Laryngeal Mask Ventilation During Lumbar Spine Neurosurgery in Knee-Chest Position is Feasible.

BACKGROUND: This study describes our experience with laryngeal mask (LM) inserted after anesthetic induction in patients already in knee-chest position for lumbar neurosurgery. METHODS: Airway management (need for LM repositioning, orotracheal intubation because of failed LM insertion), anticipated difficult airway, and airway complications were registered. Statistics were compared between groups with the t test or the χ test, as appropriate. RESULTS: A total of 358 cases were reviewed from 2008 to 2013. Tracheal intubation was performed in 108 patients and LM was chosen for 250 patients (69.8%). Intubated patients had a higher mean age and rate of anticipated difficult airway; duration of surgery was longer (P<0.001, all comparisons). LM insertion and anesthetic induction proved effective in 97.2% of the LM-ventilated patients; 7 patients (2.8%) were intubated because of persistent leakage. Incidences with airway management were resolved without compromising patient safety. CONCLUSION: LM airway management during lumbar neurosurgery in knee-chest position is feasible for selected patients when the anesthetist is experienced.

Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction.

BACKGROUND: Clinical diagnoses were correlated with results of a Co(II)-albumin binding assay in 167 patients treated at an emergency department of a health maintenance organization. METHODS: Patients were evaluated as being nonischemic or potentially ischemic through standard coronary disease indicators [creatine kinase (CK), CK-MB, cardiac troponin I, and electrocardiographic findings] and were tested by a Co(II)-albumin binding assay. Samples were tested anonymously, and the study was double-blinded. The sensitivity and specificity of this assay for the detection of ischemia were evaluated by ROC curve analysis. Known Co(II) binding sites on albumin were analyzed by N-terminal amino acid sequencing. RESULTS: The mean absorbance units (ABSU) +/- 2 SD for non-myocardial ischemic and myocardial ischemic individuals measured at 470 nm were 0.43 +/- 0.10 and 0.63 +/- 0.25, respectively (P <0.0001). The area under the ROC curve was 0.95 [95% confidence interval (CI), 0.92-0.99], and at a cutoff value of 0.50 ABSU, sensitivity and specificity were 88% (78-94%) and 94% (86-98%), respectively, suggesting a high distinction between the two groups. When we compared non-acute myocardial infarction (AMI) and AMI ischemic individuals, the area under the ROC curve was 0.66 (95% CI, 0.53-0.79) and was considered a poor discriminator between these two groups. N-Terminal amino acid sequencing data for purified albumin showed normal amino acid residues for six of seven high-ABSU (> or =0.70) individuals and one nonischemic individual tested. However, only one individual with a high ABSU (0.80) had two missing amino acid residues (DA) from the N-terminal region. Clinical diagnosis for this patient did not reveal an ischemic event. CONCLUSIONS: The Co(II)-albumin binding test may serve as a useful diagnostic tool in emergency facilities for the assessment of myocardial ischemia. High and low ABSU were associated with myocardial ischemic individuals and non-myocardial ischemic individuals, respectively. However, the Co(II)-albumin binding was a poor discriminator between ischemic individuals with and without MI.

Síndrome febril a urgències en infants menors de dos anys / Síndrome febril en urgencias en niños menores de dos años / Febrile syndromes in children younger than 2 years of age in the emergency department

Introducció. La febre és un dels motius de consulta més freqüents als serveis d’urgències pediàtriques. Com manejar-la en el lactant continua sent motiu de controvèrsia. Objectius. Analitzar les causes més freqüents de febre en el lactant. Determinar el seguiment de la pauta del lactant febril sense focus aparent al servei d’urgències i la seva relació amb l’evolució posterior del pacient. Material i mètodes. Estudi prospectiu d’infants menors de 24 mesos d’edat atesos per febre de menys de 72 hores d’evolució al nostre Servei d’Urgències. Resultats. S’inclouen 200 lactants amb una edat mitjana de 12.6±5.8 mesos. La temperatura màxima és de 39.3±0.5ºC amb un temps d’evolució de 23±19.4 hores. La simptomatologia acompanyant predominant és respiratò- ria (53.5%). S’objectiva el focus de la febre en el 67%. Els diagnòstics més freqüents són l’otitis mitjana aguda (40 casos) i la infecció respiratòria de vies altes (35 casos). L’exploració complementària més sol•licitada és el sediment urinari (31%). En els lactants amb febre sense focus (n= 66), l’adherència a la pauta és del 40% i el motiu principal per no seguir-la és la falta d’analítica sanguínia (45.5%). Ingressen 11 pacients (5.5%) i 24 infants (12%) tornen per persistència de la febre. Conclusions. Les infeccions de l’àrea ORL suposen les causes principals de febre en el lactant. El seguiment de la pauta de lactant febril sense focus a urgències és semblant al que es descriu a la bibliografia. La poca realització d’analítiques sanguínies suposa el motiu principal per no adherir-se a la pauta, sense influència negativa en l’evolució posterior del pacient (AU)

Introducción. La fiebre es uno de los motivos de consulta más frecuentes en los servicios de urgencias pediátricas. Su manejo en el lactante sigue siendo motivo de controversia. Objetivos. Analizar las causas más frecuentes de fiebre en el lactante. Determinar el seguimiento de la pauta del lactante febril sin foco aparente en el servicio de urgencias y su relación con la evolución posterior del paciente. Material y métodos. Estudio prospectivo de niños menores de 24 meses de edad atendidos por fiebre de menos de 72 horas de evolución en nuestro Servicio de Urgencias. Resultados. Se incluyen 200 lactantes con edad media de 12.6±5.8 meses. La temperatura máxima es de 39.3±0.5ºC con un tiempo de evolución de 23±19.4 horas. La sintomatología acompañante predominante es respiratoria (53.5%). Se objetiva foco de la fiebre en el 67%. Los diagnósticos más frecuentes son la otitis media aguda (40 casos) y la infección respiratoria de vías altas (35 casos). La exploración complementaria más solicitada es el sedimento urinario (31%). En los lactantes con fiebre sin foco (n= 66) la adherencia a la pauta es del 40% y el principal motivo de falta de seguimiento es la falta de analítica sanguínea (45.5%). Ingresan 11 pacientes (5.5%) y 24 niños (12%) vuelven a acudir por persistencia de la fiebre. Conclusiones. Las infecciones del área ORL suponen los principales causantes de fiebre en el lactante. El seguimiento de la pauta de lactante febril sin foco en urgencias es similar al descrito en la bibliografía. La poca realización de analíticas sanguíneas supone el motivo principal de no adherencia a la pauta, sin influir negativamente en la evolución posterior del paciente (AU)

Introduction. Fever is one of the most frequent chief complaints in children presenting to the Emergency Department. The management of young children with fever in the emergency setting continues to be controversial. Objectives. To analyze the most frequent causes of fever in infants, and to evaluate the compliance with the guidelines for the management of young children with fever of unknown origin and its relationship with outcome. Material and methods. Prospective study of patients younger than 24 months presenting to our Emergency Department with fever of less than 72 hours of evolution. Results. Two hundred children (mean age 12.6± 5.8 months) were evaluated. Mean peak temperature was 39.3 ± 0.5oC, and mean evolution was 23 ± 19.4 hours. Main symptoms were respiratory (53.5%). The focus of infection was determined in 67% of the children. More frequent diagnoses were acute otitis media (40 patients), and upper respiratory tract infections (35 patients). Urinalysis was the diagnostic test most frequently performed (31%). The hospital guidelines for the management of young children with fever of unknown origin were followed in 40% of the 60 eligible cases. The main reason for not complying with the guidelines was the lack of blood work (45.5%). Eleven children (5.5%) were admitted to the hospital, and 24 children (12%) returned to the Emergency Department with persistent fever. Conclusions. Upper respiratory tract infections are the main cause of fever in young children presenting to the Emergency Department. The compliance with the guidelines for the management of febrile children without known origin is similar to other reports. The lack of blood work is the main deviation from the guidelines, although it does not seem to impact outcome (AU)