Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

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a b s t r a c tBronchospasm is a clinical condition that can occur unexpectedly during general anaesthesia, but is extremely rare after spinal anaesthesia. The following is a case presentation of a patient who developed bronchospasm after undergoing spinal anaesthesia not attributable to other causes, and that adds another case to the limited literature. Most publications allude to asthmatic patients, and this is probably the first description about a patient with emphysema-type COPD. Our case shows that although spinal anaesthesia is considered safe for patients with respiratory disease, specifically in asthmatic patients there is a possibility of bronchospasm in susceptible patients. © 2016 Published by Elsevier España, S.L.U. on behalf of Sociedad Colombiana de Anestesiología y Reanimación. Broncoespasmo desencadenado por anestesia espinal. Informe de caso y revisión de la literatura Palabras clave: Espasmo bronquial Anestesia, general Anestesia raquídea Anestesia Revisión por expertos r e s u m e n El broncoespasmo es una condición clínica que puede aparecer inesperadamente durante la anestesia general, pero es extremadamente rara tras la anestesia espinal. Presentamos un paciente que desarrolló broncoespasmo tras ser sometido a anestesia espinal, no atribuible a otras causas y que añade un caso más a la escasa literatura al respecto. La mayoría de las publicaciones se refieren a pacientes asmáticos, y esta sea probablemente la primera descripción en un paciente con EPOC tipo enfisematoso. Nuestro caso muestra que aunque ଝ Please cite this article as: Rodilla-Fiz AM, Gómez-Garrido M, Martínez-López F, Monsalve-Naharro JÁ, Girón-La Casa M, López-Pérez A. Broncoespasmo desencadenado por anestesia espinal. Informe de caso y revisión de la literatura. Rev Colomb Anestesiol. 2016. http://dx.

Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one hemibody. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods : Patients with supratentorial ischaemic stroke were selected in the first 48 hours of admission for 6 months. Ultrasonography of the diaphragm was performed on each hemithorax to obtain the thickening fraction applying the formula [(inspiratory thickness - expiratory thickness)/expiratory thickness]. Forced breathing was then requested to them and the examination was performed again. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The statistical relationship with the vascular territory involved, the NIHSS scale, the hemiparesis degree and the success of reperfusion techniques were examined. Results : An incidence of diaphragmatic dysfunction of 51.7% was observed on the contralateral side and of 1.7% on the ipsilateral side. A reduction of up to 11.7% was seen in the incidence of dysfunction on the contralateral side upon breathing forcedly. All patients with NIHSS above 6 had diaphragmatic dysfunction on the contralateral side (p < 0.001). They also had lower degrees of muscle strength (p < 0.001). Conclusions : There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke. An estimation of the diaphragmatic function can be obtained using the thickening fraction.

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