Role of fractional exhaled nitric oxide in patients with sickle cell disease.

INTRODUCTION: Patients with sickle cell disease exhibit different patterns in pulmonary function tests. In particular, there is little evidence on the fractional exhaled nitric oxide (FeNO) test, and its value ranges and its interpretation in these patients have been under debate in recent years. METHODS: We conduced a cross-sectional, observational and descriptive study between November 2021 and January 2023 including patients aged 6-18 years with sickle cell disease able to perform the FeNO test. We applied the GLI-2012 reference values and the ERS/ATS standards. We defined statistical significance as P < 0.05. RESULTS: The sample included 43 patients with a median age of 12 years (IQR, 10-15). We did not find an association between significantly elevated FeNO (≥25 ppb) and the diagnosis of asthma (P = 0.37), an obstructive pattern in spirometry (P = 0.67), a positive bronchodilator test (P = 0.53), clinical bronchial hyperreactivity in the context of cold or flu-like symptoms (P = 0.48), cough with exercise (P = 0.42) or nocturnal cough (P = 1.0), but found an association with peripheral eosinophilia (P < 0.01). CONCLUSIONS: We found no association between FeNO values and the classic features of asthma (clinical or spirometric) in patients with sickle cell disease. Therefore, airway inflammation mechanisms are probably different in these patients.

Guía de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte I

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Extubation failure: Upper airway obstruction by chewing gum. A case report.

Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Expiratory CT scan: When to do it and how to interpret it.

Expiratory CT scan is a complementary technique of inspiratory CT that provide valuable physiological information and may be more sensitive to detect air trapping than pul-monary function tests. It is useful in many obstructive airway diseases, including obliterative bronchiolitis, asthma, Swyer-James syndrome, tracheomalacia, hypersensitivity pneumonitis and sarcoidosis. In obliterative bronchiolitis, expiratory CT scan may be the only imaging technique that shows abnormalities in the early phase of disease. In order to obtain a good quality study, we should explain the procedure to the patient, use precise instructions and do some practice before image acquisition. Here we describe strategies to optimize the techni-que and propose an algorithm that help in interpretation of imaging findings in patients with obstructive airway disease.

Difficult airway in a patient with lymphoma. A case report.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.

Manejo de vía aérea difícil en secuencia de Pierre Robin. Reporte de un caso / Difficult airway management in Pierre Robin Sequence. A case report

La secuencia de Pierre Robin (SPR) es una enfermedad rara, caracterizada por una tríada de malformaciones orofaciales como retrognatia, glosoptosis y fisura velopalatina media (paladar hendido); las cuales, generalmente provocan obstrucción de la vía aérea (OVA). La corrección de los defectos palatinos requiere en ocasiones varias intervenciones quirúrgicas, por esta razón el cuidado anestésico y abordaje de la vía aérea en forma adecuada, evita complica-ciones asociadas a esta enfermedad. Se presenta el caso de un paciente de 1 año y 20 días de edad, con antecedentes de vía aérea difícil, intentos fallidos de intubaciones preliminares e intervenido quirúrgicamente para corrección de paladar hendido, luego de una técnica combinada de intubación nasal con fibrobroncoscopio, desplazamiento de glosoptosis con ayuda de pala número 2 de videolaringoscopio (Glidescope®); manejo transoperatorio anestésico y proceso de extubación con excelentes resultados. Destacamos la importancia de realizar una adecuada planificación multidisciplinaria prequirúrgica con valoración exhaustiva de la vía aérea (VA) por laringoscopía directa o fibrobroncospia flexible para conocer el sitio exacto de la obstrucción y evitar desen-laces adversos.

Pierre Robin Sequence (PRS) is a rare disease characterized by a triad of orofacial malformations such as retrognathia, glossoptosis and velopalatine fissure (cleft palate). The malformations in PRS can lead into airway obstruction. The correction of the palatal defects sometimes requires several surgical interven-tions. Proper anesthetic care and a carefully planned approach to the airway can avoid complications associated with this disease. We present the case of a 1 year and 20 days old patient, with history of difficult airway, unsuccessful prior attempts of intubation, who underwent surgery to correct a cleft palate. We used a combined approach that included nasal intubation technique with a fiberoptic bronchoscope aided with a number 2 video laryngoscope blade (Gli-descope®) for displacement of the glossoptosys. Details of the intraoperative anesthetic management and subsequent successful extubation are provided. We highlight the importance of developing an adequate preoperative multidisciplinary plan of action, after a careful and detailed evaluation of the airway with direct laryngoscopy or fiberoptic bronchoscopy in order to identify the exact location of the obstruction and avoid adverse outcomes.

Difficult airway in a patient with lymphoma. A case report. / Vía aérea difícil en paciente con linfoma. Descripción de un caso clínico.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.

Edema agudo pulmonar Postextubación / Edema agudo pulmonar Postextubación

El edema pulmonar agudo posextubación constituye un evento poco frecuente en la práctica anestésica. Cuando ocurre es necesario administrar tratamiento adecuado, ya que las complicaciones del mismo pueden traducirse en mayor estancia hospitalaria y lesiones serias del aparato respiratorio, como edema pulmonar intersticial, elevación de la presión hidrostática capilar y aumento de la presión transmural de las cámaras cardiacas, lo que puede conducir a fallo del aparato cardiovascular y a la muerte subsecuente del paciente. Se presenta el caso de un paciente con clasificación del estado físico ASA (American Society of Anesthesiologist) II, sin patología pulmonar previa, quien al momento de la emersión anestésica presenta un episodio agudo de dificultad respiratoria, con evidencia de edema pulmonar posextubación confirmado por clínica e imágenes con ulterior resolución satisfactoria.

Post-extubation acute pulmonary edema is a rare event in anesthetic practice. When it occurs, it requires adequate treatment, since its complications may result in longer hospital stay and serious respiratory system lesions, such as interstitial pulmonary edema, increased capillary hydrostatic pressure and increased transmural pressure of the cardiac chambers, which may progress to cardiopulmonary arrest and death of the patient. We present the case of a patient who was classified with the (American Society of Anesthesiologist (ASA) II physical status, without a history of pulmonary disease, who upon emergence of general anesthesia developed an acute episode of respiratory distress, with evidence of post-extubation pulmonary edema confirmed by clinical and imaging findings with subsequent satisfactory resolution.

Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso / Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient

Reactivity Study of a Biodegradable Polydioxanone Tracheal Stent in a Rabbit Model. / Stent traqueal biodegradable de polidioxanona. Estudio de la reactividad en conejo.

INTRODUCTION: The objective of this study was to evaluate tracheal reactivity induced by a biodegradable polydioxanone tracheal stent. MATERIALS AND METHODS: Twenty-two rabbits were divided into 3 groups assigned to different survival times (30, 60 and 90days post-implantation). A biodegradable stent was implanted in each animal, except for 1 of each group (negative control). Implantation was performed through a small tracheotomy under fluoroscopic control. CT and histopathological studies were scheduled at the end of survival times. RESULTS: No animal died during the procedure or follow-up. The stent had disappeared in 100% of the cases at 90days, in 50% at 60days, and in none at 30days. CT studies revealed a greater tracheal wall thickness at 30days than at 60 and 90days (1.60±0.41mm in the central part of the stent versus 1.11±0.18 and 0.94±0.11; P=.007, respectively). No granulomas were observed on histopathology. Some degree of histological changes were noted at 30days, which had reduced at 60 and 90days. Differences were also found in both CT and histology between animals in which the stent was present and animals in which it had degraded. CONCLUSIONS: Polydioxanone stents produce a mild reaction that reverts with tracheal degradation. The use of these biodegradable stents in benign tracheal disease is promising.

A rare case of kinked reinforced endotracheal tube in an intensive care unit: a case report / Un caso infrecuente de acodamiento de un tubo endotraqueal reforzado en una unidad de cuidados intensivos: reporte de un caso

Abstract Reinforced endotracheal tubes (ETTs) are regularly applied in anesthetic practices to prevent compression or kinking. Although these tubes are designed to bend easily and prevent obstruction, they still carry a potential hazard of being obstructed following external forces. In this article, we reported an unusual case in which a reinforced ETT was collapsed due to the patient bite. The patient's bite force on the tube resulted in obstruction, hypoxia, and desaturation. To overcome this near-fatally condition, we removed the blocked reinforced ETT.

Resumen Los tubos endotraqueales reforzados (TET) se usan generalmente en la práctica anestésica para evitar la compresión o el acodamiento. Aun cuando dichos tubos están diseñados para flexionarse fácilmente y prevenir obstrucciones, de todos modos, existe la posibilidad de que se obstruyan, como consecuencia de fuerzas externas. En el presente trabajo reportamos un caso inusual en el cual se colapsó el TET a causa de la mordida del paciente. La fuerza de mordida sobre el tubo produjo obstrucción, hipoxia y desaturación. Con el fin de superar esta condición casi fatal, retiramos el TET reforzado bloqueado.

Prevalencia y factores de riesgo del fracaso de extubación en una Unidad de Cuidados Intensivos Pediátricos de alta complejidad / Prevalence of extubation and associated risk factors at a tertiary care pediatric intensive care unit

Introducción. El fracaso de la extubación (FE) está asociado a mayor riesgo de neumonía, estadía hospitalaria y mortalidad. Objetivo. Determinar la prevalencia del FE e identificar factores asociados en nuestra población. Materiales y métodos. Diseño observacional y retrospectivo. Ingresaron todos los pacientes mayores de 1 mes hasta 18 años que, en el período 2012-2016, requirieron asistencia respiratoria mecánica más de 12 h, y al menos tuvieron una extubación programada durante su internación. Se registraron los aspectos relacionados con la ventilación y las causas de fracaso. Resultados. Se extubaron 731 pacientes y la prevalencia de FE fue del 19,3 %. Las causas de fracaso fueron la obstrucción alta de la vía aérea (51,4 %), fatiga muscular (20,1 %), depresión del centro respiratorio (14,6 %) e incapacidad de proteger la vía aérea (9,7 %). Los factores independientes para explicar el FE según el análisis multivariado fueron afección crónica compleja neurológica (odds ratio -#91;OR-#93;= 2,27; intervalo de confianza del 95 % -#91;IC-#93;= 1,21-4,26); infección respiratoria aguda baja en el paciente con una secuela previa (OR= 1,87; IC 95 %= 1,113,15); lesión neurológica aguda (OR= 1,92; IC 95 %= 1,03-3,57); extubación no planeada (OR= 2,52; IC 95 %= 1,02-6,21) y la presencia de estridor (OR= 5,84; IC 95%= 3,66-9,31). Conclusión. La principal causa de FE fue la obstrucción alta de la vía aérea. La secuela neurológica y la afección neurológica aguda, la extubación no planeada y la presencia de estridor posextubación fueron identificadas como factores de riesgo asociados al FE.

Introduction. Extubation failure (EF) is associated with a higher risk for pneumonia, hospital stay, and mortality. Objective. To determine the prevalence of EF and identify the associated factors in our population.Materials and methods. Observational and retrospective design. All patients aged 1 month old to 18 years old who required mechanical ventilation for more than 12 hours and underwent at least one scheduled extubation during their stay in the 2012-2016 period were included. The aspects related to ventilation and the causes of failure were recorded. Results. Seven hundred and thirty-one patients were extubated and the prevalence of EF was 19.3 %. The causes of failure included upper airway obstruction (51.4 %), muscle fatigue (20.1 %), respiratory center depression (14.6 %), and inability to protect the airways (9.7%). As per the multivariate analysis, the independent factors that accounted for EF were neurological complex chronic condition (odds ratio [OR] = 2.27; 95 % confidence interval [CI] = 1.21-4.26); acute lower respiratory tract infection in a patient with prior sequelae (OR = 1.87, 95 % CI = 1.11- 3.15); acute neurological injury (OR = 1.92, 95 % CI=1.03-3.57); unplanned extubation (OR =2.52, 95 % CI = 1.02-6.21), and presence of stridor (OR = 5.84, 95 % CI = 3.66-9.31). Conclusion. The main cause of EF was upper airway obstruction. Neurological sequelae, acute neurological injury, unplanned extubation, and the presence of postextubation stridor were identified as risk factors associated with EF

Tratamiento de la estenosis traqueobronquial con prótesis: factores de buena respuesta / Treatment of tracheobronchial stenosis with stents: good response factors

OBJETIVO: Determinar predictores de buena respuesta con el uso de prótesis en la estenosis traqueobronquial. MATERIALES Y MÉTODO: Estudio retrospectivo descriptivo de una serie de casos entre junio de 2014 y junio de 2016. Se revisaron registros clínicos, protocolos operatorios, estudios histopatológicos y de imagen. Se consignaron antecedentes demográficos y clínicos al ingreso y luego del procedimiento, etiología de la estenosis traqueal, necesidad de oxígeno en litros, estadía hospitalaria, morbilidad asociada al procedimiento, indicación de terapia complementaria posterior y sobrevida. Se analizaron los datos con estadística descriptiva y analítica. RESULTADOS: Se realizaron 68 procedimientos, en 44 pacientes, 24 mujeres, el diagnóstico principal fue estenosis traqueal con 40 casos. La etiología neoplásica fue el 88% de los casos. El Performance status (PS) de ingreso fue mayor o igual a 2 en el 68% y posterior al procedimiento disminuyó a 22% p < 0,05. En 36 casos los pacientes requerían al menos 1 L de oxígeno lo que disminuyó en 13 casos posterior a la intervención p < 0,05. El tiempo de hospitalización promedio fue 6,2 días (1-60). En 13 pacientes con patología neoplásica se indicó terapia paliativa complementaria. La morbilidad asociada al procedimiento fue de 2,9% dado por prótesis desplazada y lesión iatrogénica. La sobrevida fue de 27% a un año. CONCLUSIONES: La etiología benigna, el PS previo a la intervención menor o igual a 3, requerimiento de oxígeno de 1 litro y obstrucción tumoral menor al 70% del lumen fueron elementos de buena respuesta.

AIM: Determine good response predictors in use of stent in benign and malignant tracheobronchial stenosis. MATERIAL AND METHODS: We retrospectively reviewed medical records of patients submitted to the procedure in the period 2014 to 2016. Clinical records, operative protocols, and histopathological and imaging studies were reviewed. Demographic and clinical data, performance status (PS) at admission and after the procedure, etiology of tracheal stenosis, need for oxygen in liters (L) Post-intervention, hospital stay, procedure-related morbidity, indication of therapy (Chemotherapy and/or Radiotherapy) and survival. Data were analyzed with descriptive and analytics statistics. RESULTS: A total of 68 procedures were performed in 44 patients, 24 women. Tracheal stenosis 40 cases were diagnosed. The malignant etiology was 88%. The admission PS was greater than or equal to 2 in 68% and 22% after the procedure. The oxygen requirements prior to the procedure were at least 1 L in 36 cases and decreased in 13 cases after the procedure. The average hospitalization period was 6.2 days (1-60). Complementary therapy was indicated in 13 patients; the morbidity associated with the procedure was 2.9%, displaced installation and iatrogenic injury. The one year survival was 27%. CONCLUSIONS: Benign etiology, el PS minor than or equal to 3, oxygen requirements prior to the procedure of 1 L and tumoral obstruction less than 75% were good response predictors in our study.

Enfermedad de Rosai-Dorfman con compromiso laríngeo: a propósito de un caso / Rosai-Dorfman disease with laryngeal involvement: about a case

RESUMEN La enfermedad de Rosai-Dorfman (ERD) o histiocitosis sinusal con linfadenopatía masiva es una enfermedad infrecuente, de etiología desconocida caracterizada por linfadenopatías cervicales masivas bilaterales. El compromiso extraganglionar puede ocurrir en diferentes sitios, incluida la vía aérea, en la cual la localización nasosinusal es la más frecuente, pero puede comprometer también otros sitios de la vía aérea superior. Dentro de éstos, el compromiso laríngeo es muy poco frecuente. Se presenta el caso de una paciente de 82 años con antecedentes de ERD localizada en los ganglios linfáticos cervicales en remisión espontánea, que desarrolló posteriormente una obstrucción subaguda de las vías respiratorias. La tomografía computarizada y la nasofaringolaringoscopía mostraron lesiones subglóticas que obstruían severamente las vías respiratorias. Se realizó una traqueostomía de emergencia y biopsia de las lesiones, confirmando el diagnóstico de ERD extranodal.

ABSTRACT Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a rare disease of unknown etiology characterized by bilateral massive cervical lymphadenopathy. Extranodal involvement can occur in different sites including airway where nasosinusal involvement is common but this disease may occur in other sites of the upper airway. Laryngeal involvement is rare. We present the case of an 82-year-old female patient with a history of Rosai-Dorfman disease located in cervical lymph nodes in spontaneous remission that subsequently develops airway obstruction. Computed tomographic scan and nasopharyngolaryngoscopy showed subglottic lessons that severely obstructed the airway. Emergency tracheotomy and biopsy were performed, confirming the diagnosis of extranodal RDD. Patient was observed and tracheostomy was maintained with good tolerance.

Labio-glosopexia de Routledge en un paciente con Secuencia Robin. Reporte de un caso / Rutledge’s lip-glossopexy in a patient with Robin sequence. Case report

La secuencia Robin, previamente conocida como síndrome de Pierre Robin, se caracteriza por la presencia de micrognatia o retrognatia, glosoptosis con o sin fisura palatina. Los recién nacidos con este síndrome, pueden presentar obstrucción de la vía aérea, dificultad para la alimentación, retraso del crecimiento e hipoxemia crónica. La mitad de estos pacientes presentan malformaciones asociadas. La incidencia es aproximadamente de 1: 8,500. Las opciones actuales del tratamiento de la obstrucción de la vía aérea en estos pacientes, van desde la posición prona, intubación nasofaríngea, glosopexia con adhesión labial, distracción mandibular hasta la traqueostomía. Se presentó una variante de tratamiento quirúrgico de urgencia realizada a un recién nacido portador de una secuencia Robin con dificultad respiratoria. Se realizó una labio-glosopexia de Routledge. El paciente tuvo una evolución postoperatoria favorable sin dificultades en su ventilación y alimentación.

The Robin sequence, previously known as Pierre Robin syndrome, is charaterized by the presence of micrognathia or retrognathia, glossoptosis with or without cleft palate. The newborns with this syndrome may present airway obstruction, feeding difficulties, growth retardation and chronic hypoxemia. Half of these patients have associated malformations. The incidence is almost 1: 8 500. The current options for the treatment of the airway obstruction in these patients range from prone position, nasofaringeal intubation, glossopexy with lip adhesion, mandibular distraction up to tracheostomy. We presented a variant of emergency surgical treatment carried out in a newborn having a Robin sequence with respiratory difficulty. A Routledge´s lip-glossopexy was made. The patient had a favorable post-surgery evolution in his ventilation and feeding.

Malformaciones craneofaciales y obstrucción de vía aérea superior: ¿qué y cómo corregir? / Craniofacial malformations and upper airway obstruction: what and how to correct?

Objetivos: revisión de las principales causas de obstrucción de la vía aérea superior relacionadas a malformaciones del territorio craneofacial. Método: Revisión de la literatura, según nivel obstructivo; de origen nasofaríngeo, orofaríngeo, glóticas o subglóticas y según la condición desindrómica o no. Resultados: Se consideran las principales características clínicas de las distintas patologías, especialmente las relacionadas con el compromiso de la vía aérea superior y el procedimiento terapéutico en cada una de ellas.Se destaca dentro del manejo quirúrgico descrito la utilidad de la distracción osteogénica, sus indicaciones, la descripción de la técnica y sus resultados. Conclusiones: La obstrucción de la vía aérea respiratoria, resulta de una condición morfológica y/o funcional presente en distintas malformaciones craneofaciales, tanto en el contexto de Síndromes como en forma aislada. Su adecuado diagnóstico y posterior manejo resulta fundamental en la sobrevida de los pacientes que presentan esta compleja condición.

Objectives: review article of the main causes obstruction of the upper airway related to craniofacial malformations. Method: Literature review, according the obstructive level; nasopharyngeal origin, oropharyngeal, glottal or subglottic and depending on the condition of syndromic or not. Results: Considered the main clinical features of various diseases, especially those related to the engagement of the upper airway and therapeutic procedure in each. The usefulness of distraction osteogenesis indications, the description of the technique and its results emerged within the described surgical management. Conclusions: Obstruction of the respiratory airway, resulting from a morphological condition and / or functional present in different craniofacial malformations, both in the context of Syndromes and isolation. Proper diagnosis and subsequent management is essential to the survival of patients with this complex condition.

Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model.

INTRODUCTION: The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). MATERIAL AND METHODS: Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multi-slice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. RESULTS: The DES group had the longest stenosis (20.51±14.08mm vs. 5.84±12.43 and 6.57±6.54mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs. 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant). CONCLUSIONS: The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis.

Reporte de caso: quemadura de la vía aérea / Case report: Airway burn

La quemadura de la vía aérea, consecuencia de encender un tubo endotraqueal con electrocauterio, presenta escasa incidencia, pero puede provocar lesiones graves o incluso la muerte. Se presenta un caso de un incendio causado por rotura del tubo endotraqueal secundario a contacto con electrocauterio durante una resección de tumor facial. En este caso las causas primarias de fuego fueron el oxígeno a FiO2 no mínima empleado para la ventilación, y la electrocauterización de alta potencia utilizada para la resección y el control de la hemorragia. En este reporte se nombran los métodos de prevención de un incendio de las vías respiratorias y el tratamiento de urgencia cuando se produce. A pesar de su baja incidencia, anestesiólogos y cirujanos deben tener un tratamiento de urgencia de incendios de vía aérea en mente y estar al tanto de los métodos de prevención.

Although the incidence of airway burns that occur when the endotracheal tube is ignited by the electrocautery is low, it is right to assume that the resulting injuries may be severe and even fatal. A case is presented of fire caused by the rupture of an endotracheal tube secondary to contact with the electrocautery during the resection of a facial tumor. In this case, the primary sources of fire were oxygen at a nonminimal FiO2 used for ventilation, and the high-powered electrocautery used for resection and bleeding control. This report will cover the methods for preventing airway fires and the emergency treatment should they happen. Despite the low incidence, both anesthesiologists as well as surgeons must have in mind an emergency treatment of airway fires and must have knowledge of preventive methods.