domingo, 25 de agosto de 2013

Casos raros/Rare cases

Efecto aditivo de propofol y fentanilo precipitando shock cardiogénico


Additive effect of propofol and fentanyl precipitating cardiogenic shock.
Prabhakaran AJ.
J Pharmacol Pharmacother [serial online] 2013 [cited 2013 Jul 5];4:217-9.
Abstract

intravenous administration of propofol and fentanyl has become a common practice in a variety of clinical settings including outpatient dermatologic, cosmetic and oral surgery. The combination provides both systematic sedation and analgesia with low incidence of unwanted side effects. The cardiogenic shock is very uncommon in healthy individuals. The cardiovascular depressive effect of propofol and fentanyl has been well established, but the development of cardiogenic shock is very rare when these drugs are used together. Hence the awareness of this effect is advantageous to the patients undergoing such surgeries
Keywords: Echocardiography, left ventricular ejection fraction, myocardial infarction
http://www.jpharmacol.com/text.asp?2013/4/3/217/114612

Obstrucción aguda de la vía aérea secundaria a un quiste epiglótico congénito

Acute airway obstruction secondary to a congenital epiglottic cyst.
Al Eid H.
Health Spec [serial online] 2013 [cited 2013 Jul 5];1:97-9.
Abstract
Congenital epiglottic cysts are a rare cause of respiratory tract obstruction in neonates and infants with an incidence of 1.82 per 100,000 live births. The majority arise from the vallecula, aryepiglottic fold, and from the saccule of the ventricle and rarely from the epiglottis. This uncommon entity requires prompt diagnosis and treatment. Traditionally, such cysts are treated surgically via endoscopic excision or marsupialization. Recurrence occurs if excision incomplete and multiple procedures may be necessary. Some authors favour an open surgical approach for more extensive cysts. The patient presented here underwent endoscopic excision and was discharged 3 days later
Keywords: Airway obstruction, congenital, epiglottic cyst


http://www.thejhs.org/text.asp?2013/1/2/97/114686



Injerto de arteria coronaria: factor precipitante para cetoacidosis diabética perioperatoria
Coronary artery bypass grafting: a precipitating factor for perioperative diabetic ketoacidosis.
Sehgal V, Jit Singh Bajwa S, Kitabchi A.
Regional Hospital of Scranton, The Commonwealth Medical College Scranton, PA, USA.
Int J Endocrinol Metab. 2013 Spring;11(2):126-8. doi: 10.5812/ijem.7183. Epub 2013 Apr 1.
Abstract
Non-Insulin Dependent Diabetes Mellitus (NIDDM) is a common disease entity in patients with Coronary Artery Disease (CAD). Diabetic Ketoacidosis (DKA) is not only one of the major complications of Diabetes Mellitus but also a significant challenging clinical entity for the patients undergoing any elective or emergency surgery. Coronary Artery Bypass Grafting (CABG) being done in a patient with DKA has not been reported. We are presenting a rare case with DKA in whom CABG was carried out in a hospital devoted exclusively to cardiac cases. Insulin was given in very large doses as a part of therapeutic regimen and the outcome was favorable. This report concludes that if a patient undergoing urgent cardiac surgery incidentally develops DKA after induction of anesthesia, then the operation can be carried out provided DKA is managed aggressively. Also, major stress factors like cardio pulmonary bypass (CPB) and hypothermia should be avoided and care should be taken to avoid cerebral edema.
KEYWORDS:
Coronary Artery Bypass Grafting, Diabetes Mellitus, Diabetic Ketoacidosis, Insulin

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693665/pdf/ijem-11-126.pdf




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

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