Casos raros/Rare cases

Inyección accidental de anestésico local en el espacio subdural durante bloqueo caudal


Accidental deposition of local anaesthetic in the subdural space following caudal block
Prachee Sachan, Veena Asthana, Sanjay Agrawal
South Afr J Anaesth Analg 2013;19(4):220-222
Abstract
The incidence of accidental injection of local anaesthetic into the subdural space during neuraxial blockade is rare. The presentation of unexplainable clinical signs that do not match the clinical picture of subarachnoid or intravascular injection of the local anaesthetic agent should invoke high suspicion of unintentional subdural block. We report on a case of a six-month-old infant who developed motor block and unconsciousness with haemodynamic stability, following a caudal block for postoperative analgesia. The report will help to illustrate the mechanism behind the complication of subdural deposition of the drug, its detection, treatment and possible avoidance.
http://www.sajaa.co.za/index.php/sajaa/article/view/1098/1301




Uso profiláctico de emulsión de lípidos en la resección de melanoma maligno invasivo realizada con anestesia local en un obeso mórbido

The Prophylactic Use of Lipid Emulsion Therapy in the Excision of Invasive Malignant Melanoma under Local Anaesthetic in a Morbidly Obese Patient.
Sharma KS, Lim P, Brotherston TM, Smith P.
Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield S10 2FJ, UK ; Department of Plastic and Reconstructive Surgery, Sheffield Teaching Hospitals, 4 Claremont Place, Glossop Road, Sheffield S102 FJ, UK.
Case Rep Surg. 2013;2013:765279. doi: 10.1155/2013/765279. Epub 2013 Jan 16.
Abstract
We present the first reported case of the prophylactic use of lipid emulsion therapy in the removal of an extensive, circumferential malignant melanoma in a morbidly obese patient, under local anaesthetic. The advantages of this technique allowed the patient to avoid intraoperative invasive monitoring and postoperative critical care admission and assisted during the operation by rotating her leg when needed. This is a useful technique that can be employed in urgent cases where there is a need to excise extensive skin malignancies in patients who are unsuitable for general or regional anaesthesia.
http://www.hindawi.com/crim/surgery/2013/765279/




Anestesia en un caso de hernia diafragmática congénita: retraso en el diagnóstico
Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis.
Joshi S, George A.
Med J DY Patil Univ [serial online] 2013 [cited 2013 Jul 10];6:281-3.
Abstract
Congenital diaphragmatic hernia results from the anomalous closure of pericardioperitoneal canal. There are various challenges faced by anesthesiologists during management of such cases which include intraoperative complications including hypoxia and hypercarbia, which leads to pulmonary hypertension and right to left shunt. Mortality remains high because of associated pulmonary hypoplasia and pulmonary hypertension. Here, we describe anesthetic management of a 2-month-old female child with difficulty in breathing since birth following feeding, due to congenital diaphragmatic hernia.
Keywords: Congenital diaphragmatic hernia, hypoxia, pulmonary hypertension, pulmonary hypoplasia


http://www.mjdrdypu.org/text.asp?2013/6/3/281/114644



Manejo anestésico del procedimiento EXIT. Informe de un caso
Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure -A case report-.
Lee H, Ryu JW, Kim DY, Lee GY.
Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl:S154-7. doi: 10.4097/kjae.2010.59.S.S154. Epub 2010 Dec 31.
Abstract
The ex utero intrapartum treatment (EXIT) procedure is a very rare technique performed in cases of fetal congenital malformations. The EXIT procedure increases the rate of survival at delivery by maintaining the uteroplacental circulation until the airway of the fetus is secured. To maintain the uteroplacental circulation, a higher dose of inhalational anesthetics and/or intravenous nitroglycerin can be used as compared to conventional Cesarean section. The aim of this report is to share our anesthetic experience during the EXIT procedure with members of the Korean society of anesthesiology for the first time, and to highlight the maternal implications of the use of inhalational anesthetics and nitroglycerin during Cesarean section for the EXIT procedure.
KEYWORDS: Cesarean delivery, Ex utero intrapartum treatment (EXIT), Fetal malformation, General anesthesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030024/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030024/pdf/kjae-59-S154.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org