Posición operatoria en cirugía colorrectal. La importancia de lo básico / Operating position in colorectal surgery. The importance of the basics

La posición operatoria en coloproctología es fundamental desde tres puntos de vista: correcto abordaje quirúrgico y exposición adecuada, requerimientos anestésicos y del mantenimiento de la vía aérea, y las complicaciones potenciales relacionadas con la propia posición. En el presente trabajo se revisan las indicaciones, colocación, ventajas e inconvenientes de cada posición operatoria, así como sus posibles complicaciones y cómo evitarlas. Éstas pueden ser de diversa índole, si bien las más frecuentes están relacionadas con lesiones por estiramiento o compresión de los nervios periféricos, seguidas por las tromboembólicas, hemodinámicas e isquémicas o síndromes compartimentales por isquemia-reperfusión tras un largo periodo en posición de Trendelenburg. Anestesistas y cirujanos deben coordinar y responsabilizarse de la posición operatoria de los pacientes (AU)

Intra-operative positioning in colorectal surgery is very important from three points of view: the proper surgical approach and exposure, adequate anaesthetic requirements with maintenance of the airway, and the potential complications related to the position. In the present study, we analyse the indications, positioning, advantages and disadvantages of each operative position, their potential complications and how to avoid them. These complications can be of a diverse nature, the most common being injuries related to stretching or compression of peripheral nerves, followed by thromboembolic, haemodynamic, and ischaemic or compartmental syndromes related to ischaemia-reperfusion after a long time in the Trendelenburg position. Anaesthetists and surgeons should coordinate and take responsibility for the position of surgical patients (AU)

[Operating position in colorectal surgery. The importance of the basics]. / Posición operatoria en cirugía colorrectal. La importancia de lo básico.

Intra-operative positioning in colorectal surgery is very important from three points of view: the proper surgical approach and exposure, adequate anaesthetic requirements with maintenance of the airway, and the potential complications related to the position. In the present study, we analyse the indications, positioning, advantages and disadvantages of each operative position, their potential complications and how to avoid them. These complications can be of a diverse nature, the most common being injuries related to stretching or compression of peripheral nerves, followed by thromboembolic, haemodynamic, and ischaemic or compartmental syndromes related to ischaemia-reperfusion after a long time in the Trendelenburg position. Anaesthetists and surgeons should coordinate and take responsibility for the position of surgical patients.

Suction catheter guided insertion of the ProSeal laryngeal mask airway is superior to the digital technique.

PURPOSE: We tested the hypothesis that digital insertion of the ProSeal laryngeal mask airway (ProSeal LMA) is more successful when using a suction catheter (SC) as a guide. METHODS: Two hundred and forty-three patients (ASA physical status I-III; aged 18-84 yr) were randomly allocated for the digital or SC-guided technique. The digital technique was performed according to the manufacturer's instructions. The SC technique involved priming the drain tube with the SC so that it protruded by 15 cm, blindly inserting the SC into the pharynx to a depth of 15 cm, followed by the digital technique. Failed insertion was defined by any of the following criteria: 1) failed passage into the pharynx; 2) malposition; and 3) ineffective ventilation. Any airway trauma, and visible or occult blood was noted. Sore throat, dysphonia and dysphagia were assessed 16 to 24 hr postoperatively. RESULTS: Fewer insertion attempts were required with the SC-guided technique (P = 0.02), but first attempt and overall success were similar. The time taken to provide an effective airway was shorter for the SC-guided technique (36 +/- 24 sec vs 44 +/- 28 sec, P = 0.02). A lateral approach was required less frequently with the SC-guided technique (0% vs 4%, P = 0.0004). There were no adverse events. Mouth trauma was more frequent with the digital technique (P = 0.04), but overall trauma was similar. There were no differences in the frequency of visible or occult blood. There were no differences in postoperative airway morbidity. CONCLUSIONS: The SC-guided technique is more frequently successful than the digital technique and is associated with less mouth trauma during insertion of the ProSeal LMA. We suggest that the SC technique may be a useful alternative when the digital technique fails.

¿Es el grosor del plugde Lichtenstein un factor determinante de infección y rechazo de la prótesis? / Is the thickness of Lichtenstein' s plug a determining factor in infection and rejection of the prosthesis?

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