<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8771</journal-id>
<journal-title><![CDATA[Anestesia en México]]></journal-title>
<abbrev-journal-title><![CDATA[Anest. Méx.]]></abbrev-journal-title>
<issn>2448-8771</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Anestesiología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-87712019000200074</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Neurotoxicidad por ácido tranexámico en trasplante renal pediátrico: reporte de caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Tranexamic acid neurotoxicity in pediatric renal transplantation: case report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López-García]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peña-Olvera]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Pediatría Anestesiología Pediátrica ]]></institution>
<addr-line><![CDATA[CDMX ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Pediatría  ]]></institution>
<addr-line><![CDATA[CDMX ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<numero>2</numero>
<fpage>74</fpage>
<lpage>83</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-87712019000200074&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-87712019000200074&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-87712019000200074&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El trasplante renal pediátrico es el tratamiento de elección en niños con enfermedad renal terminal, tiene una tasa de supervivencia del 90%; generalmente no se asocia con necesidad intraoperatoria de transfusión sanguínea y cuando se requiere; aumenta la morbimortalidad postoperatoria. Caso clínico. Paciente femenino de ocho años de edad con diagnostico de enfermedad renal crónica tubulointersticial estadio V, programado para trasplante renal de donador vivo relacionado. Durante el procedimiento quirúrgico presenta una lesión en vena y arteria renal, obteniendo un sangrado mayor al volumen sanguíneo circulante, requirió de maniobras de transfusión masiva y estabilización hemodinámica con norepinefrina. Bajo un estado de hiperfibrinolisis comprobado por tromboelatografía se administró ácido tranexámico; disminuyendo el sangrado postoperatorio y la necesidad de más hemoderivados, sin embargo presento crisis convulsivas, atribuido a accidente cerebral isquémico agudo reportado por tomografía. Discusión. La neurotoxicidad por ácido tranexámico es baja y multifactorial, siendo el principal factor la presencia de enfermedad renal, posiblemente por ser la principal vía de eliminación; generando concentraciones séricas altas, antagonismo de receptores gaba-aminobutírico asociados a vasoespasmo que desencadena un evento convulsivo. Conclusión. Es evidente el beneficio hemostático que tiene el ácido tranexámico en pacientes de alto riesgo, sin embargo los posibles efectos adversos en el sistema nervioso central han sido escasamente estudiados y por lo tanto no se encuentran claramente definidos en pacientes pediátricos con enfermedad renal en fase terminal.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Pediatric kidney transplantation has become the primary method of treating in children with final stage kidney disease, with 90% survival rate. Commonly, this surgery is not associated with bleeding disorders intraoperative and when this occurs; It increases postoperative morbidity and mortality. Clinical case: An Eight year old girl with chronic kidney disease stage V, due to tobulointerstitial disease, was scheduled for kidney transplantatio from a related living donor. During the surgical procedure she presented an injury in the kidney vein and renal artery, this caused an increase in circulating blood volume during severe hemorrhage; it required a masive transfusión protocol with blood products and hemodynamic stabilization with norepinephrine. Tranexamic acid was administered under a hyperfibrinolysis condition, verified by thromboelatografhy. It resulted in a reduced postoperative bleeding and the need for more blood products, however, there were side effects with seizures, attributed to an acute ischemic stroke reported by a tomography.  Discussion. Tranexamic acid neurotoxicity is low and multifactorial, mainly due to the presence of kidney disease; possibly becouse it is the key route for elimination. This increased its serum concentrations and gaba aminobutyric receptor antagonism associated with vasospasm that triggerseda seizure event.  Conclusión. Tranexamic acid has an important hemostatic benefit in patients at high risk of hemorrhage, however, the posible adverse effects on the central nervous system have been poorly studied and therefore were not clearly defined in pediatric patients with kidney disease in the stage.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Neurotoxicidad]]></kwd>
<kwd lng="es"><![CDATA[convulsiones]]></kwd>
<kwd lng="es"><![CDATA[ácido tranexámico]]></kwd>
<kwd lng="es"><![CDATA[trasplante renal and anestesia]]></kwd>
<kwd lng="en"><![CDATA[Neurotoxicity]]></kwd>
<kwd lng="en"><![CDATA[seizures]]></kwd>
<kwd lng="en"><![CDATA[tranexamic acid]]></kwd>
<kwd lng="en"><![CDATA[kidney transplantation and anesthesia]]></kwd>
</kwd-group>
</article-meta>
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