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2002, Número 2

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Trauma 2002; 5 (2)


Manejo anestésico en el paciente con trauma craneofacial

Huerta MC, Reyes CJL, Gil WW, Acevedo CA, Moscoso JMB

Idioma: Español
Referencias bibliográficas: 103
Paginas: 42-54
Archivo PDF: 132.58 Kb.


RESUMEN

El cuidado anestésico de los pacientes con daño cerebral debido al trauma incluye de manera integral la resucitación cerebral, resucitación de otros órganos vitales, la administración de “anestesia”, y la prevención de respuestas fisiológicas anormales en la cirugía. Las respuestas adversas a la cirugía; tales como hipertensión, taquicardia, tos y esfuerzo pueden incrementar la presión intracraneal (PIC). La manipulación de la vía aérea puede agravar lesiones en la médula espinal cervical, así como incrementar la PIC. Los agentes anestésicos pueden aumentar la inestabilidad hemodinámica, incrementar el volumen sanguíneo cerebral y la PIC, y producir depresión respiratoria. La reanimación cerebral durante la cirugía es semejante a la de los periodos preoperatorio y posoperatorio. La medición de la PIC y el monitoreo de la saturación venosa yugular (SjO2) pueden ayudar a definir en forma clave el tipo de conducta a seguir. Existe una variedad de técnicas anestésicas y agentes anestésicos con distintas ventajas y desventajas. La elección de agentes y técnicas se determina tomando en cuenta la naturaleza y severidad de las lesiones del paciente y las enfermedades preexistentes. La investigación de medicamentos que puedan proteger contra la isquemia cerebral incluyen a los anestésicos, los cuales no parecen ser igualmente efectivos. La hipotermia transoperatoria se ha probado como un protector cerebral.


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