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Beatriz Zarza

Hospital Universitario Ramón y Cajal

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Jaime Masjuán

Instituto Ramón y Cajal de Investigación Sanitaria

María Alonso de Leciñana

Universidad Autónoma de Madrid

Javier Galipienzo

MD Anderson Cancer Center Madrid

Fernando Dronda

Hospital Universitario Ramón y Cajal

C. González-Gordaliza

Hospital General de La Rioja

Alicia Felipe Mimbrera

Hospital Universitario Ramón y Cajal

J. Olarra

Hospital Universitario Ramón y Cajal

Susana Sainz de la Maza

Hospital Universitario Ramón y Cajal

José Luis López-Sendón

Instituto Ramón y Cajal de Investigación Sanitaria

Antonio Culebras

Hospital Universitario Ramón y Cajal

Cooperative Institutions

Hospital Universitario Ramón y Cajal

Instituto Ramón y Cajal de Investigación Sanitaria

Universidad de Alcalá

Instituto Cajal

Hospital Universitario de Fuenlabrada

Instituto de Salud Carlos III

Universidad Autónoma de Madrid

Hospital Universitario La Paz

Centro de Investigación Biomédica en Red

Boston University

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Focal CT hypoperfusion in HaNDL

Journal of Neurology (2012)

Nuria García Barragán Marta Guillán Beatriz Zarza C. González-Gordaliza Alicia Felipe Mimbrera

Neuroradiology

10.1007/s00415-012-6450-5

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Citations (13)

Air embolism after deflation of the pneumoperitoneum in fast-track laparoscopic assisted hemicolectomy

Chinese Medical Journal (2013)

Javier Galipienzo Rogelio Rosado Beatriz Zarza J. Olarra

To the editor: Post-deflation air embolism (AE) is an infrequent and rarely published manifestation in laparoscopic surgery, its pathophysiological mechanisms being barely understood. We present a case of AE during a fast-track laparoscopic hemicolectomy. Male, 58 years old, scheduled for a left hemicolectomy after being diagnosed a tumour in the colon. Before induction, vital signs were normal: AP of 110/80 mmHg (1 mmHg =0.133 kPa), and cardiac frequency (CF) of 76 beats/min. The patient was induced with 2 mg/kg of fentanyl, and 0.15 mg/kg of cisatracure and propofol via TCI infusion to maintain hypnosis. Analgesia was maintained through epidural perfusion of L-bupivacaine 0.25%. We began with the laparoscopic assisted procedure but by technical difficulties we decided to conduct a laparotomy. Once the laparotomy, incidental appendectomy and mobilization of the left colon and splenic flexure was performed. At this very moment, the patient's SpO2 levels plummeted to 79%, while ETCO2 ones dropped to 20 mmHg. Tachycardia (130 beats/min), and arterial hypotension (60/40) occurred. There was no response to fluids therapy. Spasm of the bronchus and pressure pneumothorax were ruled out as causes of the episode. We initiated treatment with noradrenaline. In view of a possible pulmonary thromboembolism, or an AE, the surgical procedure was suspended. Thoracic and lower limbic computerized tomographies (CT) were carried out, ruling out pulmonary embolism and deep venous thrombosis. Transthoracic ECO cardiogram was normal. Intra-operatory AE was diagnosed by exclusion. AE is a rare complication, its current incidence being unknown.1 Causes are varied, the most frequent ones being gravitational ones, amongst which are head and neck interventions, and laparoscopic assisted surgery.2 Pathophysiologic interpretation of symptomatic AEs in laparoscopic surgery must be carried out according to the moment they are manifested. If it takes place at the onset of the laparoscopic procedure, it is usually a brusque and serious episode after the undetected puncture of a blood vessel. Sudden injection of CO2 into the blood stream produces an important hemodynamic collapse, including acute rise and subsequent fall of PetCO2 and of cardiac output, as well as serious cardiorespiratory insufficiency. On the other hand, AE can also occur during the maintenance phase. Most probably, the entry of gas takes place throughout the procedure as a consequence of varying pressure levels between the pneumoperitoneum and the intravascular space. Lastly, it may happen, just as we believe it happened in our case, that the AE occurs once the pneumoperitoneum has already been released, either immediately or more or less deferred. It's a rarely published occurrence,3 and one which we generally don't often think of. Researchers have arrived at the conclusion that part of the CO2 intravascular injection may get stuck in the splenic region, only to be released with decompression of the peritoneum and or mobilisation of the patient.4 Another theory, suggests that it could be caused by physical phenomena with no vascular injury involved. A state of blood “stagnation” in the splenic region, together with CO2 saturation may lead to a releasing of CO2 bubbles with any sudden decrease in pressure.5 If these bubbles reach a considerable volume, and enter the systemic venous system, an iatrogenic AE may occur (a situation similar to decompression syndrome in scuba divers). Either of these two circumstances could have taken place in our patient. We must be aware of the possibility of AE occurring once the pneumoperitoneum has been released. Javier Galipienzo Rogelio Rosado Beatriz Zarza Jose Olarra Servicio de Anestesiología y Reanimación. Hospital Universitario de Fuenlabrada. Fuenlabrada. Madrid. Spain (Galipienzo J, Rosado R and Olarra J) Hospital Universitario Ramón y Cajal. Madrid. Spain (Zarza B) Correspondence to: Javier Galipienzo. Servicio de Anestesiologíay Reanimación. Hospital Universitario de Fuenlabrada. C/ Camino del Molino s.n. 28942. Fuenlabrada, Madrid, Spain (Email: [email protected])

Hemicolectomy

10.3760/cma.j.issn.0366-6999.20130762

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Citations (1)

Espondilodiscitis y sacroileítis por Streptococcus agalactiae en adultos: caso clínico y revisión de la literatura

Enfermedades Infecciosas y Microbiología Clínica (2005)

Eduardo Díaz-Gonzálvez Beatriz Zarza Paloma de Abreu Javier Cobo Javier Orte

10.1157/13071609

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Citations (12)

Amnesia global transitoria en el contexto de una anestesia general

Revista Española de Anestesiología y Reanimación (2012)

Javier Galipienzo M.S. Lablanca I. Zannin Rafael Rayo Rosado Beatriz Zarza

Transient global amnesia

10.1016/j.redar.2012.03.015

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Citations (5)

Successful intravenous thrombolysis in acute ischaemic stroke in a patient on rivaroxaban treatment

Thrombosis and Haemostasis (2013)

Araceli Alonso-Canovas Alicia de Felipe Mimbrera Susana Sainz de la Maza Rodrigo Álvarez‐Velasco Beatriz Zarza

Successful intravenous thrombolysis in acute ischaemic stroke in a patient on rivaroxaban treatment -

Ischaemic stroke

Stroke

Acute stroke

10.1160/th13-06-0472

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Citations (19)

Encefalopatía aguda secundaria al tratamiento con disulfiram

Revista de Neurología (2007)

Beatriz Zarza Juan Carlos Martínez‐Castrillo Jaime Masjuán

Disulfiram

10.33588/rn.4507.2007392

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[Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke].

Beatriz Zarza María Alonso de Leciñana Nuria García‐Barragán María Eugenia Díaz-Sánchez José Luis López-Sendón

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Citations (14)