RESUMEN
We report an anesthetic technique to control hypertension in a Wilms' tumor in stage I in a 25-month-old child weighing 10 kg. He was treated with actinomycin D and vincristine during 4 weeks before surgical resection, developing inadequate ADH secretion due to vincristine. General anesthesia was used, with atropine, thiopental and atracurium as muscular relaxant. Systemic intraoperative anesthesia with narcotics was not given. A catheter was placed in the epidural space, with entrance through L3-L4 and its extreme in L1. Radiological control of the distal end of the catheter was carried out with iohexol before the administration of two 0.3% bupivacaine doses without adrenaline of 3 ml each, and intraoperative normal blood pressure was achieved. It was concluded that combined superficial general anesthesia techniques, associated with continuous epidural blockade, can be useful to control hypertension in Wilms' tumor.
Asunto(s)
Anestesia Epidural , Anestesia General , Hipertensión Renal , Neoplasias Renales/cirugía , Tumor de Wilms/cirugía , Preescolar , Humanos , Hipertensión Renal/etiología , Neoplasias Renales/complicaciones , Masculino , Tumor de Wilms/complicacionesRESUMEN
We report a case of a large periorbital hematoma which furtherly extended to the ipsilateral orbit and appeared after posterior peribulbar blockade in a 70-year-old woman undergoing cataract extraction and intraocular implant. Peribulbar blockade was carried out with a 23-gauge blunt bevel Atkinson's needle introduced at the level of nasal or internal angle of the upper lid without loosing contact with the ceiling of the orbit. Anesthetic solution was bupicavaine at 0.75% with 10 U/ml of hyaluronidase, 3 ml. Usual blockade of lower lid was not carried out as with the first blockade, an almost complete paresis of extraocular muscles together with discrete conjunctival ecchymosis occurred. Ocular compression was conducted with Homan's balloon at 30 mmHg gor 30 minutes. Then, the eyeball was decompressed and a progressive increase of edema with conjunctival hemorrhage becoming bilateral was observed. Coagulation tests were normal. The incidence of conjunctival ecchymosis and palpebral hematoma with such technique ranges from 2% to 9%; it does not represent any intraoperative problem but may difficult surgery.