The agent that causes the coronavirus disease (COVID-19), associated with the severe acute respiratory syndrome (SARS-CoV-2), produces a spectrum of symptoms that mainly affect the respiratory system, the central nervous system (CNS), the regulation of hemostasis and the immune system. Bilateral vocal fold paralysis (BVFP) is a condition of unknown incidence among infected patients, either because it is short-lived or because of the difficulty in establishing a direct cause to the virus. Viral infection has been described in the literature as a cause of BVFP and there is the suspicion that a proportion of the idiopathic cases are due to undiagnosed viral infections. Although the neurotropic mechanisms for SARS-CoV-2 remain unclear, there is strong evidence to ensure its neuroinvasive potential. The most frequent etiologies of BVFP are trauma, neoplasm, and neurological, but a viral origin should not be ruled out. Causality between COVID-19 and BVFP is plausible and will require further study in the short and long term.
Cardiac mass assessment is challenging in the intraoperative scenario. We present the case of a 22-year-old woman with a new-onset left atrial mass during cardiopulmonary bypass following closure of a ventricular septal defect. We discuss the role of intraoperative echocardiographic examination, the differential diagnosis, and raise awareness of the left atrial appendage as a rare etiology of an acute left atrial mass.
Postpartum haemorrhage due to uterine atony is one of the major causes of maternal morbidity and mortality worldwide. Different control strategies have been postulated, especially during the third stage of labour, but the gold standard treatment is the use of uterotonic drugs. There are currently three well-defined groups of drugs: oxytocics, ergot derivatives and prostaglandins. Although the literature is heterogeneous, it is clear that oxytocin is the uterotonic of choice in both prophylaxis and treatment of postpartum haemorrhage. Detailed knowledge of protocols based on current evidence is mandatory, which vary according to the different medical societies and dictate the doses and order of administration of different drugs.
Caesarean section is the most frequently performed surgery in adults, with a total of 20 million procedures per year. More than 70% of cases are due to lack of labor progression, fetal distress, breech presentation or previous cesarean section. Obstetric anesthesia practice has substantially changed over the last 20 years. The main cause of this is the introduction of regional techniques to the detriment of general anesthesia, which has reduced maternal mortality due to complications such as gastric aspiration or difficulty in orotracheal intubation. In general, we can affirm that regional anesthesia is the most frequently used anesthetic technique for cesarean section, reserving general anesthesia for urgent or life-threatening situations.
Fetal surgery has evolved in the last decades, mostly because of the technical advances in therapeutic and monitoring devices. The timing and mode of surgery depend on the disease to be treated. Local, neuraxial or general anesthesia can be used on the mother. In some cases, fetal analgesia and paralysis are needed. The idea of treating the fetus as a patient has evolved in recent years, as a consequence of improvements in diagnostic imaging and surgical devices. In fetuses with congenital airway obstruction, intrapartum surgical correction or airway management can be performed while maintaining perfusion via the umbilical cord. In 1980, maternal laparotomy and hysterotomy were proposed to treat fetuses with congenital and developmental abnormalities, and the prerequisites for maternal-fetal surgery were first formulated in 1982. They are still in use with some minor modifications. A multidisciplinary approach to fetal intervention is essential. Both obstetric and pediatric anesthesia is involved and it a close collaboration with surgical teams is necessary.
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