[Air seepage from endotracheal tube cuffs during anesthetic procedures. How to solve this problem without changing tubes? An experimental model using human tracheas]. / Pérdida de aire en los manguitos de los tubos endotraqueales durante el procedimiento anestésico. Cómo solucionar este problema sin cambiar el tubo? Modelo experimental con tráqueas humanas.

OBJECTIVES: To demonstrate by an experimental model that a continuous medicinal airflow system giving a pressure of 30 cmH2O effectively stops leakage from endotracheal tubes. MATERIAL AND METHODS: Ten tracheas with their main bronchi were removed from cadavers with no pulmonary disease. The tracheas were placed vertically and tubes previously perforated with increasing caliber needles were inserted and connected to a continuous flow system. The flow of medicinal air generated in the cuff was monitored with a flow meter and pressure was measured with a manometer. When a pressure of 30 cmH2O was reached, the trachea was filled with saline. We then observed the moment at which, when pressure fell, the saline began to leak from the bronchi. The levels observed were expressed as arithmetic means and standard deviations. RESULTS: No leakage was observed when the flow produced pressures above 10 cmH2O for 25 G caliber holes, above 15 cmH2O for 24 G holes, or above 20 cmH2O for 25 G, 21 G, 20 G, 18 G or 16 G holes. For 14 G holes, a flow producing pressures over 25 cmH2O were needed. Pressure up to 80 cmH2O was required to stop leakage from a scalpel cut. CONCLUSIONS: We found that adjusting flow and pressure is a valid way to stop leakage from small holes. The method does not control leakage from large holes or cuts.

[Anesthesiologic implications of moyamoya disease]. / Implicaciones anestésicas en la enfermedad de moyamoya.

A 34-year-old woman 22 weeks pregnant suffered cerebral hemorrhage, requiring admission to the intensive care unit and mechanical ventilation. She recovered without sequelae. The diagnosis was moyamoya disease and she was scheduled for elective cesarean delivery at 38 weeks of gestation. After appropriate preoperative study and complementary testing (echocardiogram, computerized axial tomography of the brain and determination of anti-cardiolipin and other antibodies, which were normal) the patient was given intradural anesthesia with 15 mg of 0.5% bupivacaine and 24 micrograms of fentanyl, with continuous monitoring of blood pressure, tympanic temperature and neurological variables. Warm intravenous fluids and ephedrine (100 to 250 micrograms/min) were perfused. No noteworthy neurological events or hemodynamic changes occurred during or after surgery. Postoperative analgesia was provided with 2 mg/12 h of morphine through an epidural catheter.