Machine learning models based on ultrasound and physical examination for airway assessment.

PURPOSE: To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters. METHODS: This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values. RESULTS: We recruited 400 patients. Cormack-Lehanne patients≥III had higher age, BMI, cervical circumference, Mallampati class membership≥III, and bite test≥II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the "Classic Model" achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models. CONCLUSIONS: The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development. CLINICAL REGISTRY: ClinicalTrials.gov: NCT04816435.

Bloqueo del plano del músculo erector de la espina para toracoscopia en el paciente pediátrico / Erector spinae plane block for thoracoscopy in a paediatric patient

Presentamos el caso de una paciente de nueve años, con antecedentes de epilepsia y múltiples ingresos por bronconeumonía aspirativa, entre otros, que ingresa en nuestro centro por shock séptico secundario a una neumonía en el lóbulo inferior izquierdo y derrame pleural paraneumónico, con mala evolución. Durante su ingreso, se interviene bajo anestesia combinada para desbridamiento quirúrgico por videotoracoscopia y colocación de drenaje en hidroneuomotórax izquierdo complicado. Para la intervención, se realiza un bloqueo del plano del músculo erector de la espina ecoguiado, junto con una anestesia general. Este bloqueo, permitió, por un lado, disminuir la dosis de opioides postoperatorios, mejorando la ventilación de la paciente y, por otro lado, evitó el uso de diversos fármacos que podían disminuir el umbral epileptógeno y aumentar el riesgo de sufrir una convulsión. Este caso demuestra la importancia de la anestesia locorregional en el paciente pediátrico, un arma anestésica en auge.(AU)

We present the case of a 9 year old patient with a clinical history of epilepsy and various hospitalizations due to aspirative broncopneumonia among others, who was admitted to our hospital because of septic shock secondary to pneumonia of the lower left lobule associated with a parapneumonic pleural effusion and a complicated clinical course. During her stay, the patient undergoes surgical debridement using video assisted thoracoscopic surgery (VATS) under general anaesthesia and the hydropneumothorax is drained. For the procedure an ecoguided erector spinae plane block is performed and combined with general anaesthesia. On one hand this block permitted reduction of perioperative opioid administration and improved the patient's respiration, on the other hand it permitted avoiding the use of drugs, which can lower seizure threshold and increase the risk of convulsions. This case illustrates the importance of locoregional anaesthesia, a technique on the rise in the field of paediatric anaesthesia.(AU)

Erector spinae plane block for thoracoscopy in a paediatric patient.

We present the case of a 9 year old patient with a clinical history of epilepsy and various hospitalizations due to aspirative broncopneumonia among others, who was admitted to our hospital because of septic shock secondary to pneumonia of the lower left lobule associated with a parapneumonic pleural effusion and a complicated clinical course. During her stay, the patient undergoes surgical debridement using video assisted thoracoscopic surgery (VATS) under general anaesthesia and the hydropneumothorax is drained. For the procedure an ecoguided erector spinae plane block is performed and combined with general anaesthesia. On one hand this block permitted reduction of perioperative opioid administration and improved the patient's respiration, on the other hand it permitted avoiding the use of drugs, which can lower seizure threshold and increase the risk of convulsions. This case illustrates the importance of locoregional anaesthesia, a technique on the rise in the field of paediatric anaesthesia.