hipnoanestesia en cirugía oftalmológica hypnoanesthesia in ophthalmological surgery

Se informa de un paciente de 51 años de edad, obeso e hipertenso, que sufrió traumatismo con un pedazo de hueso en su ojo derecho, presentando herida perforante córneoescleral, hernia de iris y catarata traumática parcial. En el momento del acto quirúrgico sufre grave complicación anestésica con paro respiratorio por la imposibilidad de realizar intubación endotraqueal al presentar un cuello extremadamente corto de tipo constitucional y además crisis hipertensiva. Recuperado el paciente y solo bajo los efectos de la sedación administrativa, se logra reponer el iris herniado y realizar la sutura. Posteriormente, al cabo de varios días de evolución, comienza a presentar aplanamiento de la cámara anterior, catarata intumescente e hipertensión ocular. Se decidió el uso de la hipnoanestesia por el alto riesgo quirúrgico del paciente. Se realizó extracción extracapsular del cristalino, lavado con aspiración de restos capsulares y sutura sin accidentes transoperatorios. Mantuvo su presión arterial normal. No se utilizó ningún tipo de anestésico ni sedante. Al despertar del sueño hipnótico el paciente negó haber sentido dolor, refirió sentirse bien y con sensación de bienestar. El posoperatorio transcurrió sin dificultades. El alta se produjo a las 72 h. En la actualidad su presión intraocular y arterial se mantienen normales, se encuentra pendiente de láser de una tenue membrana pupilar ciclítica.
The case of a 51-year-old obese and hypertensive man, who suffered a trauma with a piece of bone in his right eye that produced a corneoscleral stab wound, hernia of the iris and traumatic partial cataract was reported. During the operation he had a severe anesthetic complication with respiratory arrest due to the impossibility of performing endotracheal intubation, since the patient had an extremely short neck of constitutional type and a hypertensive crisis, too. Once the patient recovered and only under the effects of sedation, it was possible to replace the herniated iris and to suture. After some days of evolution, he began to present flattening of the anterior chamber, intumescent cataract and ocular hypertension. It was decided to use hipnoanesthesia because of the high surgical risk of the patient. Extracapsular extraction of the crystalline lens, lavage with aspiration of capsular remains and suture were made with no transoperative accidents. The patient maintained a normal arterial pressure. No anesthetics or sedatives were used. On waking up from the hypnotic sleep the patient denied having had any pain. He also said that he felt fine and that he had a sensation of well-being. No difficulties were observed during the postoperative period. He was discharged at 72 hours. At present, his intraocular and arterial pressures are normal and he is in the process of being treated with laser due to a thin pupillary cyclitic membrane.