Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · May 2015
Case ReportsAmmonia encephalopathy and awake craniotomy for brain language mapping: cause of failed awake craniotomy.
We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. ⋯ There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration.
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Rev Esp Anestesiol Reanim · May 2015
Case Reports[Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy].
Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope.
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Cryoprecipitate is a plasma derivative rich in fibrinogen and other procoagulant factors. It has been successfully used for decades in the treatment of the coagulopathy of trauma patients, cardiovascular surgery, liver failure and disseminated intravascular coagulation. ⋯ As a consequence, many of the younger anaesthesiologists did not have any direct experience with cryoprecipitate. This article aims to describe the characteristics of cryoprecipitate since it is a different product from manufactured fibrinogen concentrate, with its own specific indications that deserve to be further studied in clinical trials.
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Rev Esp Anestesiol Reanim · Apr 2015
Comparative StudyRenal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: a comparison with intravenous propofol sedation in an animal model.
Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72h) of sevoflurane. ⋯ Long-term sedation with sevoflurane using AnaConDa™ or propofol does not negatively affect renal or hepatic function.