RESUMEN
La hidrocefalia es una distensión activa del sistema ventricular del cerebro. Las mejores tasas de supervivencia de los pacientes con enfermedad neuroquirúrgica se acompañan de un mayor número de procedimientos no neuroquirúrgicos en pacientes que tienen dispositivos neuroquirúrgicos terapéuticos. No está clara la verdadera incidencia del embarazo en pacientes con hidrocefalia obstructiva controlada con derivación ventriculoperitoneal (DVP). Presentamos un caso de una mujer embarazada de 34 años con una DVP para hidrocefalia obstructiva. Debido a la obstrucción de la DVP secundaria al volumen del útero, ella presentó varios episodios de deterioro neurológico durante el embarazo. Se planificaron una cesárea electiva y una revisión de la DVP para el mismo tiempo operatorio. Este caso inusual representa un desafío al que el anestesiólogo debe enfrentarse para proporcionar el mejor manejo simultáneo del delicado bienestar de la madre, su cerebro, y el feto
Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices. The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear. We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time. This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Derivación Ventriculoperitoneal , Hidrocefalia/complicaciones , Cesárea/métodos , Anestesia General , Rocuronio/uso terapéutico , Fármacos Neuromusculares no Despolarizantes/uso terapéutico , Sevoflurano/uso terapéutico , Anestésicos por Inhalación/uso terapéutico , Anestésicos Generales/uso terapéutico , Fentanilo/uso terapéutico , Propofol/uso terapéutico , Sugammadex/uso terapéutico , Hidrocefalia/cirugíaRESUMEN
Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices. The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear. We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time. This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus.
Asunto(s)
Anestesia/métodos , Cesárea , Hidrocefalia/cirugía , Hipertensión Intracraneal/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Derivación Ventriculoperitoneal , Adyuvantes Anestésicos/administración & dosificación , Adulto , Anestésicos por Inhalación/administración & dosificación , Femenino , Fentanilo/administración & dosificación , Escala de Coma de Glasgow , Humanos , Fármacos Neuromusculares no Despolarizantes/administración & dosificación , Embarazo , Propofol/administración & dosificación , Rocuronio/administración & dosificación , Sevoflurano/administración & dosificación , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
Lophine and four of its derivatives were used as activators (ACTs) of the chemiluminescent peroxyoxalate (PO) reaction of bis(2,4,6-trichlorophenyl)oxalate with H2O2, catalysed by imidazole. Kinetic emission assays have shown that with the tested compounds the reaction mechanism, regarding the formation of the high energy intermediate (HEI) of the PO reaction, occurs as previously seen for commonly used ACTs. A bimolecular interaction of the compounds with the HEI leads to chemiexcitation through the chemically initiated electron exchange luminescence (CIEEL) mechanism, as confirmed by a linear free-energy correlation between the relative catalytic rate constants and the oxidation potentials of the compounds. The yields of excited state formation and light emission, in the range of 10(-2)-10(-3) E mol(-1), are comparable to the ones seen with commonly used ACTs. A Hammett plot with ρ = -0.90 indicates the buildup of a partial positive charge on the transition step of the catalytic process, consistent with the formation of a radical cation of the ACT, being an additional validation of the CIEEL mechanism in this system.