[Internal jugular venous valve as a cause of difficult central venous access]. / Válvula venosa yugular interna como causa de dificultad para acceso venoso central.

Central venous cannulation is a commonly performed procedure in the hospital setting, while the internal jugular vein is one of the most frequently used to perform central venous access. The presence of venous valves in the jugular veins is a well-known fact, albeit often neglected during central venous cannulation. However, venous valves can make this procedure difficult, increasing the chance of developing complications. We report the case of a patient in whom the presence of a valve in the internal jugular vein did not permit a vascular access to be obtained through this vessel.

[Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal]. / Hipertensión intracraneal idiopática: cesárea con anestesia epidural tras normalización de la presión del líquido cefalorraquídeo.

Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined. The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia. We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery.

[Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients]. / Comparación de las cánulas VAMA(®) y Berman(®) para la intubación fibroscópica orotraqueal en pacientes anestesiados.

OBJECTIVES: In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS: 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS: No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS: The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.

[Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope]. / Intubación orotraqueal con laringoscopio óptico Airtraq en pacientes acromegálicos.

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.

[Management of the easy or complicated airway by nonexperts using the AirTraq optical laryngoscope]. / Manejo de la vía aérea fácil y complicada con el laringoscopio optico AirTraq en manos inexpertas.

OBJECTIVES: To evaluate the utility of the AirTraq optical laryngoscope in a retrospective case series, assessing indications for use and benefits as well as possible limitations. PATIENTS AND METHODS: Retrospective study of the first 124 patients in whom we used the AirTraq for tracheal intubation. Anatomical and demographic variables were recorded in addition to preoperative findings on examination of the airway. Ease in accomplishing the maneuver and quality of the procedure were assessed after intubation with the AirTraq. RESULTS: The trachea was correctly intubated in 97.6% of the patients. Intubation failed in only 3 (2.4%) patients. Laryngoscopic quality was optimal in over 95% of the cases. There were few complications or other events. CONCLUSIONS: The AirTraq laryngoscope has been shown to facilitate intubation even when nonexpert staff perform the maneuver in cases in which previous attempts at laryngoscopy have failed and in which a difficult airway is anticipated. Ease of use and relative safety make the AirTraq a practical device for a variety of patient types and clinical settings.

[Anesthetic management in a patient previously diagnosed with takotsubo cardiomyopathy]. / Manejo anestésico en una paciente previamente diagnosticada de síndrome de takotsubo.

Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the reported cases an emotional or physical stress event has been identified as a trigger, and perioperative stress has been suggested as the trigger in some of these cases. Outcome is favorable with the right treatment, though recurrences are possible. We report the anesthetic management of a 79-year-old woman with a previously diagnosed episode of Takotsubo cardiomyopathy, who was admitted to our hospital for total hip replacement. Care was taken to provide proper preoperative sedation before provision of hyperbaric spinal anesthesia, followed by sedation with intravenous propofol. Surgery and the early postoperative period were uneventful. We believe that minimizing perioperative anxiety should be a priority in these patients due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy.