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2020, Número 4

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Rev Mex Anest 2020; 43 (4)


Manejo perioperatorio del paciente neuroquirúrgico COVID-19

Osorio-Santiago MA, Manrique-Carmona LP

Idioma: Español
Referencias bibliográficas: 39
Paginas: 245-250
Archivo PDF: 253.15 Kb.


RESUMEN

La enfermedad provocada por el virus COVID-19 causa el síndrome infeccioso respiratorio agudo severo conocido como SARS-2; este virus puede penetrar el sistema nervioso central y afectar neuronas y células gliales. Clínicamente se manifiesta como encefalitis, ictus isquémico e incluso polineuropatía. Cuando nos enfrentamos a un paciente neuroquirúrgico COVID-19 positivo se requiere una evaluación rápida pero detallada del estado general y neurológico del enfermo. Toda cirugía en presencia de un paciente COVID-19 positivo deberá realizarse con medidas de protección de nivel alto durante la cirugía, el uso de craneotómos y electrocauterios deberá minimizarse, a fin de reducir la producción de aerosol. Los procedimientos transesfenoidales endonasales deben ser evitados durante el período de la pandemia. Nos basamos en el consenso de expertos realizados por la SNACC (Society for Neuroscience in Anesthesiology and Critical Care) para emitir recomendaciones adaptadas a nuestro entorno. La terapia endovascular es una alternativa viable a la trombólisis intravenosa para el reestablecimiento de la circulación. Se ha observado mejor reperfusión en aquellos pacientes que no recibieron sedación o ésta fue ligera, comparado con los pacientes que recibieron anestesia general. En algunos casos no es indispensable la extubación postquirúrgica (especialmente en pacientes infectados con COVID-19), por lo que se deberá mantener sedación profunda y trasladar al paciente a la Unidad de Cuidados Intensivos (UCI). Es importante recordar que la infección por COVID-19 se ha evidenciado en los principales sistemas, causando daño multiorgánico en los pacientes susceptibles, razón por la cual se deberá vigilar estrechamente todos los datos que nos lleven a pensar en disfunción a corto y mediano plazo. La toma de decisiones éticas respecto a qué paciente es candidato a una craniectomía descompresiva urgente o tratamiento endovascular, si más de un vaso está ocluido, se deberá discutir en conjunto con el equipo tratante para no caer en ensañamiento terapéutico, o bien, en la omisión de un tratamiento oportuno.


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