Aguado BOM, Bermúdez BSM, Rodríguez RC

Language: Spanish
References: 10
Page: 46-51
PDF size: 101.81 Kb.

ABSTRACT

Background: Marfan Syndrome is a hereditary disorder of the conjunctive tissue that presents with valve diseases, aneurism of the thoracic aeorta and articular lax of the skeleton. Patients can present important respiratory problems such as the restraint of the pulmonary function due to both alterations in the thoracic wall and Kyphoscoliosis that require surgical correction.
Objectives: To show an anaesthetic behaviour in a patient that presented to hospital for a surgical correction of scoliosis secondary to Marfan Syndrome.
Methods: General anaesthesia with the total intravenous technique with Propofol, Fentanyl and Vecuronio was given after an adequate preoperative assessment. Controlled hypotension and antifibrinolitics were used as blood-saving techniques and intrathecal Morphine was administered which, apart from providing an adequate postoperative analgesia, contributed to the controlled hypotension technique.
Results: The patient presented neither surgical complications nor anaesthetic ones. Bleeding was of 1 000 mL. Good analgesic conditions were obtained during the postoperative phase.
Conclusions: In a patient suffering from Marfan Syndrome, the preoperative evaluation should be focused to both respiratory and cardiovascular alterations. Adequeate analgesic conditions were obtained with the administration of intrathecal Morphine.

REFERENCES

1. Dennis L. Síndrome de Marfán. En: Harrison. Principios de Medicina Interna. Cap. 342. 16ª ed. McGraw-Hill Interamericana; 2010. p. 12086-91.

2. Robbins. Síndrome de Marfán. En: Patología estructural y funcional. 6ª ed. Madrid: McGraw-Hill Interamericana; 2000. p.159-60.

3. Buntinx IM, Willems PJ, Spitaels SE, Van Reempst PJ, De Papepe AM, Dumon JE. Neonatal Marfan syndrome with congenital arachnodactyly, flexion contractures, and severe cardiac valve insufficiency. J Med Genet. 1991;28:267-73.

4. Summers KM, West JA, Peterson MM, Stark D, McGill JJ, West MJ. Challenges in the diagnosis of Marfan syndrome. Med J Aust. 2006;184:627-31.

5. Phersson K, Danielsson A, Nachemson A. Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax. 2001;56(5):388-93.

6. Wills B, Auerbach J, Zhu X, Caird M, Horn D, Flynn J, et al. Comparison of Cobb angle measurement of scoliosis radiographs with preselected end vertebrae. Traditional versus digital acquisition. Spine. 2007;32(1):98-105.

7. Colomina MJ, Godet C. Anestesia para la cirugía de la escoliosis. Estudio preoperatorio y selección de los pacientes de riesgo en la cirugía de las deformidades raquídeas. Rev Esp Anestesiol Reanim. 2005;52:24-43.

8. Bonow R, Carabello B, Chatterjee K. ACC/AHA 2006 guidelines for the ACC / AHA 2006 las directrices para el manejo de pacientes con enfermedad cardíaca valvular. Disponible en: http://www.scahq . org/ sca3/ org / SCA3 / VHDFullText.pdf. Accessed February 7, 2010. [Consultado 25 Abril 2012].

9. Goodarzi M. The advantages of intrathecal opioids for spinal fusion in children. Paediatric Anaesthesia. 1998;8:131-4.

10. Tripi PA, Poe-Kochert C, Potzman J, Son-Hing JP, Thompson GH. Intrathecal morphine for postoperative analgesia in patients with idiopathic scoliosis undergoing posterior spinal fusion. Spine. 2008;33(20):22-48.