Manejo anestésico para cirurgia de atresia de esôfago em um recém‐nascido com síndrome de Goldenhar

ResumoJustificativa e objetivosA síndrome de Goldenhar é um quadro de polimalformação que consiste em uma disostose craniofacial que determina uma via respiratória difícil em até 40% dos casos. Nós descrevemos um caso de um recém‐nascido com síndrome de Goldenhar com atresia de esôfago e fístula traqueoesofágica para a qual foi feita cirurgia de reparo.Relato de casoApresentamos o caso de um recém‐nascido de 24horas de vida com síndrome de Goldenhar. Ele apresentava atresia de esôfago, com fístula traqueoesofágica distal. Decidiu‐se por uma cirurgia de emergência para reparo. Ela foi feita sob sedação, intubação com fibrobroncoscópio distal à fístula, para limitar passagem do ar para o esôfago e possível distensão abdominal. Após o reparo completo da atresia de esôfago e ligadura da fístula, o paciente foi transferido para a unidade de terapia intensiva e intubado com sedoanalgesia.ConclusõesO achado de um paciente com síndrome de Goldenhar e atresia de esôfago supõe uma situação excepcional e um desafio para os anestesiologistas, pois o manejo anestésico depende da comorbidade do paciente, do tipo de fístula traqueoesofágica, da prática hospitalar habitual e das habilidades do anestesiologista responsável, sendo que a peculiaridade principal é manter uma ventilação pulmonar adequada na presença de uma comunicação entre a via respiratória e o esôfago. A intubação com fibrobroncoscópio distal à fístula resolve o manejo da via respiratória provavelmente difícil e limita a passagem de ar para o esôfago através da fístula.AbstractBackground and objectivesGoldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery.Case reportWe report the case of a 24‐hour‐old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia.ConclusionsThe finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula

Manejo anestésico para la cirugía de atresia de esófago en un neonato con síndrome de Goldenhar

ResumenJustificación y objetivosEl síndrome de Goldenhar es un cuadro polimalformativo consistente en una disostosis craneofacial que condiciona una vía aérea difícil hasta en el 40% de los casos. Describimos un caso de un neonato con síndrome de Goldenhar con atresia de esófago y fístula traqueoesofágica al que se practicó cirugía de reparación de la misma.Relato del casoPresentamos un caso de un neonato con síndrome de Goldenhar de 24 h de vida. Presentaba atresia esofágica con fístula traqueoesofágica distal. Se decidió una intervención quirúrgica urgente para la reparación de la misma. Se realizó bajo sedación, intubación con fibrobroncoscopio distal a la fístula, para limitar el paso de aire a esófago y la posible distensión abdominal. Tras la completa reparación de la atresia esofágica y la ligadura de la fístula, el paciente fue trasladado a la unidad de cuidados intensivos con sedoanalgesia e intubado.Conclusionesel hallazgo de un paciente con síndrome de Goldenhar y atresia de esófago supone una situación excepcional y un reto para los anestesiólogos, por lo que el manejo anestésico depende de la comorbilidad del paciente, del tipo de fístula traqueoesofágica, de la práctica hospitalaria habitual y de las habilidades del anestesiólogo responsable, siendo la principal particularidad el mantenimiento de una adecuada ventilación pulmonar en presencia de una comunicación entre la vía aérea y el esófago. La intubación con fibrobroncoscopio distal a la fístula solventa el manejo de la vía aérea probablemente difícil y limita el paso de aire al esófago a través de la fístula.AbstractBackground and objectivesGoldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery.Case reportWe report the case of a 24-hour-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia.ConclusionsThe finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula

Manejo anestésico de épulis congénito

SummaryIntroductionepulis of the newborn is a granular cell tumor arising in the mucosa of the dental ridge. It presents as a pedunculated soft tissue mass that can be lobular or multinodular. It is more common in females than in males (8:1) perhaps due to hormonal factors. It may be accompanied by other congenital malformations. Anesthetic management is based on a potentially difficult intubation and the risk of bleeding.ObjectivesTo present the case of a newborn with congenital epulis and to review this pathology and its anesthetic management.Methods and ResultsClinical case presentation.ConclusionsSeveral types of anesthesia have been described depending, among other factors, on tumor size and on the professionals involved in excising the lesion. In our case, and given the characteristics of the tumor, we chose inhalation sedation with O2/ air / sevoflurane, lateral decubitus position and local infiltration at the base of implantation. Good collaboration between the surgeon and the anesthetist is critical for success

Estudio experimental sobre las modificaciones de la presión coloidosmótica plasmática y su relación con el desarrollo del edema pulmonar

Los mecanismos de intercambio a nivel del capilar han sido foco de atención para diversos autores en los últimos años. Sus resultados han sido dispares, quedando por aclarar la utilidad del equilibrio descrito por starling. Estas discrepancias nos han impulsado al desarrollo de este estudio. Hemos estudiado en 20 animales (perros), divididos en 4 grupos de 5, las variaciones de la presión coloidosmótica plasmática, y de los responsables de la osmolaridad del plasma, tras la agresión de la membrana del capilar pulmonar, con ácido oleico, y tras la elevación de la presión hidrostática a dicho nivel. Las determinaciones fueron efectuadas a la entrada y salida del capilar pulmonar. Los resultados han mostrado una diferencia estadísticamente significativa al comparar los niveles de presión coloidosmótica plasmática a la entrada (art. pulmonar) y salida (art. femoral) del capilar pulmonar en los animales a los que administramos ácido oleico. Estas diferencias fueron así mismo observadas en aquellos animales a los que elevamos la presión de la aurícula izquierda, si bien en este grupo se hicieron patentes en forma tardía. El resto de los parámetros estudiados, no presentaron diferencias estadísticamente significativas ni en los grupos controles ni en los grupos de estudio. A la vista de nuestros resultados estamos en condiciones de afirmar que la determinación de las diferencias de la presión coloidosmótica plasmática, medida a la entrada y salida del capilar pulmonar, puede ser utilizada como prueba diagnostica en las fases iniciales del disstres respiratorio del adulto

Anesthetic management for surgery of esophagus atresia in a newborn with Goldenhar's syndrome

AbstractBackground and objectivesGoldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery.Case reportWe report the case of a 24-h-old newborn with Goldenhar's syndrome. He had esophageal atresia with distal tracheoesophageal fistula. It was decided that an emergency surgery would be performed for repairing it. It was carried out under sedation, intubation with fibrobronchoscope distal to the fistula, to limit the air flow into the esophagus, and possible abdominal distension. Following complete repair of the esophageal atresia and fistula ligation, the patient was transferred to the intensive care unit and intubated under sedation and analgesia.ConclusionsThe finding of a patient with Goldenhar's syndrome and esophageal atresia assumes an exceptional situation and a challenge for anesthesiologists, since the anesthetic management depends on the patient comorbidity, the type of tracheoesophageal fistula, the usual hospital practice and the skills of the anesthesiologist in charge, with the main peculiarity being maintenance of adequate pulmonary ventilation in the presence of a communication between the airway and the esophagus. Intubation with fibrobronchoscope distal to the fistula deals with the management of a probably difficult airway and limits the passage of air to the esophagus through the fistula

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery