Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo / Results of a surgical cricothyrotomy workshop with a pig trachea model

Introducción: Las últimas guías de la Difficult Airway Society recomiendan que todos los anestesiólogos deberían estar entrenados para la realización de una cricotiroidotomía quirúrgica (CtQ). El objetivo de este estudio es analizar los resultados de aprendizaje de un taller de CtQ mediante la evaluación de la tasa de éxito y el tiempo necesario para realizarla en un modelo de tráquea porcina. Material y métodos: Diseñamos un taller en el que cada alumno respondía un cuestionario con datos demográficos y conocimientos teóricos sobre el abordaje quirúrgico de la vía aérea. Durante la hora siguiente se revisaron aspectos teóricos. Se mostró el modelo y realizamos una CtQ siguiendo la técnica clásica. Después, en grupos de 3-4 alumnos con un instructor, los alumnos realizaron 6 CtQ cada uno. Registramos si la ventilación era correcta, el tiempo necesario para realizarla y la facilidad de realización evaluada por alumno e instructor. Finalmente, los alumnos respondieron un cuestionario de aspectos teóricos. Realizamos un análisis estadístico, considerando estadísticamente significativo un valor de p<0,05. Resultados: Llevamos a cabo 8 ediciones del taller, con 91 alumnos. Consiguieron hacer la CtQ y ventilar correctamente el 86% en el primer intento y el 92% en el sexto (p<0,0001). El tiempo necesario para hacer una CtQ pasó de 163 [107-211] a 70 [55-85] segundos (p<0,0001). Al final del taller los alumnos habían mejorado sus conocimientos teóricos (p<0,0001) y la percepción de facilidad de la técnica. Conclusión: El taller realizado mejora los conocimientos teóricos y la competencia en la realización de una CtQ

Background: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. Material and methods: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. Results: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. Conclusion: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy

Results of a surgical cricothyrotomy workshop with a pig trachea model. / Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo.

BACKGROUND: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. MATERIAL AND METHODS: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. RESULTS: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. CONCLUSION: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy.

Evaluación del videolaringoscopio TruviewPCD para la intubación de niños / Assessment of TruviewPCD videolaryngoscope for intubation in children

Objetivo. El objetivo de este estudio observacional y prospectivo fue evaluar la utilidad de TruviewPCD para la intubación pediátrica en la práctica clínica y generar datos para nuevos estudios. Material y método. Incluimos 86 niños consecutivos intervenidos de cirugía otorrinolaringológica, pediátrica o ambas, bajo anestesia general con intubación orotraqueal. Los niños que presentaban 2 o más criterios de dificultad para el manejo de la vía aérea se excluyeron del estudio. Realizamos análisis estadístico descriptivo. Resultados. Ochenta y tres pacientes se intubaron con TruviewPCD. Datos demográficos: edad 4,9 (2,8) años, peso 19,5 (7,7)kg. Setenta y nueve niños se intubaron en el primer intento y 4 en 2 intentos. El tiempo necesario para obtener la mejor visión glótica posible fue (media y desviación estándar) 10,8 (5,6)seg y el tiempo de intubación total (mediana y distancia intercuartil 25-75%) fue de 30 (27,9-37)seg. La intubación fue catalogada como fácil o muy fácil en 81 pacientes. No se registró ninguna complicación importante. Conclusiones. Concluimos que TruviewPCD es un buen dispositivo para el manejo de la vía pediátrica. Sería interesante disponer de un tamaño de pala intermedio, entre la 1 y la 2, ya que hay una diferencia considerable de tamaño entre ambas (AU)

Objective. The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. Material and method. A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. Results. Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. Conclusions. TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide (AU)

Assessment of TruviewPCD videolaryngoscope for intubation in children. / Evaluación del videolaringoscopio TruviewPCD para la intubación de niños.

OBJECTIVE: The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. MATERIAL AND METHOD: A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. RESULTS: Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. CONCLUSIONS: TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide.

Uso del videolaringoscopio McGrath (R) e intercambiador de tubos pediátrico para cambio de tubo endotraqueal en un paciente con vía aérea difícil / Use of the McGrath (R) video laryngoscope and paediatric tube exchanger for endotrachial tube replacement in a patient with a difficult airway

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[McGrath video laryngoscope used with a Frova intubating introducer for management of the difficult airway]. / Uso del videolaringoscopio de McGrath junto con la guía Frova en el manejo de la vía aérea difícil.

The McGrath video laryngoscope is a new airway management device. It is similar to the Macintosh laryngoscope but incorporates a blade at a 60 degrees angle and a camera that sends an image to a color display screen connected to the handle. The device, which requires use of an anti-fog substance and an introducer to guide the angled blade, has been reported to aid in the management of difficult airways. We present 3 cases of difficult oral-tracheal intubation managed with the McGrath video laryngoscope and a Frova intubating introducer. Advantages of this introducer are that it offers the possibility of administering oxygen or changing the size of the endotracheal tube if the first choice proves inappropriate. We discuss whether or not tests to predict difficult airways are applicable when the McGrath video laryngoscope is being used, given that it is not necessary to align the axes of the 3 airways. We conclude it may be useful to combine the McGrath video laryngoscope and the Frova introducer to manage difficult airways.

Uso del videolaringoscopio de McGrath junto con la guía Frova en el manejo de la vía aérea difícil / McGrath video laryngoscope used with a Frova intubating introducer for management of the difficult airway

El videolaringoscopio de McGrath es un nuevo dispositivopara el tratamiento de la vía aérea, se asemeja aun laringoscopio de Macintosh pero incorpora una palacon una angulación de 60º y un sistema óptico conectadoa una pantalla en color que va unida al mango del videolaringoscopio.Requiere de la utilización de una sustanciaantivaho y de una guía que permita vencer el ángulode la pala. En la literatura se ha descrito su uso enpacientes con criterios de dificultad en el manejo de lavía aérea. Presentamos tres casos de intubación orotraquealdifícil que fueron intubados con el videolaringoscopiode McGrath y un introductor de Frova para laintubación. La utilización de este tipo de guía aporta unaserie de ventajas como la posibilidad de administraciónde oxígeno a través de la misma o la posibilidad de cambiarel tamaño del tubo endotraqueal si no hemos elegidoel adecuado. Discutimos la idoneidad de las pruebaspredictoras de intubación orotraqueal difícil debido a lano necesidad de alineación de los tres ejes cuando se utilizael videolaringoscopio de McGrath. Concluimos quela combinación de videolaringoscopio de McGrath yguía Frova puede ser una buena opción para el manejode la vía aérea difícil(AU)

The McGrath video laryngoscope is a new airwaymanagement device. It is similar to the Macintoshlaryngoscope but incorporates a blade at a 60° angle anda camera that sends an image to a color display screenconnected to the handle. The device, which requires useof an anti-fog substance and an introducer to guide theangled blade, has been reported to aid in themanagement of difficult airways. We present 3 cases ofdifficult oral-tracheal intubation managed with theMcGrath video laryngoscope and a Frova intubatingintroducer. Advantages of this introducer are that itoffers the possibility of administering oxygen or changingthe size of the endotracheal tube if the first choice provesinappropriate. We discuss whether or not tests to predictdifficult airways are applicable when the McGrath videolaryngoscope is being used, given that it is not necessaryto align the axes of the 3 airways. We conclude it may beuseful to combine the McGrath video laryngoscope andthe Frova introducer to manage difficult airways(AU)

Propuesta sobre las competencias en Anestesiología, Reanimación y Terapéutica del Dolor de un graduado de Medicina. Consenso del profesorado de las universidades de Cataluña / No disponible

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Opioides por vía intranasal en el tratamiento del dolor agudo / Intranasal opioids for acute pain

La vía intranasal es una vía de administración transmucosaque aporta como ventajas la facilidad de administración,es incruenta, bien aceptada por el paciente ycarece de efecto de primer paso hepático. La mucosanasal supone una superficie extensa muy vascularizadarecubierta por epitelio ciliar pseudoestratificado, secretorade moco sometido a un movimiento mucociliar quepuede determinar el tiempo de contacto entre los fármacosy la superficie. Los factores que influyen en la absorciónson de tipo anatómico, fisiológico y otros relacionadoscon las propiedades del fármaco y los sistemas deadministración.Revisamos los artículos publicados sobre el uso de fentanilo,meperidina, diamorfina y butorfanol utilizadospor vía intranasal para el tratamiento del dolor agudo.Los efectos adversos sistémicos son similares a los descritospara la vía intravenosa, siendo los más frecuentessomnolencia, náuseas y vómitos. En cuanto a los efectosadversos locales, se ha descrito sensación de quemazóncon meperidina y mal sabor

Intranasal drug administration is an easy, well-tolerated,noninvasive transmucosal route that avoids first-passmetabolism in the liver. The nasal mucosa provides anextensive, highly vascularized surface of pseudostratifiedciliated epithelium. It secretes mucus that is subjected tomucociliary movement that can affect the time of contactbetween the drug and the surface. Absorption is influencedby anatomical and physiological factors as well as byproperties of the drug and the delivery system.We review the literature on intranasal administrationof fentanyl, meperidine, diamorphine, and butorphanolto treat acute pain. The adverse systemic effects aresimilar to those described for intravenousadministration, the most common being drowsiness,nausea, and vomiting. Local effects reported are aburning sensation with meperidine and a bad taste

Comentarios al artículo titulado "Traqueostomía de emergencia para resolver una vía aérea difícil no conocida" / Comments on the article "Emergency tracheostomy to resolve an unforeseen difficult airway"

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Tramadol, una puesta al día tras 28 años de uso / Tramadol, an update after 28 years

Tramadol es un fármaco analgésico con un doble mecanismo de acción, que actúa sobre los receptores opioides e inhibe la recaptación de monoaminas. Se ha demostrado su eficacia por diversas vías de administración y es ampliamente utilizado. Sus principales vías metabólicas son la O-desmetilación que da lugar a un metabolito activo M1 y la N-desmetilación. Debido a que en su metabolismo están implicadas varias isoformas del citocromo P-450, tramadol está sometido a una serie de interacciones farmacológicas con fármacos de uso corriente como ondansetrón o metoclopramida. Está indicado en el tratamiento del dolor agudo. Se ha administrado también en el manejo de diversoso tipos de dolor crónica, en anestesia y en otras indicaciones poco conocidas (patología neurológica, psiquiétrica, etc.). Está indicado en el tratamiento del dolor agudo postoperatorio en adultos y en otras formas de dolor agudo. Se ha administrado también en el manejo de diversos tipos de dolor crónico, en anestesia y en otras indicaciones poco conocidas (patología neurológica, psiquiétrica, etc.). La utilización de tramadol se acompaña de una serie de efectos adversos siendo los más frecuentes las naúseas, los vómitos y la sensación de mareo. Aunque hay algún caso de dependencia, se trata de un fármaco muy seguro. No se ha descrito ninguna muerte atribuible a tramadol

Tramadol is an analgesic with a double-action mechanisms. It act on µ opioid receptors and inhibits noradrenalina and serotonine re-uptake. Its efficiency has been demonstrated with different methods of administration. Its principal metabolic pathways are O-desmethylation which produces an active metabolite called M1 and N-desmethylation. Because various P-450 cytochrome isoforms are implicated in its metabolism, tramadol undergoes a series of pharmacological interactions with current drugs as ondasetron or metoclopramide. Tramadol is indicated in the treatment of acute postoperative pain in adults and also other forms of acute pain. It has also been used in the management of different types of chronic pain, in anaesthesia and other lesser known indications (neurological pathology, psychiatric, etc). Tramadol has several side-effects such as nausea, vomiting and dizzines. Although there have been some reports about dependency on the drug, it is believe to be quite safe. No death have been attribuded to tramadol use

[Intranasal opioids for acute pain]. / Opioides por vía intranasal en el tratamiento del dolor agudo.

Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.

¿Mascarilla laríngea Fastrach o mascarilla laríngea ProSeal en el manejo de la vía aérea difícil en urgencias extrahospitalarias? / Urgent management of the difficult airway outside the hospital: Fastrach or Proseal laryngeal mask?

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