[A case of "ventilation difficulty-intubation difficulty" solved with transtracheal jet ventilation]. / Un caso de "dificultad de ventilación-dificultad de intubación" resuelto con ventilación jet transtraqueal.

A 56-year-old man recovering from a glossectomy and radical neck dissection presented severe oral bleeding, tracheal deviation with an asphyxiating hematoma and cyanosis. When 2 attempts at orotracheal intubation with the patient awake failed, transtracheal jet ventilation was used temporarily until a definitive airway could be established. Transtracheal jet ventilation is highly useful for managing an airway and maintaining gas exchange in life-threatening situations in which intubation and ventilation has become impossible, yet it is rarely used for that purpose. An easy, fast procedure that has not been widely used in Spain, this technique provides effective ventilation and oxygen while a definitive resolution of the emergency is sought.

[Immune response in the surgical patient: effect of anesthesia and blood transfusion]. / Respuesta inmune en el paciente quirúrgico: influencia de la anestesia y la transfusión sanguínea.

Anesthesiology has progressed spectacularly over the last two decades, largely parallel to developments in basic and clinically applied sciences such as immunology. The anesthesiologist's involvement now extends to all matters involved in perioperative care. Surgery, anesthetic procedures themselves, and other associated techniques such as blood transfusion all alter the patient's immune response and all fall within the range of procedures monitored by the anesthesiologist. The repercussions on the patient are important, given that alterations suppose increased risk of postoperative infection and increased recurrence of neoplastic disease. The present article reviews available knowledge on how and to what extent the patient's immune status is affected in the perioperative period. Generally, surgery and anesthesia induce immune system depression. It is possible to demonstrate a decrease in the number and activity of circulating immune cells and alterations of various types in interleukins and in protein synthesis during acute phase response. Research in this field is complex given that the individual effect of each factor involved is difficult to measure and experimental or clinical designs usually yield only biased views. Replacement of lost red blood cells is another factor leading to immunological changes. New anesthetic techniques, the optimization of methods already in use, and the development of modern, less immunodepressant drugs and of alternatives to homologous blood transfusion are all solutions that have been proposed. This is an exciting field of study in which today, perhaps more than ever, the anesthesiologist has a critical role to play.