MANEJO ANESTÉSICO EN PACIENTE CON ESTENOSIS AÓRTICA Y OBESIDAD. PRESENTACIÓN DE CASO Y REVISIÓN DE LITERATURA
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Rev. Méd. La Paz
Abstract
El caso clínico está enfocado en el manejo anestésico de un paciente con valvulopatía aórtica estenótica severa, que además presenta patología secundaria que influye en el proceder anestésico, como es la obesidad con alta probabilidad de vía aérea difícil y cambios en la fisiología respiratoria; por lo mismo el objetivo es describir el procedimiento anestésico en este escenario complejo. Se realizó valoración preanestésica detallada, con enfoque en varios sistemas, debido a que la cardiopatía genera cambios a nivel respiratorio, renal y hepático, cambios que pueden influir en la farmacocinética y farmacodinamia de anestésicos. A continuación, se describe el procedimiento transanestesico, con el abordaje de vía aérea, ventilación mecánica, tipo de monitorización y administración de fármacos anestésicos y vasoactivos. La intervención quirúrgica en estos pacientes incluye la concentración plena del anestesiólogo, ya que la administración de anestésicos genera leves o grandes variaciones a nivel cardiovascular- pulmonar. La monitorización invasiva es primordial durante una cirugía cardiaca, la capacidad de interpretación clínica cardiopulmonar es necesaria. El manejo de vía aérea difícil incluye la preparación con dispositivos especiales para abordarla, además de destrezas para su colocación. La perfusión de fármacos vasoactivos y conocimiento de su farmacología evita eventos adversos y/o catastróficos. La fisiología de la ventilación mecánica y posibles cambios debido a la patología de base genera la necesidad de conocer diferentes modos ventilatorios y su programación según el peso corregido. Por lo tanto, el especialista en anestesiología debe contar con conocimientos, destrezas y aptitudes necesarias en la variedad de cada evento quirúrgico - anestésico.
This clinical case focuses on the anesthetic management of a patient with severe stenotic aortic valve disease, who also presents with secondary pathologies that influence the anesthetic procedure, such as obesity with a high probability of a difficult airway and changes in respiratory physiology. Therefore, the objective is to describe the anesthetic procedure in this complex scenario. A detailed preanesthetic assessment was performed, focusing on several systems, because heart disease generates changes at the respiratory, renal, and hepatic levels, changes that can influence the pharmacokinetics and pharmacodynamics of anesthetics. The transanesthetic procedure is described below, including airway management, mechanical ventilation, type of monitoring, and administration of anesthetic and vasoactive drugs. Surgical intervention in these patients requires the full concentration of the anesthesiologist, as the administration of anesthetics generates mild to severe cardiovascular-pulmonary variations. Invasive monitoring is essential during cardiac surgery, and the ability to interpret cardiopulmonary clinical data is essential. Managing difficult airways includes preparation with special devices for accessing them, as well as skills for theirplacement. The infusion of vasoactive drugs and knowledge of theirpharmacologyprevents adverse and/or catastrophic events. The physiology of mechanical ventilation and possible changes due to the underlyingpathology require knowledge of different ventilation modes and their programming based on the corrected weight. Therefore, the anesthesiology specialist must have the knowledge, skills, and abilities necessary for the variety of surgical-anesthetic events.
This clinical case focuses on the anesthetic management of a patient with severe stenotic aortic valve disease, who also presents with secondary pathologies that influence the anesthetic procedure, such as obesity with a high probability of a difficult airway and changes in respiratory physiology. Therefore, the objective is to describe the anesthetic procedure in this complex scenario. A detailed preanesthetic assessment was performed, focusing on several systems, because heart disease generates changes at the respiratory, renal, and hepatic levels, changes that can influence the pharmacokinetics and pharmacodynamics of anesthetics. The transanesthetic procedure is described below, including airway management, mechanical ventilation, type of monitoring, and administration of anesthetic and vasoactive drugs. Surgical intervention in these patients requires the full concentration of the anesthesiologist, as the administration of anesthetics generates mild to severe cardiovascular-pulmonary variations. Invasive monitoring is essential during cardiac surgery, and the ability to interpret cardiopulmonary clinical data is essential. Managing difficult airways includes preparation with special devices for accessing them, as well as skills for theirplacement. The infusion of vasoactive drugs and knowledge of theirpharmacologyprevents adverse and/or catastrophic events. The physiology of mechanical ventilation and possible changes due to the underlyingpathology require knowledge of different ventilation modes and their programming based on the corrected weight. Therefore, the anesthesiology specialist must have the knowledge, skills, and abilities necessary for the variety of surgical-anesthetic events.
Description
Vol. 31, No. 1