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.

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 factor, 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 factor, 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.

[Preoxygenation for anesthesia]. / Preoxigenación en anestesia.

Oxygenation, or rather denitrogenation, prior to apnea during anesthetic induction attempts to replace alveolar nitrogen with oxygen to achieve an intrapulmonary oxygen reserve that will allow apnea to be as prolonged as possible with the least possible desaturation. During apnea, the rate of arterial desaturation depends mainly on the volume of oxygen stored in the lung, on mixed venous oxygen saturation, and on the presence of intrapulmonary shunt. Together, these factors account for the higher rate of desaturation during apnea in children, obese individuals, postoperative patients, and pregnant women. Two approaches to preoxygenation have proven effective to date: ventilation with 100% oxygen at tidal volume for 3 minutes using a well-sealed face mask and the performance of 8 vital capacity maneuvers in 1 minute. The efficacy of preoxygenation can be assessed by expired oxygen fraction or by pulse oximetry. In a healthy adult, both methods described ensure sufficient oxygenation (pulse oximetry 90% to 95%) after a period of apnea lasting between 6 and 10 minutes.

[Multicenter study on the usefulness of the NasOral system for the denitrogenation and apneic oxygenation in anesthesia]. / Estudio multicéntrico sobre la utilidad del sistema NasOral para la desnitrogenación y oxigenación apneica en anestesia.

OBJECTIVES: To study the usefulness of the NasOral system for denitrogenation prior to anesthetic induction for improving pulmonary oxygen storage that maintains SpO2 within the normal range during induced apnea and facilitates apneic oxygenation. MATERIAL AND METHODS: To establish the study population of 125, five hospitals of the Valencian Community (Spain) enrolled patients scheduled for elective procedures under general anesthesia. The patients were preoxygenated using the NasOral system (denitrogenation). For two minutes, the patients inhaled oxygen through the nose (FiO2 1) at a flow rate of 8-10 l/min (never less than the patient's own minute volume) and exhaled orally through a unidirectional valve. We measured time of apnea with SpO2 > or = 96% to assess the usefulness of the device for denitrogenation. We also measured PetCO2 after endotracheal intubation and after maximum time of apnea (< or = 10 minutes) to assess use of the device for apneic oxygenation during laryngoscopy. RESULTS: We found no significant differences with regard to age, sex, ASA or Mallampati classification among patient groups enrolled at the participating hospitals. Cox's regression analysis was used to determine relative risk of SpO2 < 96%. At 10 minutes post-apnea, 88.8% of all patients maintained SpO2 > or = 96%. However, SpO2 > 96% was maintained by 94.1% in the Mallampati I group and by 84.1% in the Mallampati II group. SpO2 fell below the cut-off (< 96%) in 33.3% of obese patients and in 7.5% of non-obese patients. Analysis of the likelihood of SpO2 < 96% associated with the variables of obesity, sex, age, ASA and Mallampati classification was significant only for obesity, for which a risk of 1.95 was calculated relative to non-obesity (95% CI 1.14-3.35). The NasOral system allows performance of direct laryngoscopy for oral tracheal intubation, maintaining oxygen flow through the permeable airway to facilitate apneic oxygenation. CONCLUSIONS: The NasOral system facilitates denitrogenation before induction of anesthesia in all patients with permeable nasal fossae as well as apneic oxygenation during laryngoscopy.