cardiorespiratory complications. We report the cases of 2 pediatric patients with mediastinal masses who developed serious complications during general anesthesia. The first was a 13-year-old boy with a suspected diagnosis of high-grade T-cell non-Hodgkin lymphoma, lymph node disease, and an anterior mediastinal mass. He developed negative pressure pulmonary edema secondary to severe upper airway obstruction in spontaneous ventilation. The second was a 14-year-old boy with Rosai-Dorfman disease and paratracheal lymph node involvement. He developed severe airway obstruction in the early postoperative period. The anesthetic difficulties that arise in these cases include acute airway occlusion, superior vena cava syndrome, pulmonary artery or cardiac compression, acute pulmonary edema, and cardiopulmonary collapse. The technique of choice is induction with inhaled anesthetics and maintenance of spontaneous ventilation. Neuromuscular relaxants are avoided.

Anestesia intradural para una cesárea urgente en una gestante con obesidad mórbida / Intradural anestesin for an emergency cesarean section in an obese patient

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