Amigdalectomía mediante electrodisección y mascarilla laríngea / Electrodissection tonsillectomy with laryngeal mask

Introducción: La electrodisección con bisturí de Colorado® se utiliza desde hace 30 años como alternativa a la disección fría. Alexander fue el primero en publicar resultados de la mascarilla laríngea en otorrinolaringología y cirugía maxilofacial. Posteriormente se ha introducido como alternativa anestésica habitual en nuestra especialidad. Objetivo: El objetivo de este estudio es comprobar los resultados de la aplicación combinada de estas 2 técnicas en amigdalectomías, ya por separado han demostrado sus beneficios. Métodos: Presentamos un estudio observacional prospectivo de 107 amigdalectomías con o sin adenoidectomía pediátricas. Se analizan una serie de variables durante todo el proceso como el dolor (escala de Brodman), la analgesia, el sangrado, el edema de úvula, los días hasta normalizar la dieta, la habituación a la vida normal y los tiempos quirúrgico, anestésico y total de quirófano. Resultados: La técnica de electrodisección con bisturí de Colorado® minimiza el sangrado intraoperatorio y la necesidad de hemostasia. El edema de úvula y el dolor local aumenta comparado con la disección en frío. No hay variaciones clínicas en cuanto a los días que tarda el paciente en recuperar su vida normal. La combinación de la anestesia con mascarilla laríngea y la electrodisección con Colorado® reduce el tiempo quirúrgico, anestésico y total de quirófano. Conclusiones: La combinación de ambas técnicas es un método seguro, rápido y eficaz que se beneficia de las ventajas de ambas sin suponer un aumento de los riesgos quirúrgicos ni anestésicos (AU)

Introduction: The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective: The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods: We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results: The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions: The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks (AU)

Electrodissection tonsillectomy with laryngeal mask.

INTRODUCTION: The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks.

[Anesthesia for surgical emergencies in Catalonia, Spain, in 2003]. / Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. PATIENTS AND METHOD: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. RESULTS: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. CONCLUSIONS: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred.

Actividad anestésica para urgencias quirúrgicas en Cataluña en 2003 / Anesthesia for surgical emergencies in Catalonia, Spain, in 2003

Fundamento y objetivo: Conocer la actividad anestésica urgente de las especialidades quirúrgicas en Cataluña (España). Pacientes y método: Estudio prospectivo de las anestesias realizadas en 131 hospitales en 14 días aleatorios de 2003 (ANESCAT 2003), se seleccionaron las anestesias urgentes para cirugía (excluyendo obstetricia y procedimientos no quirúrgicos) y se analizaron: tipo de hospital, características de los pacientes, procedimientos, técnicas anestésicas, tiempos empleados, destino de los pacientes y tipo de urgencia (diferible o no). Los datos se expresan como mediana y percentiles del 10-90%, y se extrapolaron a la población catalana. Resultados: De las 23.136 anestesias, 2.088 (estimación de 54.437 anestesias anuales) fueron urgencias quirúrgicas, lo que supone el 9% del total de anestesias y el 11,5% de las anestesias para procedimientos quirúrgicos. El 51% fueron urgencias diferibles (estimación de 26.906 anestesias anuales). El 81,2% de las urgencias se realizó en centros del Institut Català de la Salut y el 18,8% en centros privados. De lunes a viernes se realizó el 80,6% de las urgencias. El 46,5% de la actividad urgente se efectuó entre las 8 y 16 h y el 8,1% entre las 0 y 8 h. El 60% de la actividad diferible se realizó entre las 8 y 16 h. El 52,4% de los pacientes eran varones, la edad mediana era de 51 años (15-83) y un 15,3% eran pacientes graves (clase 4 de la clasificación de la American Society of Anesthesiologists ­ASA­). La cirugía ortopédica y traumatología y la cirugía general y digestiva sumaban el 74% de la actividad. Se aplicó anestesia general en el 51% de los casos y locorregional en el 38%. La duración de la anestesia fue mayor en las urgencias diferibles (90 min). El 18% de los pacientes ingresaron en unidades de cuidados críticos en el postoperatorio. Conclusiones: Anestesia para urgencias quirúrgicas supuso alrededor del 10% de las anestesias que se realizaron en Cataluña en el año 2003, y más de un 50% de ellas podían haberse diferido

Background and objective: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain. Patients and method: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia. Results: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases. Conclusions: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred