[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.

[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.

[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.