Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX(R) / Permanent tunneled drainage for malignant ascites: Initial experience with the PleurX(R) catheter

Objetivo. El tratamiento más utilizado en la ascitis maligna de repetición es generalmente el drenaje peritoneal temporal. Presentamos nuestra experiencia en la colocación de catéteres tunelizados permanentes en una serie de pacientes y el análisis de la seguridad y efectividad del mismo. Material y métodos. El procedimiento se llevó a cabo en una serie de 10 pacientes, con medidas de asepsia total, en la sala de ecografías dedicada a intervencionismo, únicamente con control ecográfico y bajo anestesia local. Resultados. Los catéteres se mantuvieron permeables una mediana de 52 días en los 9 pacientes que fallecieron. A uno de estos pacientes se le retiró el catéter, que permanecía permeable, por una sepsis generalizada. Un paciente permanecía con el catéter permeable a la conclusión del estudio 124 días tras la colocación. Conclusión. A pesar del escaso número de pacientes, el catéter peritoneal tunelizado parece ser un procedimiento seguro, efectivo y mínimamente invasivo para el tratamiento de la ascitis maligna en pacientes oncológicos terminales, facilitando la evacuación de la ascitis en el domicilio sin necesidad de acudir a un centro hospitalario y evitando punciones de repetición con el consiguiente riesgo para el paciente. No obstante, sería necesaria una mayor experiencia y estudios prospectivos aleatorizados (AU)

Objective. The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. Material and methods. We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. Results. The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. Conclusion. Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary (AU)

[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter]. / Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX®.

OBJECTIVE: The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. MATERIAL AND METHODS: We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. RESULTS: The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. CONCLUSION: Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

[Airtraq optical laryngoscopy]. / Laringoscopio óptico Airtraq.

Endotracheal intubation using direct laryngoscopy continues to be the "gold standard" amongst all the techniques for isolating the airway. Generally this is a secure manoeuvre, but it might become a situation of extreme emergency when dealing with an unexpected difficult airway. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a new tool for use with the patient. The fact that it is easy to learn to use and simple to handle makes it a practical device in many situations where managing the airway is indicated. Its advantages over the Macintosh laryngoscope have been demonstrated in patients with an airway that it is difficult to manage and in adverse situations outside the surgical setting, when endotracheal intubation has been achieved in a simple way following unsuccessful attempts with conventional laryngoscopes. The greatest benefits in using the Airtraq laryngoscope have been shown in patients with a pronounced limitation of cervical mobility, and in those where the airway is distorted for anatomical reasons, such as pregnant women and obese patients.

Laringoscopio óptico Airtraq® / Airtraq® optical laryngoscopy

La intubación endotraqueal mediante laringoscopiadirecta sigue siendo el gold standard entre todas lastécnicas de aislamiento de la vía aérea. Se trata, generalmente,de una maniobra segura, pero en ocasionespuede convertirse en una situación de extrema emergenciaante una vía aérea difícil imprevista.El laringoscopio Airtraq® (Prodol Meditec, Vizcaya,Spain) representa una nueva herramienta a utilizaren el paciente. Su fácil aprendizaje y sencillo manejo loconvierten en un práctico dispositivo en muchas indicacionesde manejo de la vía aérea. Ha mostrado ventajasfrente al laringoscopio de Macintosh en pacientes convía aérea de difícil manejo y en situaciones adversasfuera del medio quirúrgico, lográndose la intubaciónendotraqueal de forma sencilla tras intentos ineficacescon laringoscopios convencionales.Los mayores beneficios con el uso del laringoscopioAirtraq® se han visto en pacientes con una marcadalimitación de la movilidad cervical y aquellos, comoembarazadas y obesos, en los que por razones anatómicasla vía aérea se ve distorsionada(AU)

Endotracheal intubation using direct laryngoscopycontinues to be the “gold standard” amongst all thetechniques for isolating the airway. Generally this is asecure manoeuvre, but it might become a situation ofextreme emergency when dealing with an unexpecteddifficult airway.The Airtraq® laryngoscope (Prodol Meditec, Vizcaya,Spain) is a new tool for use with the patient. Thefact that it is easy to learn to use and simple to handlemakes it a practical device in many situations wheremanaging the airway is indicated. Its advantages overthe Macintosh laryngoscope have been demonstratedin patients with an airway that it is difficult to manageand in adverse situations outside the surgical setting,when endotracheal intubation has been achieved in asimple way following unsuccessful attempts with conventionallaryngoscopes.The greatest benefits in using the Airtraq® laryngoscopehave been shown in patients with a pronouncedlimitation of cervical mobility, and in those wherethe airway is distorted for anatomical reasons, such aspregnant women and obese patients(AU)

Tratamiento de atelectasias postoperatorias mediante fibrobroncoscopia asociada a Manujet / No disponible

No disponible

Implicaciones anestésicas del síndrome de Swyer-James / Anesthetic implications of Swyer-James syndrome

No disponible

No disponible