Endarterectomía carotídea en paciente con estenosis aórtica crítica. Importancia de la anestesia regional y del neuromonitoreo.
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| Title: | Endarterectomía carotídea en paciente con estenosis aórtica crítica. Importancia de la anestesia regional y del neuromonitoreo. |
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| Alternate Title: | Carotid endarterectomy in a patient with critical aortic stenosis. Importance of regional anesthesia and transoperative neurological monitoring. |
| Authors: | Lazcano-Díaz, Emmanuel Adrián1 ea.lazcano.diaz@gmail.com, Escamilla-Ríos, Dania E.2, Torres Maldonado, Arely Seir3, Manzur-Sandoval, Daniel1, Villalobos-Pedroza, Montserrat4, Rojas-Velasco, Gustavo1 |
| Source: | Revista Mexicana de Anestesiología. abr-jun2023, Vol. 46 Issue 2, p140-143. 4p. |
| Abstract (English): | Carotid stenosis occurs in 13% of patients with aortic valve stenosis. The risk of stroke in patients with significant carotid stenosis undergoing heart valve surgery may increase to 11%. Proposing a patient with critical aortic valve stenosis and left ventricular dysfunction to carotid endarterectomy is an anesthetic challenge, where the objective is to avoid hypotension and low cardiac output. Regional anesthesia is an option for these patients. Due to the high incidence of intraoperative stroke during carotid endarterectomy, continuous neurological monitoring is of relevance. We present the case of a 70-year-old man diagnosed with significant carotid stenosis and critical aortic valve stenosis and left ventricular dysfunction who underwent carotid endarterectomy with superficial cervical plexus block due to a high risk of circulatory collapse. In addition, this anesthetic strategy made it possible to keep the patient awake during surgery, and to continuously assess their neurological status. Likewise, transoperative changes in brain NIRS and transcranial Doppler were documented, which correlated with the patient’s clinical status. In a second time, aortic valve replacement was performed without complications. This case highlights the importance of regional anesthesia and neurological monitoring in patients undergoing carotid endarterectomy with high surgical risk due to critical aortic valve stenosis. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | La estenosis carotídea (EC) ocurre en 13% de los pacientes con estenosis valvular aórtica (EVA). El riesgo de evento vascular cerebral (EVC), en los pacientes con EC significativa sometidos a cirugía valvular cardíaca, puede aumentar hasta 11%. Someter a un paciente con EVA crítica y fracción de eyección del ventrículo izquierdo (FEVI) disminuida a endarterectomía carotídea es todo un reto anestésico, cuyo principal objetivo es evitar la hipotensión y el bajo gasto cardíaco. La anestesia regional es una opción para estos pacientes. Presentamos el caso de un hombre de 70 años con diagnóstico de EC significativa y EVA crítica con disfunción ventricular izquierda, al que se realizó endarterectomía carotídea con bloqueo del plexo cervical superficial por alto riesgo de colapso circulatorio. Dicha estrategia anestésica permitió mantener al paciente despierto durante la cirugía, al valorar continuamente su estado neurológico. Asimismo, se documentaron los cambios transoperatorios en el NIRS (Near-infrared spectroscopy) cerebral y Doppler transcraneal (DTC), los cuales se correlacionaron con el estado clínico del paciente. En un segundo tiempo se hizo cambio valvular aórtico sin complicaciones. En este caso destaca la importancia de la anestesia regional y el monitoreo neurológico con Doppler transcraneal, en pacientes sometidos a endarterectomía carotídea con alto riesgo quirúrgico por EVA crítica. [ABSTRACT FROM AUTHOR] |
| Copyright of Revista Mexicana de Anestesiología is the property of Colegio Mexicano de Anestesiologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | MedicLatina |
| FullText | Links: – Type: pdflink Text: Availability: 0 |
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| Header | DbId: lth DbLabel: MedicLatina An: 162819672 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Endarterectomía carotídea en paciente con estenosis aórtica crítica. Importancia de la anestesia regional y del neuromonitoreo. – Name: TitleAlt Label: Alternate Title Group: TiAlt Data: Carotid endarterectomy in a patient with critical aortic stenosis. Importance of regional anesthesia and transoperative neurological monitoring. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Lazcano-Díaz%2C+Emmanuel+Adrián%22">Lazcano-Díaz, Emmanuel Adrián</searchLink><relatesTo>1</relatesTo><i> ea.lazcano.diaz@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Escamilla-Ríos%2C+Dania+E%2E%22">Escamilla-Ríos, Dania E.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Torres+Maldonado%2C+Arely+Seir%22">Torres Maldonado, Arely Seir</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Manzur-Sandoval%2C+Daniel%22">Manzur-Sandoval, Daniel</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Villalobos-Pedroza%2C+Montserrat%22">Villalobos-Pedroza, Montserrat</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Rojas-Velasco%2C+Gustavo%22">Rojas-Velasco, Gustavo</searchLink><relatesTo>1</relatesTo> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Revista+Mexicana+de+Anestesiología%22">Revista Mexicana de Anestesiología</searchLink>. abr-jun2023, Vol. 46 Issue 2, p140-143. 4p. – Name: Abstract Label: Abstract (English) Group: Ab Data: Carotid stenosis occurs in 13% of patients with aortic valve stenosis. The risk of stroke in patients with significant carotid stenosis undergoing heart valve surgery may increase to 11%. Proposing a patient with critical aortic valve stenosis and left ventricular dysfunction to carotid endarterectomy is an anesthetic challenge, where the objective is to avoid hypotension and low cardiac output. Regional anesthesia is an option for these patients. Due to the high incidence of intraoperative stroke during carotid endarterectomy, continuous neurological monitoring is of relevance. We present the case of a 70-year-old man diagnosed with significant carotid stenosis and critical aortic valve stenosis and left ventricular dysfunction who underwent carotid endarterectomy with superficial cervical plexus block due to a high risk of circulatory collapse. In addition, this anesthetic strategy made it possible to keep the patient awake during surgery, and to continuously assess their neurological status. Likewise, transoperative changes in brain NIRS and transcranial Doppler were documented, which correlated with the patient’s clinical status. In a second time, aortic valve replacement was performed without complications. This case highlights the importance of regional anesthesia and neurological monitoring in patients undergoing carotid endarterectomy with high surgical risk due to critical aortic valve stenosis. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Abstract (Spanish) Group: Ab Data: La estenosis carotídea (EC) ocurre en 13% de los pacientes con estenosis valvular aórtica (EVA). El riesgo de evento vascular cerebral (EVC), en los pacientes con EC significativa sometidos a cirugía valvular cardíaca, puede aumentar hasta 11%. Someter a un paciente con EVA crítica y fracción de eyección del ventrículo izquierdo (FEVI) disminuida a endarterectomía carotídea es todo un reto anestésico, cuyo principal objetivo es evitar la hipotensión y el bajo gasto cardíaco. La anestesia regional es una opción para estos pacientes. Presentamos el caso de un hombre de 70 años con diagnóstico de EC significativa y EVA crítica con disfunción ventricular izquierda, al que se realizó endarterectomía carotídea con bloqueo del plexo cervical superficial por alto riesgo de colapso circulatorio. Dicha estrategia anestésica permitió mantener al paciente despierto durante la cirugía, al valorar continuamente su estado neurológico. Asimismo, se documentaron los cambios transoperatorios en el NIRS (Near-infrared spectroscopy) cerebral y Doppler transcraneal (DTC), los cuales se correlacionaron con el estado clínico del paciente. En un segundo tiempo se hizo cambio valvular aórtico sin complicaciones. En este caso destaca la importancia de la anestesia regional y el monitoreo neurológico con Doppler transcraneal, en pacientes sometidos a endarterectomía carotídea con alto riesgo quirúrgico por EVA crítica. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Revista Mexicana de Anestesiología is the property of Colegio Mexicano de Anestesiologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.35366/110202 Languages: – Code: spa Text: Spanish PhysicalDescription: Pagination: PageCount: 4 StartPage: 140 Titles: – TitleFull: Endarterectomía carotídea en paciente con estenosis aórtica crítica. Importancia de la anestesia regional y del neuromonitoreo. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Lazcano-Díaz, Emmanuel Adrián – PersonEntity: Name: NameFull: Escamilla-Ríos, Dania E. – PersonEntity: Name: NameFull: Torres Maldonado, Arely Seir – PersonEntity: Name: NameFull: Manzur-Sandoval, Daniel – PersonEntity: Name: NameFull: Villalobos-Pedroza, Montserrat – PersonEntity: Name: NameFull: Rojas-Velasco, Gustavo IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 04 Text: abr-jun2023 Type: published Y: 2023 Identifiers: – Type: issn-print Value: 04847903 Numbering: – Type: volume Value: 46 – Type: issue Value: 2 Titles: – TitleFull: Revista Mexicana de Anestesiología Type: main |
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