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array:24 [ "pii" => "S2341192923001385" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.03.004" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1510" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2024;71:54-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935623001391" "issn" => "00349356" "doi" => "10.1016/j.redar.2023.03.003" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1510" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2024;71:54-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "Consideraciones anestésicas en el manejo perioperatorio del paciente con síndrome de Jarcho-Levin" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "57" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Anesthetic considerations in the perioperative management of the patient with Jarcho-Levin syndrome" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 2184 "Ancho" => 2508 "Tamanyo" => 350343 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Radiografías de tórax anteroposterior y lateral. Malformación de caja torácica evidente, con agenesia de costillas superiores de forma bilateral, tórax algo campaniforme y escoliosis, con barras metálicas correctoras de una intervención anterior. A nivel pulmonar no se objetivan condensaciones ni atelectasias.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Rico Rodríguez, D.A. Camargo Espitia, A. Mayoral Márquez, S. Ruan Lin, M.C. Martín Lorenzo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Rico Rodríguez" ] 1 => array:2 [ "nombre" => "D.A." "apellidos" => "Camargo Espitia" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Mayoral Márquez" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Ruan Lin" ] 4 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín Lorenzo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192923001385" "doi" => "10.1016/j.redare.2023.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001385?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001391?idApp=UINPBA00004N" "url" => "/00349356/0000007100000001/v2_202403290953/S0034935623001391/v2_202403290953/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192923001373" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.02.006" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1513" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2024;71:58-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Use of a flexible tip bougie (FlexTip) in the management of the first-attempt failure intubation with the C-MAC D-Blade videolaryngoscope in the intensive care unit: A prospective, case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "58" "paginaFinal" => "63" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de una guía de punta flexible (FlexTip) para manejar el fallo del primer intento de intubación con el videolaringoscopio C-MAC D-Blade en la unidad de cuidados intensivos: serie prospectiva de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 949 "Ancho" => 1800 "Tamanyo" => 288498 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">FlexTip (a) the bougie has a curve similar to the blade of the C-MAC video laryngoscope (D-Blade). The arrows shows the position of the slider tabs that control the anterior (b) and posterior (c) flexion of the bougie.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Taboada, A. Cariñena, J. Regueira, C. Francisco, M. Rodríguez, T. Seoane-Pillado" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Taboada" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Cariñena" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Regueira" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Francisco" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Seoane-Pillado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623001561" "doi" => "10.1016/j.redar.2023.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001561?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001373?idApp=UINPBA00004N" "url" => "/23411929/0000007100000001/v2_202403290730/S2341192923001373/v2_202403290730/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192923001567" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.09.007" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1509" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2024;71:48-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Imágenes Doppler de arterias intrapulmonares dentro de la atelectasia y su impacto en la poscarga del ventrículo derecho con ecocardiografía transesofágica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1397 "Ancho" => 1175 "Tamanyo" => 158362 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mid-oesophageal image of the lung: the probe is placed the level of the pulmonary veins draining into the left atrium, and is then rotated to scan the medial segment of the non-ventilated right lung.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Longo, I. Cheong, J.E. Siri, F. Tamagnone, C. Acosta" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Longo" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Cheong" ] 2 => array:2 [ "nombre" => "J.E." "apellidos" => "Siri" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Tamagnone" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Acosta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003493562300138X" "doi" => "10.1016/j.redar.2023.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493562300138X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001567?idApp=UINPBA00004N" "url" => "/23411929/0000007100000001/v2_202403290730/S2341192923001567/v2_202403290730/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Anesthetic considerations in the perioperative management of the patient with Jarcho-Levin Syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "57" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Rico Rodríguez, D.A. Camargo Espitia, A. Mayoral Márquez, S. Ruan Lin, M.C. Martín Lorenzo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Rico Rodríguez" "email" => array:1 [ 0 => "pakyrico@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D.A." "apellidos" => "Camargo Espitia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Mayoral Márquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Ruan Lin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M.C." "apellidos" => "Martín Lorenzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Doctorado Biomedicina, Investigación traslacional y nuevas tecnologías en salud de la Universidad de Málaga (UMA), Especialista en Medicina Familiar y Comunitaria, Residente Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consideraciones anestésicas en el manejo perioperatorio del paciente con síndrome de Jarcho-Levin" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2184 "Ancho" => 2508 "Tamanyo" => 326650 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior and lateral chest radiograph. Evident rib deformities, with bilateral agenesia of the upper ribs, slightly bell-shaped thorax, and scoliosis, with correction bars from a previous intervention. No evidence of pulmonary condensations or atelectasis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 1938, Jarcho and Levin first described a syndrome consisting of various malformations or abnormal fusion of the thoracic vertebrae and ribs, short trunk, and respiratory distress.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The syndrome, which has a prevalence of 0.25/10,000,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is inherited in an autosomal recessive pattern, has no predilection for either sex, and has been classified into 2 subtypes: spondylothoracic dysostosis and spondylocostal dysostosis. The disease is characterised by vertebral and rib deformities of varying severity that alter the shape of the thorax and cause scoliosis, a short, rigid neck, and short stature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of an 11-year-old boy diagnosed with Jarcho-Levin syndrome who was scheduled for bilateral posterior rib distraction. Informed consent was obtained from the mother to publish this report.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the pre-anaesthesia consultation, we assessed an 11-year-old boy, 33 kg, diagnosed with Jarcho-Levin syndrome at 1 year of life. His parents reported probable allergy to beta-lactams and several admissions at 9 months and 4 years of age due to respiratory complications, together with repeated episodes of bronchitis that responded well to bronchodilator treatment. He had undergone vertical expandable prosthetic titanium rib placement at 17 months and subsequent reoperations for distraction.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The physical examination found predictors of difficult intubation due to his specific phenotype: small teeth, short neck, asymmetric thorax, bilateral agenesis of upper ribs, scoliosis. His breathing was normal and auscultation was unremarkable. A chest X-ray was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). CT images of the spinal column showed segmentation failure. Spirometry showed a severely restrictive pattern that did not improve significantly after the bronchodilator test.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the day of surgery, he was premedicated with oral midazolam 0.4 mg/kg. On arrival at the operating room, continuous monitoring was started with electrocardiogram, pulse oximetry for SaO2, non-invasive blood pressure, temperature, depth of anaesthesia (BIS), and neuromuscular blockade measured by accelerometry. Normothermia was maintained with a thermal blanket and a fluid heater. Anaesthesia was induced with 8%–3% sevoflurane, and 2 peripheral veins were cannulated with an 18 G catheter in both upper limbs. He also received infusion of remifentanil and a single bolus of propofol 2 mg/kg. Face mask ventilation was assessed (I on the HAN scale) and rocuronium 0.6 mg/kg was administered. Direct laryngoscopy with a Macintosh number 2 blade showed a Cormack Lehane grade I view. Intubation using a 6.5 mm reinforced endotracheal tube was uneventful. Antibiotic prophylaxis with vancomycin 500 mg was administered. The patient was placed prone, with eye protection and pressure point padding.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Anaesthesia was maintained with TIVA (propofol 8−10 mg/kg/h and remifentanil 0.05 mcg/kg/min) to achieve BIS between 40 and 60. Mechanical ventilation in volume-controlled mode was delivered without incident. Fluid therapy consisted of administration of crystalloids with sustained diuresis of over 1 ml/kg/h. Paracetamol 15 mg/kg, ketamine 0.25 mg/kg, and morphine chloride 0.15 mg/kg were administered as analgesic rescue. Dexamethasone 0.1 mg/kg and ondansetron 0.1 mg/kg were administered for antiemetic prophylaxis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgery lasted 2 h.</p><p id="par0040" class="elsevierStylePara elsevierViewall">After the intervention, residual neuromuscular blockade was reversed with sugammadex 2 mg/kg under monitoring. The patient was extubated in the operating room without incident and transferred to the paediatric intensive care unit.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient made good progress, remaining in the intensive care unit for 24 h and on the ward for 4 days.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Jarcho-Levin syndrome was described by Saul Jarcho and Paul Levin, based on the case of 2 brothers with vertebral and costal disorders. The non-eponymous name is spondylocostal dysostosis 1, or SCDO1.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is inherited in an autosomal recessive pattern, the culprit chromosome being 19q13.2, and the syndrome occurs equally in both sexes. Estimates suggest an incidence of 0.2 per 100,000 live births, although its prevalence is unknown. Clinical severity is variable, prognosis is generally good with appropriate medical follow-up. In this syndrome, morbidity and mortality are related to respiratory complications, such as respiratory infections, and also pulmonary hypertension and congestive heart failure.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As the individual grows and develops, several vertebral alterations (hemivertebra, butterfly vertebra, fused vertebrae, hypoplastic vertebrae) and rib alterations (fused, misaligned, crowded, bifid, absent, etc.) occur resulting in a "fan-like" or "crab-like” ribcage, which will give rise to scoliosis or kyphoscoliosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Malformation of the chest is due to posterior fusion of the ribs with the costovertebral joints and anterior flaring, giving the individual a short trunk, and therefore, low stature.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The vertebral and costal abnormalities cause a restrictive breathing pattern with the risk of respiratory failure, which can be aggravated by repeated infections. This is why it is so important to optimise respiratory function before surgery, individualize intra-operative management of mechanical ventilation, and prepare postoperative strategies to prevent and treat respiratory failure (use of non-invasive mechanical ventilation, among others).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The short, rigid neck - a typical feature in these patients - restricts neck mobility and can be an indication of difficult intubation.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Some authors have reported widening of the carina and narrowing of the bronchial lumen, with reduced airflow, possibly associated with repetitive aspiration, so it is important to take measures to prevent bronchial aspiration.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Surgical correction increases chest volume, reduces restriction, and therefore, improves lung function and corrects and prevents progression of scoliosis. Corrective surgery performed under optimal anesthetic management can help prolong survival and, above all, improve the patient's quality of life.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Spinal distraction involves separating the ribs and even removing fused ribs in some cases. There is a risk of bleeding from dissection of anomalous segmental arteries.</p><p id="par0090" class="elsevierStylePara elsevierViewall">These patients can also present other disorders: hydrocephalus, hydroureteronephrosis, myelomeningocele, atrial septal defects, ventricular septal defects, renal agenesis, hypoplasia, polycystic kidneys, anal atresia, diaphragmatic hernia, oesophageal fistula, Meckel's diverticulum, bifid uvula, etc.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Differential diagnosis of Jarcho-Levin syndrome must include a group of autosomal recessive dysostoses that are also challenging for the anaesthesiologist, such as: Goldenhar syndrome, Larsen syndrome, oculovertebral syndromes, Klippel-Syndrome Feil, Casamassima Morton Nance syndrome, Alagille syndrome, Robinow syndrome, Vacterl syndrome, Morquio syndrome, severe congenital bone dysplasias.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Although Jarcho-Levin syndrome is a very rare disease, is of interest to the anaesthesiologist due to its preoperative, intraoperative, and postoperative challenges. Good anaesthesia management in these patients consists of a thorough pre-anaesthesia assessment to detect predictors of difficult intubation, preoperative optimization (particularly lung function), preparation of the material needed for airway management, choice of an appropriate anaesthesia technique and ventilatory support, neuromuscular relaxation monitoring, and prevention and prompt treatment of respiratory failure.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres2115109" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1801981" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2115108" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1801982" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-01-29" "fechaAceptado" => "2023-03-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1801981" "palabras" => array:5 [ 0 => "Jarcho-Levin syndrome" 1 => "Disease management" 2 => "Anesthesia" 3 => "Vertebral defects" 4 => "Respiratory insufficiency" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1801982" "palabras" => array:5 [ 0 => "Síndrome de Jarcho-Levin" 1 => "Manejo de la enfermedad" 2 => "Anestesia" 3 => "Alteraciones vertebrales" 4 => "Insuficiencia respiratoria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Jarcho-Levin syndrome is an eponym used to describe a spectrum of small thoracic skeletal dysplasias with variable involvement of vertebrae and ribs. Initially considered lethal, it is currently compatible with life in its mildest forms. Bone alterations that lead to a restrictive respiratory pattern, recurrent respiratory infections and particular phenotype, can make perioperative anesthetic management difficult. The proper assessment of the airway is of special interest because it presents predictors of a difficult airway, as well as the prevention, early diagnosis and adequate treatment of respiratory failure.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We present the case of a patient with Jarcho-Levin Syndrome who underwent vertebral distraction surgery, with its most notable implications in anesthetic management.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El síndrome de Jarcho-Levin es un epónimo usado para describir un espectro de displasias esqueléticas de tórax pequeño con el compromiso variable de vertebras y costillas. Inicialmente considerado letal, actualmente es compatible con la vida en sus presentaciones más leves. Las alteraciones óseas que conllevan a un patrón respiratorio restrictivo, las infecciones respiratorias de repetición y el fenotipo particular, pueden dificultar el manejo anestésico perioperatorio. Siendo de especial interés la adecuada valoración de la vía aérea por presentar predictores de vía aérea difícil, así como la prevención, diagnóstico precoz y tratamiento adecuado de la insuficiencia respiratoria.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un paciente con Síndrome de Jarcho-Levin intervenido de distracción vertebral, con sus implicaciones en el manejo anestésico más destacables.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2184 "Ancho" => 2508 "Tamanyo" => 326650 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior and lateral chest radiograph. Evident rib deformities, with bilateral agenesia of the upper ribs, slightly bell-shaped thorax, and scoliosis, with correction bars from a previous intervention. No evidence of pulmonary condensations or atelectasis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "OMIM. Spondylocostal dysostosis 1, autosomal recessive; SCDO1. 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