ABSTRACT
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, IntratrachealABSTRACT
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, IntratrachealABSTRACT
La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por 3 Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse, y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados postoperatorios
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures
Subject(s)
Humans , Tracheotomy/methods , Coronavirus Infections/surgery , Severe Acute Respiratory Syndrome/surgery , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Respiratory Insufficiency/surgery , Pandemics/statistics & numerical data , Respiration, Artificial/methods , Airway Management/methodsABSTRACT
OBJECTIVES: Inflammatory disorders of the parathyroid gland are poorly defined. Only seven cases of granulomatous infection have been reported in the literature. PATIENTS AND METHODS: A 68-year-old woman presented with parathyroid hormone level at 277pg/mL and calcium level at 10.8mg/dL, considered as primary hyperparathyroidism. Parathyroidectomy was performed, normalizing analytical values. RESULTS: Normal-size gland with chief cell hyperplasia, focal pseudofollicular changes, and presence of epithelioid granulomas with Langhans giant cells and caseous necrosis areas, and a positive PCR for M. tuberculosis complex was identified. Chronic granulomatous inflammation could provoke a cascade of immune system activation, resulting in hyperplasia with the consequent increase in parathyroid function, and therefore primary hyperparathyroidism. CONCLUSIONS: In populations with a high incidence of tuberculosis, the coexistence of these pathologies must be kept in mind. This theory needs further biomolecular studies to be confirmed, but it provides a new perspective within the possible etiologies of hyperparathyroidism.
Subject(s)
Hyperparathyroidism, Primary , Tuberculosis , Aged , Female , Humans , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/pathology , Hyperplasia/pathology , Inflammation/etiology , Parathyroid Glands/pathology , Tuberculosis/pathologyABSTRACT
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methodsABSTRACT
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methodsABSTRACT
The Minimally Invasive Video-Assisted Thyroidectomy, described by P. Miccoli in 1998, is a safe and feasible procedure, for the surgical treatment of thyroid nodules of less than 3.5 centimeters. After our first 11 cases, we conclude that only a large experience with the technique will reduce the operating time and the percentage of conversions into a conventional technique. But, as soon as it is possible to succeed already in the first procedures, the benefits of a good cosmetic result and less postoperative pain are evident since the beginning of the learning curve.
Subject(s)
Endoscopy/methods , Thyroidectomy/instrumentation , Humans , Minimally Invasive Surgical Procedures/methodsABSTRACT
La Tiroidectomía Video-Asistida Mínimamente Invasiva, descrita por P. Miccoli en 1998, es un procedimiento seguro y reproducible para el tratamiento quirúrgico de nódulos tiroideos de menos de 3,5 cm. Después de los11 primeros casos, concluimos que sólo una gran experiencia con la técnica permite reducir los tiempos quirúrgicos y el porcentaje de conversiones a la técnica convencional. Pero ya que es posible concluir casos con éxito desde las primeras intervenciones, los beneficios de un buen resultado cosmético y un menor dolor postoperatorio son evidentes desde el principio de la curva de aprendizaje (AU)
The Minimally Invasive Video-Assisted Thyroidectomy, described by P. Miccoli in 1998, is a safe and feasible procedure, for the surgical treatment of thyroid nodules of less than 3.5 centimeters. After our first 11 cases, we conclude that only a large experience with the technique will reduce the operating time and the percentage of conversions into a conventional technique. But, as soon as it is possible to succeed already in the first procedures, the benefits of a good cosmetic result and less postoperative pain are evident since the beginning of the learning curve (AU)
