[McGrath video laryngoscope used with a Frova intubating introducer for management of the difficult airway]. / Uso del videolaringoscopio de McGrath junto con la guía Frova en el manejo de la vía aérea difícil.

The McGrath video laryngoscope is a new airway management device. It is similar to the Macintosh laryngoscope but incorporates a blade at a 60 degrees angle and a camera that sends an image to a color display screen connected to the handle. The device, which requires use of an anti-fog substance and an introducer to guide the angled blade, has been reported to aid in the management of difficult airways. We present 3 cases of difficult oral-tracheal intubation managed with the McGrath video laryngoscope and a Frova intubating introducer. Advantages of this introducer are that it offers the possibility of administering oxygen or changing the size of the endotracheal tube if the first choice proves inappropriate. We discuss whether or not tests to predict difficult airways are applicable when the McGrath video laryngoscope is being used, given that it is not necessary to align the axes of the 3 airways. We conclude it may be useful to combine the McGrath video laryngoscope and the Frova introducer to manage difficult airways.

[Intranasal opioids for acute pain]. / Opioides por vía intranasal en el tratamiento del dolor agudo.

Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.

[Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial]. / Analgesia postoperatoria en la intervención abierta de hallux valgus en Cma. comparación entre analgesia oral y bloqueo perineural contínuo del nervio tibial posterior.

INTRODUCTION: This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery. MATERIAL AND METHODS: Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend. RESULTS: The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique. CONCLUSION: Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.

[Elective cesarean section with epidural anesthesia in a pregnant woman with obstructive hypertrophic myocardiopathy]. / Cesárea electiva con anestesia epidural a una gestante con miocardiopatía hipertrófica obstructiva.

Hypertrophic obstructive myocardiopathy (HOM) is characterised by left ventricular hypertrophy, which causes dynamic obstruction at the exit of the chamber and diastolic dysfunction of the myocardium. The use of epidural anesthesia in patients with HOM is controversial due to the hemodynamic repercussions of reduced preloading and postloading that occur. A 28-year-old woman with HOM was scheduled for cesarean delivery at 36.5 weeks because of delayed intrauterine growth. Satisfactory epidural anesthesia was provided with 0.5% bupivacaine with prior invasive hemodynamic monitoring. Analgesic and anesthetic management of a full-term parturient with HOM is a major challenge for the anesthesiologist. Although elective cesarean under general anesthesia is traditionally suggested for such patients, vaginal delivery with epidural analgesia is currently also being used. However, experience in using epidural anesthesia for cesarean delivery is scarce. For our patient, epidural anesthesia with appropriate hemodynamic monitoring allowed surgery to take place without complications. We therefore believe that the technique might be useful for such patients.

[Convulsions induced by ropivacaine after brachial plexus block]. / Convulsiones inducidas por ropivacaína tras la realización de un bloqueo del plexo braquial.

Ropivacaine is a local anesthetic frequently used to provide regional blocks because its toxicity threshold is favorable and it is highly selective for sensory nerve fibers. Few reports of adverse events and complications related to use of ropivacaine have been published. We report 2 cases of central nervous system toxicity. Each occurred after a brachial plexus block with 0.75% ropivacaine, one performed by an axillary approach and one by an infraclavicular approach with nerve stimulation.

Uso del videolaringoscopio de McGrath junto con la guía Frova en el manejo de la vía aérea difícil / McGrath video laryngoscope used with a Frova intubating introducer for management of the difficult airway

El videolaringoscopio de McGrath es un nuevo dispositivopara el tratamiento de la vía aérea, se asemeja aun laringoscopio de Macintosh pero incorpora una palacon una angulación de 60º y un sistema óptico conectadoa una pantalla en color que va unida al mango del videolaringoscopio.Requiere de la utilización de una sustanciaantivaho y de una guía que permita vencer el ángulode la pala. En la literatura se ha descrito su uso enpacientes con criterios de dificultad en el manejo de lavía aérea. Presentamos tres casos de intubación orotraquealdifícil que fueron intubados con el videolaringoscopiode McGrath y un introductor de Frova para laintubación. La utilización de este tipo de guía aporta unaserie de ventajas como la posibilidad de administraciónde oxígeno a través de la misma o la posibilidad de cambiarel tamaño del tubo endotraqueal si no hemos elegidoel adecuado. Discutimos la idoneidad de las pruebaspredictoras de intubación orotraqueal difícil debido a lano necesidad de alineación de los tres ejes cuando se utilizael videolaringoscopio de McGrath. Concluimos quela combinación de videolaringoscopio de McGrath yguía Frova puede ser una buena opción para el manejode la vía aérea difícil(AU)

The McGrath video laryngoscope is a new airwaymanagement device. It is similar to the Macintoshlaryngoscope but incorporates a blade at a 60° angle anda camera that sends an image to a color display screenconnected to the handle. The device, which requires useof an anti-fog substance and an introducer to guide theangled blade, has been reported to aid in themanagement of difficult airways. We present 3 cases ofdifficult oral-tracheal intubation managed with theMcGrath video laryngoscope and a Frova intubatingintroducer. Advantages of this introducer are that itoffers the possibility of administering oxygen or changingthe size of the endotracheal tube if the first choice provesinappropriate. We discuss whether or not tests to predictdifficult airways are applicable when the McGrath videolaryngoscope is being used, given that it is not necessaryto align the axes of the 3 airways. We conclude it may beuseful to combine the McGrath video laryngoscope andthe Frova introducer to manage difficult airways(AU)