Use of second generation supra-glottic airway devices during laparoscopic cholecystectomy: a prospective, randomized comparison of LMA Proseal™, LMA SupremeTM and igel™.

INTRODUCTION: Supra-glottic airway devices (SADs) with an inbuilt drain channel, such as the LMA Proseal™ (LMA-P), LMA SupremeTM (LMA-S) and i-gel™ (i-gel), have been used for laparoscopic cholecystectomy. We compared safety, efficacy, and ease of use, as well as the incidence of adverse events between these devices. METHODS: One hundred and eighty adult, ASA 1-3 patients scheduled to undergo elective cholecystectomy under general anesthesia were randomly allocated to one of three groups: LMA-P, LMA-S or i-gel. The primary outcome was to evaluate oropharyngeal leak pressure (OLP). Secondary outcomes were to evaluated speed of insertion, ease of insertion of the device and the drain tube, as well as the incidence of intraoperative adverse events and postoperative oropharyngeal discomfort (POPD). RESULTS: Mean OLP was significantly higher for LMA-P (LMA-P 30.87; i-gel 29.28; LMA-S 29.02 cm H20, P = 0.007). OLP was correlated with a higher maximum tidal achieved volume (P = 0.025). Insertion times were shorter for the i-gel, which was 1.7 s faster to insert than LMA-P (P = 0.04). The success rate on first attempt was higher for the LMA-S (P = 0.004). The drain tube was easily inserted in the LMA-S group (p < 0.001). I-gel showed higher sore throat scoring 2 hours postoperatively (P = 0.008) and reported slower POPD decrease during that time (P < 0.001). CONCLUSIONS: Among SAD's, LMA-S is the easiest to insert (including the drain tube), LMA-P achieved the best leak pressure, and i-gel fastest to insert, although associated with the worst POPD scoring.

Miopatía hipotiroidea / Hypothyroidism myopathy

Presentamos dos caso de miopatía, como cuadro de debut de hipotiroidismo, destacando lo poco frecuente de este acontecimiento. En ambos casos, el desconocimiento de la existencia de dicho trastorno endocrino, llevaron a un enfoque inicial erróneo del cuadro muscular. El diagnóstico final correcto de miopatía tiroidea y su tratamiento con L-tiroxina, determinan una mejoría inmediata. Recordar, pues que un cuadro miopático aislado puede ser debido a hipofunción tiroidea, teniendo en cuenta la "dificultad" del diagnóstico de dicha endocrinopatía cuando faltan sus datos clínicos más típicos (AU)

[Spontaneous splenic rupture: surgical or conservative treatment?]. / Ruptura esplénica espontánea: tratamiento quirúrgico o conservador?

A case of Splenic Spontaneous Rupture (SSR) due to Infectious Mononucleosis is presented, occurring after a slight clinical course without significative abdominal pain. The SSR was recognized by ultrasonography and CT, with free intraperitoneal liquid. The evolution was successful with non operative management. The Medical literature concerning SSR is comment, enhancing the possibility of non operative management of SSR associated to infectious mononucleosis.