RESUMEN
The early use of continuous positive airway pressure ventilation has been shown to be effective and is recommended for patients with obstructive sleep apnea. The complications of continuous positive airway pressure ventilation are not well described. We report two cases of pneumocephalus following the use of continuous positive airway pressure ventilation after transsphenoidal surgery. One patient had an obstructive sleep apnea and the other suffered acute respiratory failure. In both cases, pneumocephalus caused major morbidity and required specific treatment and prolonged considerably hospital stay. Based on these observations we believe new precautions in the use of noninvasive continuous positive airway pressure ventilation should be recommended.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Ventilación no Invasiva/efectos adversos , Neumocéfalo/etiología , Complicaciones Posoperatorias/terapia , Hueso Esfenoides/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/terapiaRESUMEN
Intubation and ventilation impossible mask is a dramatic situation with potentially serious consequences. We report the case of a patient of 43 years, followed for a goiter, which was scheduled for a total thyroidectomy under general anesthesia. Preoperative evaluation is not noted signs of compression or tracheal deviation, and there were no criteria predictive of intubation or difficult mask ventilation. The induction of anesthesia was standard. Mask ventilation was effective allowing paralysis. The standard laryngoscopy showed a score of Cormack and Lehane grade IV. Several attempts at intubation were made leading to a situation of intubation and ventilation impossible mask with deep desaturation. A tracheostomy was done urgently. The patient was operated on, six months later, with a fiber optic intubation. Through this case, the authors draw attention to the difficulty of achieving an emergency tracheotomy in the presence of goiter and emphasize the need for integration of different modes of learning and retention of management skills of the upper airway.