Pulmonary artery banding (PAB) is a procedure mainly performed during the neonatal period as an initial stage to definitive palliative reconstruction, a scenario in which the criteria for banding adjustment are well defined. However, the indication for BAP in the adult is extraordinarily rare, even more in patients with single ventricle and unrepaired transposition of the great arteries (TGA), and there are no established criteria for banding adjustment. Due to the small number of these procedures, there is limited experience in their anesthetic management and complications. We describe a case of a 29-year-old patient diagnosed with a cyanotic congenital heart disease of double-inlet left ventricle with TGA and unrepaired mitral stenosis, who underwent to a hybrid procedure of PAB and enlargement of the communication between the two atria.

OBJECTIVE: The aim of this study was compare the palpation technique and ultrasound-guidance for femoral artery catheterization in pediatric patients undergoing surgery for congenital heart disease.
METHODS: This prospective and randomized controlled study included American Society of Anesthesiologists III-IV 40 children who underwent congenital heart surgery. The patients were divided into two groups; ultrasound-guided catheterization group and palpation-guided catheterization group. Demographic and clinical characteristics of the patients, access time, success rate, number of attempts, first-attempt success, number of trials, and failed cannulations were recorded.
RESULTS: The diameter of the femoral artery was significantly shorter, access time and numbers of trials were significantly lower, and first-attempt success rate was significantly higher in the US group. The complication rate was significantly higher in the P group. The number of failed catheterization was higher in the P group. Total cost required for the procedure was significantly lower in the US group.
CONCLUSIONS: We found that ultrasound-guided arterial catheterization increases the success rate and the number of successful catheterizations, while reducing the overall procedure time, incidence of complications, and cost. Therefore, we believe that the use of ultrasound guidance in arterial catheterization in pediatric cardiac surgery would be a better choice.
OBJECTIVE: El objetivo de este estudio fue comparar la técnica de palpación y ecoguiado para el cateterismo de la arteria femoral en pacientes pediátricos operados de cardiopatías congénitas.
UNASSIGNED: Este estudio prospectivo, aleatorizado y controlado incluyó a 40 niños ASA III-IV que se sometieron a cirugía cardíaca congénita. Los pacientes se dividieron en 2 grupos; Grupo de cateterismo guiado por ecografía y grupo de cateterismo guiado por palpación.
RESULTS: El diámetro de la arteria femoral fue significativamente más corto, el tiempo de acceso y el número de intentos fueron significativamente menores y la tasa de éxito del primer intento fue significativamente mayor en grupo estadounidense. La tasa de complicaciones fue significativamente mayor en el grupo P. El número de cateterismos fallidos fue mayor en el grupo P. El costo total requerido para el procedimiento fue significativamente menor en el grupo de EE.
CONCLUSIONS: Encontramos que el cateterismo arterial guiado por ultrasonido aumenta la tasa de éxito y el número de cateterismos exitosos, al tiempo que reduce el tiempo total del procedimiento, la incidencia de complicaciones y el costo. Por tanto, creemos que el uso de guía ecográfica en cateterismo arterial en cirugía cardiaca pediátrica sería una mejor opción.

Intraperitoneal administration of local anaesthetics may reduce postoperative pain after ovariohysterectomy in dogs. The aim of this prospective, randomised, blinded, placebo-controlled clinical trial was to compare postoperative analgesia and opioid requirements after intraperitoneal and incisional administration of ropivacaine versus 0,9 % NaCl (saline). Forty-three client-owned dogs were enrolled in the study and anaesthetised using a standardized protocol that included premedication with acepromazine (0,03-0,05 mg/kg) and dexmedetomidine (0,01 mg/kg) intramuscularly. Anaesthesia was induced with propofol titrated to effect and ketamine (1 mg/kg) intravenously and maintained with isoflurane in oxygen. The analgesic regimen included carprofen (4 mg/kg) subcutaneously and morphine (0,2 mg/kg) intravenously. Depending on group assignment, each dog received either an intraperitoneal and incisional splash with ropivacaine (2 mg/kg and 1 mg/kg, respectively) (group R), or an equal volume of saline (group S). Buprenorphine (0,02 mg/kg) was administered intramuscularly once the uterus was removed. Sedation and pain were assessed 0,5, 1, 2, 4, 6 and 8 hours after extubation using a sedation scale, the short form of the Glasgow Composite Pain Scale (CMPS-SF) and a dynamic interactive visual analogue scale (DIVAS). Postoperatively, buprenorphine (0,01 mg/kg) was administered intravenously if dogs scored 6/24 on CMPS-SF. The ordinal mixed model showed no difference in pain scores between groups. Fisher\'s exact test showed no significant difference in postoperative buprenorphine requirements between group S (3/22 dogs) and group R (1/21 dogs) at the doses used. In addition, lower sedation scores were associated with higher DIVAS scores. In this multimodal analgesic protocol, ropivacaine could not improve analgesia compared to saline.
Die intraperitoneale Verabreichung von Lokalanästhetika kann postoperativen Schmerzen nach einer Ovariohysterektomie bei Hunden lindern. Das Ziel dieser prospektiven, randomisierten, verblindeten, Placebo kontrollierten klinischen Studie war der Vergleich der postoperativen Analgesie und des Opioidbedarfs nach intraperitonealer und inzisionaler Verabreichung von Ropivacain im Vergleich zu 0,9 % NaCl (Kochsalzlösung). In die Studie wurden 43 Hunde aufgenommen und nach einem standardisierten Protokoll mittels intramuskuläre Prämedikation (0,03–0,05 mg/kg Acepromazin, 0,01 mg/kg Dexmedetomidin 0,01 mg/kg) und mit auf die Wirkung eingestelltem Propofol und Ketamin (1 mg/kg) intravenös eingeleitet, sowie die Anästhesie mit Isofluran in Sauerstoff aufrechterhalten. Das analgetische Regime umfasste Carprofen (4 mg/kg) subkutan und Morphin (0,2 mg/kg) intravenös. Abhängig von der Gruppenzuordnung erhielt jeder Hund entweder eine intraperitoneale und inzisionele Verabreichung von Ropivacain (2 mg/kg bzw. 1 mg/kg) (Gruppe R) oder eine gleiche Menge Kochsalzlösung (Gruppe S). Bei Entfernung der Gebärmutter wurde zusätzlich Buprenorphin (0,02 mg/kg) intramuskulär verabreicht. Sedierung und Schmerzen wurden 0,5, 1, 2, 4, 6 und 8 Stunden nach der Extubation anhand einer Sedierungsskala, der Kurzform der Glasgow Composite Pain Scale (CMPS-SF) und einer dynamischen interaktiven visuellen Analogskala (DIVAS) bewertet. Postoperativ wurde Buprenorphin (0,01 mg/kg) intravenös verabreicht, wenn die Hunde im CMPS-SF einen Wert von 6/24 erreichten. Das ordinale gemischte Modell zeigte keinen Unterschied in den Schmerzwerten zwischen den Gruppen. Der Exakte Fisher-Test zeigte bei den verwendeten Dosen keinen signifikanten Unterschied im postoperativen Buprenorphinbedarf zwischen Gruppe S (3/22 Hunde) und Gruppe R (1/21 Hunde). Darüber hinaus waren niedrigere Sedierungswerte mit höheren DIVAS-Werten verbunden. In diesem multimodalen Analgetikaprotokoll konnte Ropivacain die Analgesie im Vergleich zu Kochsalzlösung nicht verbessern.
L’administration intrapéritonéale d’anesthésiques locaux peut réduire la douleur postopératoire après une ovariohystérectomie chez la chienne. L’objectif de cet essai clinique prospectif, randomisé, en aveugle et contrôlé par placebo était de comparer l’analgésie postopératoire et les besoins en opioïdes après l’administration intrapéritonéale et incisionnelle de ropivacaïne par rapport à du NaCl 0,9 % (sérum physiologique). Quarante-trois chiennes appartenant à des clients ont été enrôlés dans l’étude et anesthésiés selon un protocole standardisé comprenant une prémédication par acépromazine (0,03 - 0,05 mg/kg) et dexmedetomidine (0,01 mg/kg) par voie intramusculaire. L’anesthésie a été induite avec du propofol dosé à l’effet et de la kétamine (1 mg/kg) par voie intraveineuse et maintenue avec de l’isoflurane dans de l’oxygène. Le traitement analgésique comprenait du carprofène (4 mg/kg) par voie sous-cutanée et de la morphine (0,2 mg/kg) par voie intraveineuse. En fonction de son affectation à un groupe, chaque chien a reçu soit une injection intrapéritonéale et incisionnelle de ropivacaïne (2 mg/kg et 1 mg/kg, respectivement) (groupe R), soit un volume égal de solution saline (groupe S). La buprénorphine (0,02 mg/kg) a été administrée par voie intramusculaire après l’ablation de l’utérus. La sédation et la douleur ont été évaluées 0,5, 1, 2, 4, 6 et 8 heures après l’extubation à l’aide d’une échelle de sédation, de la forme courte de l’échelle composite de douleur de Glasgow (CMPS-SF) et d’une échelle visuelle analogique interactive dynamique (DIVAS). En postopératoire, de la buprénorphine (0,01 mg/kg) a été administrée par voie intraveineuse si les chiens obtenaient un score de 6/24 sur l’échelle CMPS-SF. Le modèle mixte ordinal n’a montré aucune différence dans les scores de douleur entre les groupes. Le test exact de Fisher n’a pas montré de différence significative dans les besoins postopératoires en buprénorphine entre le groupe S (3/22 chiens) et le groupe R (1/21 chiens) aux doses utilisées. De plus, des scores de sédation plus faibles étaient associés à des scores DIVAS plus élevés. Dans ce protocole d’analgésie multimodale, la ropivacaïne n’a pas permis d’améliorer l’analgésie par rapport au sérum physiologique.
L’amministrazione intraperitoneale di anestetici locali potrebbe ridurre il dolore post-operatorio dopo una ovarioisterectomia nei cani. Lo scopo di questo studio clinico prospettico, randomizzato, in doppio cieco, controllato con placebo, era di mettere a confronto l’analgesia post-operatoria e il fabbisogno di oppioidi dopo l’amministrazione intraperitoneale e incisionale di ropivacaina rispetto allo 0,9% di NaCl (soluzione salina). Quarantatré cani sono stati arruolati nello studio e anestetizzati utilizzando un protocollo standardizzato che includeva la premedicazione con acepromazina (0,03 - 0,05 mg/kg) e dexmedetomidina (0,01 mg/kg) per via intramuscolare. L’anestesia è stata indotta con propofol titolato per effetto e ketamina (1 mg/kg) per via endovenosa e mantenuta con isoflurano in ossigeno. Il regime analgesico includeva carprofene (4 mg/kg) per via sottocutanea e morfina (0,2 mg/kg) per via endovenosa. A seconda dell’assegnazione al gruppo, ciascun cane ha ricevuto un’infusione intraperitoneale e incisionale di ropivacaina (rispettivamente 2 mg/kg e 1 mg/kg) (gruppo R), oppure un volume equivalente di soluzione salina (gruppo S). La buprenorfina (0,02 mg/kg) è stata somministrata per via intramuscolare una volta che l’utero è stato rimosso. Sedazione e dolore sono stati valutati 0,5, 1, 2, 4, 6 e 8 ore dopo l’estubazione utilizzando la scala di sedazione, la versione abbreviata della Glasgow Composite Pain Scale (CMPS-SF) e la scala visiva analogica interattiva dinamica (DIVAS). Dopo l’intervento, la buprenorfina (0,01 mg/kg) è stata somministrata per via endovenosa se i cani avevano un punteggio 6/24 sulla CMPS-SF. Il modello misto ordinale non ha mostrato differenze tra i punteggi del dolore tra i gruppi. Il test esatto di Fisher non ha mostrato differenze significative nel fabbisogno post-operatorio di buprenorfina tra il gruppo S (3/22 cani) e il gruppo R (1/21 cani) alle dosi utilizzate. Inoltre, punteggi di sedazione più bassi erano associati a punteggi più alti per la DIVAS. In questo protocollo di analgesia multimodale, la ropivacaina non è riuscita a migliorare l’analgesia rispetto alla soluzione salina.

Angioedema is a potentially life-threatening condition due to the risk of airway compromise leading to deterioration of respiratory function, hypoxia, and ultimately, cardiopulmonary arrest. It can be either unprovoked or triggered by pharmaceutical agents, emotional or physiologic factors, upper airway trauma, or surgical stress. A 46-year-old man previously prescribed perindopril developed angioedema of the tongue 4 h after being discharged from the Post Anesthesia Care Unit (PACU). A multidisciplinary team was called and they outlined an airway management strategy to use in the event of worsening. The strategy consisted of either fiberoptic intubation by an anesthesiologist or surgical tracheostomy performed by the surgical team, both performed with the patient awake and in spontaneous ventilation. The aim of this case report is to raise awareness that angioedema is a potentially life-threatening condition. For optimal management, it is important to prepare in advance a detailed airway management strategy to be implemented by a multidisciplinary team.

Jarcho-Levin syndrome is an eponym used to describe a spectrum of small thoracic skeletal dysplasias with variable involvement of vertebrae and ribs. Initially considered lethal, it is currently compatible with life in its mildest forms. Bone alterations that lead to a restrictive respiratory pattern, recurrent respiratory infections and particular phenotype, can make perioperative anesthetic management difficult. The proper assessment of the airway is of special interest because it presents predictors of a difficult airway, as well as the prevention, early diagnosis and adequate treatment of respiratory failure. We present the case of a patient with Jarcho-Levin Syndrome who underwent vertebral distraction surgery, with its most notable implications in anesthetic management.

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare type of vasculitis with multisystemic involvement. Very few authors have described the anaesthesia technique in these patients. We present the first report on ambulatory surgery in a patient with EGPA. This case dispels concerns about the safety of day surgery and reports successful regional anaesthesia management in a patient with EGPA.

A 26-year-old patient with Friederich\'s ataxia with hypertrophic obstructive cardiomyopathy undergoing total thyroidectomy due to persistent amiodarone-induced thyrotoxicosis (despite high doses of antithyroid drugs and corticosteroids), presented an intraoperative episode suggestive of thyroid storm. Thyroid storm is an endocrine emergency that is associated with high morbidity and mortality. Early diagnosis and treatment, which is of vital importance to improve survival, includes symptomatic treatment, treatment of cardiovascular, neurological, and/or hepatic manifestations and thyrotoxicosis, measures to suppress or avoid triggering stimuli, and definitive treatment.

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In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA.
Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital\'s rapid intervention team. Data were collected over 1 year.
Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm.
These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.

This study aimed to assess the safety and efficacy of midazolam and ketamine as adjuvants to the peribulbar block in vitreoretinal surgeries.
This randomized controlled trial included 93 adult patients undergoing vitreoretinal surgeries performed with peribulbar anaesthesia. Patients were randomly allocated to 3 groups (31 participants each): control (standard anaesthetic mixture), midazolam (standard mixture + midazolam), and ketamine (standard mixture + ketamine). The primary outcomes were onset of globe akinesia and duration of analgesia. Secondary outcomes were duration of motor blockade, onset of corneal anaesthesia and lid akinesia, and changes in vital data (blood pressure, oxygen saturation, and pulse rate).
The ketamine group vs. the control and midazolam groups showed the most rapid onset of lid and globe akinesia (p < 0.001) and corneal anaesthesia (0.7 ± 0.2 vs. 1.5 ± 0.5 and 1.2 ± 0.4, respectively; p < 0.001) and the longest duration of both analgesia (3.7 ± 0.6 vs. 2.3 ± 0.4 and 3.1 ± 0.6, respectively; p < 0.001) and akinesia (3.8 ± 0.5 vs. 3.0 ± 0.4, and 3.7 ± 0.5, respectively; p < 0.001). The midazolam group showed better outcomes than controls, but the drug was less effective than ketamine. There were no significant differences in vital data among groups (p > 0.05).
Ketamine is an effective adjuvant for peribulbar blockade. It enhances both motor and sensory blockade by hastening onset and prolonging duration. These effects are desirable in lengthier ophthalmic procedures such as vitreoretinal surgeries. The effects of ketamine were superior to those of midazolam.