martes, 21 de abril de 2009

Operar o no operar de amígdalas. That´s the question

Operar a un niño siempre es motivo de preocupación para los padres. Lo que me llama la atención es que no temen a la intervención en sí sino a "la anestesia". Cuando les recomiendo una intervención - o un especialista lo hace- siempre les explico lo siguiente para que sepan por dónde nos movemos. Yo clasifico a las operaciones en:
  1. Urgentes: los padres no pueden decidir. Hay que operara ya o el niño puede morir, por ejemplo, una apendicitis.
  2. Semi urgentes: los padres pueden buscar segundas opiniones pero tienen un tiempo limitado porque si no se realiza el órgano queda descompensado y una intervención tardía no obtendría ninguna ninguna mejora. Tal es el caso de las cardiopatías congénitas o malformaciones de riñón.
  3. Nada urgentes: no hay una fecha determinada. Se puede realizar, en teoría, más pronto o más tarde e incluso posponer durante años. Algunas de estas intervenciones mejoran algo en el organismo que a la larga se traduce en una mejor calidad de vida (fimosis, adenoides/vegetaciones, amígdalas o hernia umbilical).
Pues bien, las intervenciones a las que los padres son más remisos son sin duda la de adenoides/vegetaciones y amígdalas. Pero no tienen miedo a la operación sino a la "anestesia" y por este motivo la retrasan o se niegan a hacerla. Hay niños que da pena verlos con cara de "bobalicón" por respirar mal debido a una hipertrofia amigdalar o adenoidea.

Un fenómeno que yo ya había apreciado en la consulta es que algunos de los niños operados subían de peso e incluso se "pasaban". La causa no está clara pero son niños que durante años han hecho un sobreesfuerzo para poder respirar: la respiración es ruidosa por la noche, tienen mal aliento y sed al levantarse, duermen intranquilos cambiando de postura continuamente. En cuanto se intervienen duermen como angelitos-no roncan- y no tienen ninguna dificultad para tragar. En un estudio reciente de la revista Pediatrics unos médicos holandeses demostraban que cuando se operaban de adeno-amigdalectomía entre los 2 y 5 años se asociaban a un aumento de peso e incluso obesidad.

A muchos niños no se les mejora el paso del aire y están flacuchos, se les deforma la cara y, al crecer, pueden ser roncadores de campeonat, tener sueño durante el día, dormirse conduciendo o tener problemas cardiovasculares

20 comentarios:

Dr. Gluck dijo...

Dr.Santi:
Es verdad que los padres tienen sobre todo miedo a la anestesia. Suelo comentarles que, estadisticamente, es mucho más peligroso el viaje en coche hasta el hospital que la anestesia, y parece que les tranquiliza ..... algo.
Saludos.

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