Guía de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte I / Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I

La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)

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 factor, 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.(AU)

Guía de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte II / Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II

La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)

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 factor, 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.(AU)

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

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.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

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.

Clínica, epidemiología e imagenología del fibroma osificante y la displasia fibrosa del territorio cráneo-maxilofacial: revisión narrativa / Clinical, epidemiology and imaging of ossifiying fibroma and fibrous dysplasia of the cranio-maxillofacial territory: narrative review

Introducción: El fibroma osificante (FO) y la displasia fibrosa (DF) tienen características imagenológicas e histopatológicas similares que dificultan el diagnóstico diferencial. El propósito de la presente revisión narrativa es analizar las características clínicas, epidemiológicas e imagenológicas del FO y la DF, y evaluar la relación entre las características imagenológicas y las variantes histopatológicas del FO, en reportes y series de casos publicados.Materiales y métodos:Se realizó una búsqueda de reportes y series de casos de FO y DF entre 2017-2021 en PubMed, Scopus y Web of Science. Los casos debían tener suficiente información clínica, epidemiológica, histopatológica e imagenológica.Resultados:Se incluyeron 23 artículos con 25 lesiones: 17 FO y 8 DF. El tiempo de evolución de DF es más prolongado que FO. FO se ubica con mayor tendencia en complejo osteomeatal en comparación con DF. Sólo FO presentó alteraciones en piel, radiolucidez/hipodensidad periférica, perforación ósea y rizalisis externa, además, tuvo mayor tendencia al avance a espacios anatómicos adyacentes y a generar asimetría facial y/o craneal. FO psammomatoide y FO trabecular comparten patrones imagenológicos y tienen límites definidos corticalizados. FO convencional tuvo mayor tendencia a perforar corticales. DF puede tener límites mal definidos y definidos corticalizados. El FO mostró características imagenológicas de mayor agresividad que la DF.Conclusiones:La histología e imagenología por sí solas no son decisivas en el diagnóstico de FO y DF. Es imprescindible considerar conjuntamente clínica, imagenología e histopatología, enfatizando en las características que orienten el diagnóstico diferencial.(AU)

Introduction: Ossifying fibroma (OF) and fibrous dysplasia (FD) have similar imaging and histopathological characteristics, which make differential diagnosis difficult. The aim of this narrative review was to analyze the clinical, epidemiological and imaging characteristics of OF and FD, as well as to evaluate the relationship between imaging characteristics and histopathologic variants of OF, in reports and case series published.Materials and methods:A search of reports and case series of OF and FD between 2017-2021 in PubMed, Scopus and Web of Science was performed. The cases had to have enough clinical, epidemiological, histopathological and imaging information.Results:23 articles with 25 lesions were included: 17 OF and 8 FD. FD had a longer time of evolution than OF. OF is more likely to be in osteomeatal complex compared to FD. Only OF had skin alterations, peripheral radiolucency/hypodensity, bone perforation and external root resorption, in addition, it had a greater tendency to advance to adjacent anatomical spaces and generate facial and/or cranial asymmetry. Psammomatoid OF and trabecular OF share imaging patterns and have defined and corticated margins. Conventional OF had a greater tendency to cortical perforation. DF can have ill-defined and defined and corticated margins. OF has imaging characteristics of greater aggressiveness than FD.Conclusion:Histology and imaging alone are not decisive in OF and FD diagnosis. It is essential to consider clinical, imaging and histopathological evaluations as a whole, emphasizing in the characteristics that guide the differential diagnosis.(AU)

Current practice of rapid sequence induction in adults: A national survey among anesthesiologists in Spain. / Práctica actual de la inducción de secuencia rápida en adultos: una encuesta nacional entre anestesiólogos en España.

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.

[Anaesthetic management in left ventricular assist device implantation as destination therapy: Our first experience]. / Manejo anestésico en el implante de un dispositivo de asistencia ventricular izquierda como terapia definitiva: nuestra primera experiencia.

Left ventricular assist devices have emerged as one of the main therapies of advanced cardiac failure due the increase of this disease and lack of organ supply for cardiac transplantation. The anaesthetic management is described on a patient without cardiac transplantation criteria. The device was successfully implanted as a destination therapy.

[Blind tracheal intubation through two supraglottic devices: i-gel versus Fastrach intubating laryngeal mask airway (ILMA)]. / Intubación traqueal "a ciegas" a través de dos dispositivos supraglóticos: i-gel frente a mascarilla laríngea de intubación ILMA-Fastrach.

BACKGROUND AND OBJECTIVES: The use of supraglottic devices as a means of rescue in patients difficult to intubate or ventilate has increased in the field of anaesthetics and in emergency medicine. This study is designed to evaluate the success rate of blind intubations using two supraglottic devices, the Fastrach ILMA and the i-gel mask. PATIENTS AND METHODS: A total of 80 patients (40 per group) were included. After positioning them a leak test was performed, the glottis view was checked with a fibrobronchoscope, and an attempt was made to introduce an endotracheal tube through the device, and the procedure was repeated. Adequate ventilation was evaluated, as well as the grade of fibrobronchoscope view, the success of the intubation, and the complications observed after their use. RESULTS: There were no differences in the incidence of adequate ventilation with either device. The glottis view (Brimacombe scale) was better with i-gel (77.78% versus 68.42%) at the second attempt, but not on the first. A higher percentage of intubations were achieved with the Fastrach ILMA (70% versus 40%; P=.013). The incidence of throat pain was similar with both devices, but post-operative dysphonia was more frequent with i-gel (20% versus 0; P=.0053). CONCLUSIONS: Both devices were equally effective in achieving adequate ventilation; however, the Fastrach ILMA enabled a higher number of intubations to be made than i-gel and with a lower incidence of post-operative dysphonia.

Intubación traqueal "a ciegas" a través de dos dispositivos supraglóticos: i-gel frente a mascarilla laríngea de intubación ILMA-Fastrach / Blind tracheal intubation through two supraglottic devices: i-gel versus Fastrach intubating laryngeal mask airway (ILMA)

Introducción y objetivos: El empleo de dispositivos supraglóticos como medida de rescate en pacientes con dificultades para la intubación y/o ventilación se ha incrementado en el ámbito de la anestesia y de la medicina de emergencias. Este estudio se diseñó para evaluar la tasa de éxito de intubación "a ciegas" a través de dos dispositivos supraglóticos: la ILMA-Fastrach y la mascarilla i-gel. Pacientes y métodos: Se incluyó a 80 pacientes (40 por grupo). Tras la colocación, se realizó un test de fugas, se comprobó la visión glótica con un fibrobroncoscopio y se intentó la introducción de un tubo endotraqueal a través del dispositivo. Si el intento resultaba fallido, se retiraba el dispositivo y se repetía el procedimiento. Se evaluaron la ventilación adecuada, el grado de visión fibrobroncoscópica, el éxito en la intubación y las complicaciones observadas tras su uso. Resultados: No hubo diferencias en la incidencia de ventilación adecuada entre los dispositivos. La visión glótica (escala de Brimacombe) fue mejor con i-gel (el 77,78 frente al 68,42%) al segundo intento, pero no en el primero. Se consiguió una mayor porcentaje de intubaciones "a ciegas" con ILMA-Fastrach (el 70 frente al 40%; p = 0,013). La incidencia de dolor de garganta fue similar con ambos dispositivos, pero la disfonía postoperatoria fue más frecuente con i-gel (el 20% frente a 0; p = 0,0053). Conclusiones: Ambos dispositivos fueron igual de eficaces para conseguir una adecuada ventilación; sin embargo, ILMA-Fastrach permitió mayor número de intubaciones que igel con menos incidencia de disfonía postoperatoria(AU)

Background and objectives: The use of supraglottic devices as a means of rescue in patients difficult to intubate or ventilate has increased in the field of anaesthetics and in emergency medicine. This study is designed to evaluate the success rate of blind intubations using two supraglottic devices, the Fastrach ILMA and the i-gel mask. Patients and methods: A total of 80 patients (40 per group) were included. After positioning them a leak test was performed, the glottis view was checked with a fibrobronchoscope, and an attempt was made to introduce an endotracheal tube through the device, and the procedure was repeated. Adequate ventilation was evaluated, as well as the grade of fibrobronchoscope view, the success of the intubation, and the complications observed after their use. Results: There were no differences in the incidence of adequate ventilation with either device. The glottis view (Brimacombe scale) was better with i-gel (77.78% versus 68.42%) at the second attempt, but not on the first. A higher percentage of intubations were achieved with the Fastrach ILMA (70% versus 40%; P=.013). The incidence of throat pain was similar with both devices, but post-operative dysphonia was more frequent with i-gel (20% versus 0; P=.0053). Conclusions: Both devices were equally effective in achieving adequate ventilation; however, the Fastrach ILMA enabled a higher number of intubations to be made than i-gel and with a lower incidence of post-operative dysphonia(AU)

Dolor agudo postoperatorio (DAP) en cirugía general / Postoperative acute pain (PAP) in general surgery

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Left-sided cardiac gas embolism produced by hydrogen peroxide: intraoperative diagnosis using transesophageal echocardiography.

IMPLICATIONS: We present a case of an adult who suffered a left-sided gas embolism after surgical lavage of the thoracic cavity with hydrogen peroxide. An intraoperative diagnosis was made using transesophageal echocardiography.

[Inhalation administration of nitric oxide during selective pulmonary ventilation decreases the intrapulmonary shunt]. / La administración inhalatoria de óxido nítrico durante la ventilación pulmonar selectiva disminuye el shunt intrapulmonar.

OBJECTIVE: To assess the effects of inhaled nitric oxide (NO) on oxygenation and hemodynamics in patients undergoing lung resection surgery during one-lung ventilation (OPV). PATIENTS AND METHODS: Prospective study of 16 patients aged 62 +/- 10 years scheduled for chest surgery under combined general and epidural anesthesia. During ventilation of only one lung, NO was administered for 15 minutes. Arterial blood and mixed venous blood samples were taken for analysis of blood gases and the calculation of intrapulmonary shunt. Pulmonary and systemic hemodynamic variables were also recorded using a Swan-Ganz catheter at three times: baseline (ventilation of both lungs), OLV, and with OLV plus NO (OLV NO). RESULTS: The most relevant data consisted of a significant decrease in shunt after start of NO inhalation in comparison with the level during OLV (31.1 +/- 0.5% versus 36 +/- 0.6%; p < 0.05). Arterial oxygen pressure decreased significantly during OLV and increased after start of NO (118.9 +/- 53.6 versus 155.4 +/- 78.5 mmHg; p < 0.05). Mean pulmonary artery pressure, pulmonary and systemic vascular resistances, and cardiac index did not change with inhalation of NO. CONCLUSIONS: Inhalational administration of NO during OLV significantly improves arterial oxygenation and decreases intrapulmonary shunt during OLV, without causing hemodynamic or systemic effects.