%0 Journal Article
%T Consideraciones anest¨¦sicas para cirug¨ªa ortogn¨¢tica: reporte de un caso cl¨ªnico Anesthetic considerations for orthognathic surgery: Clinical case report
%A Nayely Garc¨ªa M¨¦ndez
%A Pedro Alberto Gonz¨¢lez Ram¨ªrez
%A Mar¨ªa Magdalena Crisostomo Pineda
%A Concepci¨®n Rivero Picazo
%J Revista Colombiana de Anestesiolog¨ªa
%D 2013
%I Sociedad Colombiana de Anestesiolog¨ªa
%X Objetivo: Selecci¨®n de f¨¢rmacos anest¨¦sicos ideales en cirug¨ªa maxilofacial. Material y m¨¦todos: Var¨®n de 22 a os, 75 kg de peso y 171cm de altura. No premedicado. Par¨¢metros vitales prequir¨²rgicos: PA120/70; FC72¡Ámin; SPO(2)96%; temperatura 36,5¡ãC; ECG 5 derivaciones ritmo sinusal, y capnograf¨ªa. Preoxigenaci¨®n por 5min mediante mascarilla facial. Se realiza prueba de olfateo corroborando buena ventilaci¨®n, se coloca hisopo impregnado de oximetazolina spray 0,05%. Se inicia la administraci¨®n de dexmedetomidina (concentraci¨®n de soluci¨®n 0,8¦Ìg/ml) en infusi¨®n continua por v¨ªa intravenosa a 0,05¦Ìg/kg/h con una escala Ramsay 2, se inicia inducci¨®n con fentanil 3¦Ìg/g, propofol 2mg/kg, rocuronio 0,6mg/kg. Se introduce por narina derecha tubo endotraqueal Murphy N.¡ã 7, lubricado con lidoca¨ªna 10% spray, a trav¨¦s de la nasofaringe. Comenzando la cirug¨ªa se la ajusta dosis de dexmedetomidina a 0,1¦Ìg/kg/h. Durante el acto anest¨¦sico-quir¨²rgico se mantiene con PA entre 84/55 y 90/53mmHg, FC con cifras entre 58-76 por minuto. Resultados: La selecci¨®n de los f¨¢rmacos anest¨¦sicos permiti¨® lograr la estabilidad hemodin¨¢mica y bienestar en el despertar del paciente. Conclusi¨®n: La anestesia para cirug¨ªa ortogn¨¢tica en la actualidad por su evoluci¨®n hace necesario combinar diferentes t¨¦cnicas anest¨¦sicas para poder proporcionar a los pacientes tranquilidad, seguridad, bienestar y analgesia postoperatoria. Objective: Selection of ideal anesthetic drugs in maxillofacial surgery. Material and methods: A 22-year-old male patient weighing 75 kg and 171cm in height, with no premedication. Pre-operative vital parameters were BP 120/70, HR 72¡Á min, SpO2 96%, temperature 36.5  C, sinus rhythm on 5-lead EKG, capnograpy. The patient was subjected to 5 min of pre-oxygenation through a facial mask. The sniff test was performed, good ventilation was confirmed and a Q-tip impregnated in 0.05% oxymetazoline was applied. An intravenous continuous infusion of dexmedetomidine (solution concentration of 0.8 cg/ml) was initiated at a rate of 0.05 mcg/kg/h with a score of 2 on the Ramsay scale. Induction was initiated with fentanyl 3 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg. A No. 7 Murphy endotracheal tube lubricated with a 10% lidocaine spray was introduced through the right nostril down to the nasopharynx. At the start of surgery, the dose of dexmedetomidine was increased to 0.1 mcg/kg/h. Intra-operatively, BP was maintained between 84/55mmHg and 90/53mmHg, and HR between 58 and 76 per minute. Results: The selection of anesthetic drugs allowed for hemodynamic stability and comfort
%K Cirug¨ªa ortogn¨¢tica
%K Anestesia
%K Osteotom¨ªa
%K Dexmedetomidina
%K Orthognathic surgery
%K Anesthesia
%K Osteotomy
%K Dexmedetomidine
%U http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472013000100013