Case report
Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications
Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias
P. Kot Baixauli
, P. Rodriguez Gimillo, J. Baldo Gosalvez, J. de Andrés Ibáñez
Corresponding author
Servicio de Anestesia, Reanimación y Terapia del Dolor, Consorcio Hospital General Universitario de Valencia, Spain
Read
1
Timeswas read the article
0
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2341192918301653" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.11.001" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "944" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:593-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935618301099" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.05.008" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "944" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:593-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 143 "formatos" => array:2 [ "HTML" => 81 "PDF" => 62 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "596" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications" ] ] "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" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 711 "Ancho" => 755 "Tamanyo" => 51384 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Radiografía de tórax donde se aprecia elevación del hemidiafragma derecho.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Kot Baixauli, P. Rodriguez Gimillo, J. Baldo Gosalvez, J. de Andrés Ibáñez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Kot Baixauli" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodriguez Gimillo" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Baldo Gosalvez" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "de Andrés Ibáñez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918301653" "doi" => "10.1016/j.redare.2018.11.001" "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/S2341192918301653?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618301099?idApp=UINPBA00004N" "url" => "/00349356/0000006500000010/v1_201811250605/S0034935618301099/v1_201811250605/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918301689" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.11.004" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "949" "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). 2018;65:597-600" "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" => "Anaesthetic management of median arcuate ligament syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "600" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo anestésico del síndrome del ligamento arcuato medio" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1060 "Ancho" => 1133 "Tamanyo" => 56987 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance angiography in expiration, showing compression of the celiac trunk (TC) by the median arcuate ligament (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Álvarez-Fuente, A. Fadrique Fuentes, R. Poves-Álvarez, E. Gómez-Pesquera, A. Hernández Lozano" "autores" => array:5 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Álvarez-Fuente" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Fadrique Fuentes" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Poves-Álvarez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Gómez-Pesquera" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Hernández Lozano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618301166" "doi" => "10.1016/j.redar.2018.06.004" "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/S0034935618301166?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301689?idApp=UINPBA00004N" "url" => "/23411929/0000006500000010/v1_201812070615/S2341192918301689/v1_201812070615/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918301707" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.05.003" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "945" "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). 2018;65:589-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 86 "formatos" => array:2 [ "HTML" => 82 "PDF" => 4 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Ultrasound guided erector spinae plane block as a cause of unintended motor block" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "589" "paginaFinal" => "592" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo en el plano del erector de la columna ecoguiado como causa de bloqueo motor imprevisto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Selvi, S. Tulgar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Selvi" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Tulgar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618301105" "doi" => "10.1016/j.redar.2018.05.009" "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/S0034935618301105?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301707?idApp=UINPBA00004N" "url" => "/23411929/0000006500000010/v1_201812070615/S2341192918301707/v1_201812070615/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "596" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Kot Baixauli, P. Rodriguez Gimillo, J. Baldo Gosalvez, J. de Andrés Ibáñez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Kot Baixauli" "email" => array:1 [ 0 => "skakeops@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodriguez Gimillo" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Baldo Gosalvez" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "de Andrés Ibáñez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesia, Reanimación y Terapia del Dolor, Consorcio Hospital General Universitario de Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 711 "Ancho" => 755 "Tamanyo" => 51384 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph showing elevation of the right hemidiaphragm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The diaphragm is the main muscle involved in breathing. It is innervated by the phrenic nerves, which have their origin in the anterior rami of C3–C5. Both nerves descend through the neck to the anterior scalene muscle and then through the thorax to reach the diaphragm. Brachial plexus block is a standard technique for major shoulder surgery; however, no supraclaviclar techniques have been shown to reduce the phrenic nerve block rate to below 20%.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4,7</span></a> Phrenic nerve block affects breathing by causing equally intense paralysis of the ipsilateral hemidiaphragm, which significantly diminishes forced vital capacity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In healthy patients, the loss of function of a hemidiaphragm does not usually have clinical repercussions; however, it can sometimes lead to postoperative respiratory complications (especially in patients with prior altered respiratory function). In these cases, a rapid, sensitive and specific diagnostic tool is needed for prompt diagnosis that can prevent the appearance of complications in the immediate postoperative period. We present a clinical report in which ultrasound was used to obtain a rapid evaluation of diaphragm function in the presence of high suspicion of paralysis due to phrenic nerve block after continuous interscalene block.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 68-year-old woman who underwent surgery to insert an inverted right shoulder prosthesis due to glenohumeral osteoarthritis. Her history was significant for clonal B lymphocytosis, dyslipidaemia and vertigo. Weight: 65<span class="elsevierStyleHsp" style=""></span>kg, height: 158<span class="elsevierStyleHsp" style=""></span>cm, body mass index: 26. ASA class II An interscalene catheter was inserted under ultrasound guidance for administration of 10<span class="elsevierStyleHsp" style=""></span>cc levobupivacaine 0.375%, and the intervention was performed under general anaesthesia. Anaesthesia was induced with 140<span class="elsevierStyleHsp" style=""></span>mg propofol and 40<span class="elsevierStyleHsp" style=""></span>mg rocuronium, and maintained with 2–3% sevoflurane and continuous remifentanil infusion. At the end of surgery, the patient was woken up and extubated without incident. The nerve block was reversed with sugammadex 2<span class="elsevierStyleHsp" style=""></span>mg/kg, achieving a TOF ratio<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.9.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After transfer to the postanaesthesia care unit (PACU), the patient reported shortness of breath with superficial tachypnea and inadequate respiratory mechanics. Given the high suspicion of phrenic nerve block and the possibility respiratory complications, a point-of-care ultrasound was performed to evaluate diaphragmatic function. Diaphragmatic excursion (DE) was measured in both hemispheres using a convex transducer placed on the midline in the subcostal region. The difference between maximum inspiration and maximum expiration was measured in M mode in millimetres (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Right sided DE was 7.9<span class="elsevierStyleHsp" style=""></span>mm and left sided DE was 56.5<span class="elsevierStyleHsp" style=""></span>mm. The ultrasound data allowed us to confirm complete paralysis of the hemidiaphragm ipsilateral to the block. This technique yielded a quick, specific diagnosis in the immediate postoperative period, and gave us the information needed to predict the onset of iatrogenic respiratory complications. The initial measures included immediate removal of the interscalene catheter, administration of oxygen therapy using a Ventimask at an FiO<span class="elsevierStyleInf">2</span> of 50%, and intensive monitoring during the first few postoperative hours.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Thanks to the early diagnosis and the measures taken, the patient's remaining stay in the PACU was uneventful. A per protocol follow-up chest radiography (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed elevation of the right hemidiaphragm (not present on the preoperative radiograph), which correlated with the symptoms and ultrasound findings. The patient was discharged home 2 days later, without further incident.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Phrenic nerve block causes dysfunction of the ipsilateral hemidiaphragm. It is usually clinically asymptomatic, as the contralateral hemidiaphragm and the accessory muscles are capable of generating adequate volumes.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The phenomenon is sometimes associated with postoperative respiratory complications, such as dyspnoea, atelectasis, pneumonia, the need for reintubation, or prolonged mechanical ventilation, especially in patients with prior lung disease. However, some patients with no prior history, such as the case reported here, can present clinical signs of respiratory failure, which is why early diagnosis and treatment are so important. Although electrophysiological studies are the “gold standard”, diagnosis is usually made by studying hemidiaphragm elevation on a chest radiograph.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Other methods for evaluating diaphragmatic function include fluoroscopy, respiratory function tests, and ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,6,7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ultrasound is a quick, affordable, non-invasive technique that can be performed almost anywhere. It can evaluate diaphragmatic function by measuring DE and the shortening fraction (SF),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and is highly sensitive (S) and specific (SP) for the diagnosis of diaphragm dysfunction (S 93%, SP 100%).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> DE values below 11<span class="elsevierStyleHsp" style=""></span>mm are diagnostic for diaphragm dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,7,8</span></a> The safest approach is to measure both DE and SF, given the difficulty sometimes encountered in measuring DE in the left hemidiaphragm. Ultrasound evaluation of the diaphragm has been described as diagnostic in different situations. It can rapidly detect phrenic paralysis after interscalene block in upper limb surgery<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> (particularly in patients at risk of developing postoperative respiratory complications). Some studies have also described its role in predicting successful mechanical ventilation weaning in critically ill patients,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,7,8</span></a> and the technique has been used to diagnose diaphragm dysfunction after abdominal,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> cardiac, and thoracic surgery. Phrenic nerve block or injury can be associated with acute complications in the immediate postoperative period, hence the importance of a diagnostic tool that can quickly and accurately confirm or rule out this complication. Given our patient's symptoms and the high risk of complications, ultrasound allowed us to confirm hemidiaphragm paralysis quickly and safely.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We hope this case report will raise awareness of the importance of diaphragmatic ultrasound as an immediate, non-invasive, point-of-care, post-education method of diagnosing patients with high suspicion of phrenic nerve block or injury in the PACU or even in the operating room. Immediate diagnosis of diaphragm function by ultrasound measurement of SF and DE can give an early indication of possible postoperative respiratory complication. Furthermore, ultrasound, which is an inexpensive, rapid and safe technique, can be used to identify diaphragmatic hypokinesia in patients undergoing upper limb surgery prior to administering nerve block, which is contraindicated in this population due to the high risk of triggering serious complications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1124175" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1058850" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1124176" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1058849" "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" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-09" "fechaAceptado" => "2018-05-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1058850" "palabras" => array:4 [ 0 => "Diaphragmatic ultrasound" 1 => "Interscalene block" 2 => "Phrenic nerve" 3 => "Post-operative respiratory complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1058849" "palabras" => array:4 [ 0 => "Ecografía diafragmática" 1 => "Bloqueo interescalénico" 2 => "Nervio frénico" 3 => "Complicaciones respiratorias postoperatorias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del nervio frénico es una complicación que puede producirse tras la anestesia del plexo braquial por encima de la clavícula. La principal consecuencia de este bloqueo es la parálisis diafragmática ipsolateral, que en ocasiones puede suponer aparición de complicaciones respiratorias postoperatorias. Presentamos un caso clínico de una mujer que tras ser intervenida de una prótesis total de hombro presentó disnea en la unidad de recuperación posquirúrgica. Se realizó una ecografía diafragmática que permitió un diagnóstico rápido de parálisis completa del hemidiafragma ipsolateral. Ante la sospecha de bloqueo del nervio frénico, la ecografía ha demostrado ser una herramienta diagnóstica rápida con alta sensibilidad y especificidad. Su empleo puede anticipar el posible desarrollo de complicaciones inmediatas, y orientarnos para escoger la estrategia terapéutica adecuada para cada caso de una manera precoz. En nuestro caso nos permitió tratar de forma precoz mediante oxigenoterapia, retirada de catéter interescalénico y vigilancia intensiva.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Kot Baixauli P, Rodriguez Gimillo P, Baldo Gosalvez J, de Andrés Ibáñez J. Utilidad de la ecografía diafragmática en el diagnóstico precoz de parálisis frénica tras cirugía de hombro para prevenir complicaciones respiratorias postoperatorias. Rev Esp Anestesiol Reanimac. 2018;65:593–596.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 467 "Ancho" => 1255 "Tamanyo" => 140141 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diaphragmatic excursion measured by ultrasound in M (a) and B (b) mode in both hemidiaphragms on the anterior midline, subcostal zone. The image shows paralysis of the right hemidiaphragm. Derecho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>right, Izquierdo<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>left.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 711 "Ancho" => 755 "Tamanyo" => 51384 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph showing elevation of the right hemidiaphragm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Urmey" 1 => "K. Talts" 2 => "N. Sharrock" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1991" "volumen" => "72" "paginaInicial" => "498" "paginaFinal" => "503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2006740" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phrenic nerve palsy and regional anesthesia for shoulder surgery. Anatomical, physiologic, and clinical considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. El-Boghdadly" 1 => "K.J. Chin" 2 => "V.W. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000001668" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2017" "volumen" => "127" "paginaInicial" => "173" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28514241" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory impact of analgesic strategies for shoulder surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Verelst" 1 => "A. van Zundert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e318272195d" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "50" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23132510" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of the ultrasound assessment of diaphragmatic function in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.F. Sferrazza Papa" 1 => "G.M. Pellegrino" 2 => "F. Di Marco" 3 => "G. Imeri" 4 => "L. Brochard" 5 => "E. Goligher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000446518" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "403" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27216909" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dysfunction of the diaphragm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.D. McCool" 1 => "E. Tzelepis George" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "932" "paginaFinal" => "942" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Boon" 1 => "H. Sekiguchi" 2 => "C.J. Harper" 3 => "J.A. Strommen" 4 => "L.S. Ghahfarokhi" 5 => "J.C. Watson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0000000000000841" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2014" "volumen" => "83" "paginaInicial" => "1264" "paginaFinal" => "1270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25165390" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two dimensional ultrasound imaging of the diaphragm: Quantitative values in normal subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Boon" 1 => "C.J. Harper" 2 => "L.S. Ghahfarokhi" 3 => "J.A. Strommen" 4 => "J.C. Watson" 5 => "E.J. Sorenson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mus.23702" "Revista" => array:6 [ "tituloSerie" => "Muscle Nerve" "fecha" => "2013" "volumen" => "47" "paginaInicial" => "884" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23625789" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valoración ecográfica de la función diafragmática y sus aplicaciones en el paciente crítico, en ventilación mecánica y en la anestesia del plexo braquial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.B. De la Quintana" 1 => "B.N. Nacarino Alcorta" 2 => "M. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2017.01.001" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2017" "volumen" => "64" "paginaInicial" => "513" "paginaFinal" => "521" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28343681" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La ratio de grosor diafragmático (inspiratorio/espiratorio) como método diagnóstico de parálisis diafragmática asociada al bloqueo interescálenico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.M. López Escárraga" 1 => "K. Dubos España" 2 => "R.H. Castillo Bustos" 3 => "L. Peidró" 4 => "S. Sastre" 5 => "X. Sala-Blanch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2017.09.008" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2018" "volumen" => "65" "paginaInicial" => "81" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29126611" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.H. Kim" 1 => "S. Na" 2 => "J-S. Choi" 3 => "S.H. Na" 4 => "S. Shin" 5 => "S.O. Koh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181d5e4d8" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "110" "paginaInicial" => "1349" "paginaFinal" => "1354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418298" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000010/v1_201812070615/S2341192918301653/v1_201812070615/en/main.assets" "Apartado" => array:4 [ "identificador" => "65601" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000010/v1_201812070615/S2341192918301653/v1_201812070615/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301653?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
