Locating the cricothyroid membrane in males: Influence of the morphological characteristics of the neck. / Localización de la membrana cricotiroidea en varones: influencia de las características morfológicas del cuello.

INTRODUCTION: Cricothyrotomy is a recommended technique to restore oxygenation in most of guidelines for difficult airway management. A correct location of the cricothyroid membrane (CTM) is fundamental for a proper performance of the technique. Several studies have shown poor accuracy with the identification the CTM by palpation, resulting in a high failure rate of the technique. OBJECTIVE: The aim of this study was to determine the impact of the patient's neck morphology on the accurate location of the CTM and on the time employed. MATERIALS AND METHOD: Observational study in which anaesthesiologists and intensivists voluntarily participated in a simulation that consisted of a «cannot intubate, cannot oxygenate¼ scenario, where they had to locate the CTM, as soon as possible, in 2 selected male patients with different morphological characteristics of the neck. The time was measured from the beginning of CTM palpation to locating it with a marker. RESULTS AND CONCLUSIONS: A higher body mass index and a higher neck circumference correlated with a 70% location failure rate and with a longer time as compared with a standard model.

Use of GlideScope for double lumen endotracheal tube insertion in an awake patient with difficult airway.

There is scientific evidence that an anticipated difficult airway must be managed with the patient being awake. The GlideScope has been proven to be a useful device to intubate the trachea in some instances when difficult airway is present, and particularly in the awake patient. It has also been used for double lumen tube (DLT) in the anaesthetized patient, but its use with DLT in both circumstances, awake patients with difficult airway has not been described. GlideScope enabled us to achieve accurate local anesthetic spraying and a successful endotracheal intubation with a double lumen tube (DLT) in an awake patient with predicted difficult airway and bronchoaspiration risk. Different ways to resolve cases like this can be found in the anesthetic literature, but we think this could be another option to bear in mind. We also describe a new variation in the maneuver of introducing a DLT into the trachea under GlideScope view as DLT presents with some difficulties when introduced under normal circumstances. This option could add some risk for the patients when used in inexperienced hands and there is not sufficient scientific evidence in the literature to recommend it for all cases.

[Antiemetic prophylaxis after laparoscopic cholecystectomy: comparative study of dehydrobenzperidol, metoclopramide, ondansetron and placebo]. / Profilaxis antiemética tras la colecistectomía laparoscópica: estudio comparativo de dehidrobenzoperidol, metoclopramida, ondansetrón y placebo.

OBJECTIVES: To compare the efficacy of ondansetron to that of metoclopramide, dehydrobenzperidol and placebo for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in a double-blind random study. PATIENTS AND METHOD: A total of 100 ASA I, II and III patients undergoing scheduled laparoscopic cholecystectomy were divided into 4 groups according to whether they received one of the following intravenously just prior to anesthetic induction: 1.25 mg dehydrobenzperidol (group D), 10 mg metoclopramide (group M), 4 mg ondansetron (group O) or 2 ml of saline (group P). All received general anesthesia with induction by thiopental, analgesia with fentanyl, muscle relaxation with atracurium and maintenance with oxygen-air and isoflurane. Episodes of nausea and/or vomiting during the first 24 h after surgery were recorded. Treatment was considered effective if no episodes occurred during this period. RESULTS: Nine of the 100 patients were excluded from the study. There were no significant differences in demographic variables among the 4 groups. The incidence of PONV was significantly greater in group P than in any of the other groups. There were no significant differences in PONV among groups D, M and O. CONCLUSIONS: Ondansetron provides safe, effective prophylaxis for PONV after laparoscopic cholecystectomy, but it is not superior to the antiemetic drugs usually used. Its use may be justified in patients in whom dehydrobenzperidol or metoclopramide are contraindicated.

[Analysis of knowledge about the anesthesiology specialty among a population of medical students]. / Análisis de los conocimientos de la especialidad de anestesiología en una población de estudiantes de medicina.

OBJECTIVES: To analyze the knowledge of anesthesiology possessed by a group of medical students representative of medically trained individuals who have not yet worked in a hospital. MATERIAL AND METHOD: Students in their fifth year of medical studies at the University of Valencia were invited to voluntarily and anonymously answer a questionnaire with dichotomous and multiple choice responses covering general and specific aspects of anesthesiology. The survey also collected personal and epidemiological data. One hundred eighty-five questionnaires were returned. RESULTS: The results obtained were analyzed for correlations with epidemiological and personal data (sex, information received, prior anesthesia); no significant correlations were found between these data and correct response. It was believed by 78.4% that the anesthesiologist's function during surgery does not go beyond warning the surgeon of changes in vital signs. Nevertheless, 76.2% asserted that the anesthesiologist's function is to protect the patient during the perioperative period. CONCLUSION: In comparison with the general population, medical students' training has left them with inadequate understanding of anesthesiology.