Results of a surgical cricothyrotomy workshop with a pig trachea model. / Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo.

BACKGROUND: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. MATERIAL AND METHODS: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. RESULTS: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. CONCLUSION: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy.

Assessment of TruviewPCD videolaryngoscope for intubation in children. / Evaluación del videolaringoscopio TruviewPCD para la intubación de niños.

OBJECTIVE: The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. MATERIAL AND METHOD: A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. RESULTS: Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. CONCLUSIONS: TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide.

[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.

[Laryngeal mask for intubation (Fastrach)]. / Mascarilla laríngea para intubación (Fastrach).

The laryngeal mask for intubation (MLI), or "Fastrach", is a new device designed by Brain for airway management. The MLI, a modified version of the conventional laryngeal mask, allows for blind intubation through the device using endotracheal tubes up to 8 mm in diameter. Insertion with the head in a neutral position makes this system useful for managing the airway when neck injury is present. The device has been used successfully in patients assessed as having difficult-to-manage airways and its use in emergencies inside or outside the hospital is promising. The MLI has been used with high rates of success in combination with other techniques such as fiberoptic bronchoscopy (success rate 99 to 100%) and transillumination (95 to 100% success rate) in patients whose airways have been considered difficult to manage. Given such high rates of success for MLI placement (95 to 100%) and for blind orotracheal intubation (81 to 100%), the Fastrach may offer an alternative to the conventional laryngeal mask in algorithms for airway management.