[Pharmacological properties of aprotinin and its therapeutic use in heart surgery]. / Propiedades farmacológicas de la aprotinina y empleo terapéutico en cirugía cardíaca.

Aprotinin (Trasylol) is a protease-specific inhibitor that has been used for over 5 years in extracorporeal circulation (ECC) during cardiac surgery. Patients treated with this inhibitor have considerably less postoperative bleeding, along with correspondingly lower consumption of blood products. This article reviews the history of the drug, its pharmacokinetics and pharmacodynamics, its usefulness in biological sciences and its clinical application in cardiac surgery, as well as drug interactions and side effects.

[Anesthesia in a case of Holt-Oram syndrome]. / Anestesia en un caso de síndrome de Holt-Oram.

A 19-year-old man with Holt-Oram syndrome (HOS) underwent emergency surgical treatment of an occipital abscess. He presented total aplasia of the radius and first and second finger of the left hand, asymmetric thorax and complex cyanotic cardiopathy with double output of the right ventricle that had been treated on several occasions, malpositioning of the large vessels and interventricular conduction. He had been treated with digoxin for episodes of supraventricular tachycardia. After premedication with 0.4 mg of atropine, balanced general anesthesia was induced with etomidate and remifentanil and maintained with O2/air/desflurane and infused remifentanil. The patient remained hemodynamically stable during surgery and tubes were removed in the operating room with no complications. HOS, a hereditary disease characterized by congenital malformations of the upper extremities and the heart, is often associated with rhythm disorders. Problems that may develop in such patients during anesthesia include difficulty catheterizing vessels, difficult orotracheal intubation and ventilation, hemodynamic instability, and the presentation of arrhythmias and cardiac arrest.