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 I.

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 factors, 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 factors, 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.

Executive Summary of the 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 section of the 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) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Anesthetic management of endovascular neurosurgical procedures in acute ischemic stroke patients: A systematic review of meta-analyses.

Restoration of cerebral circulation in the ischemic area is the most critical treatment task for reducing irreversible neuronal injury in ischemic stroke patients. The recanalización of appropriately selected patients became indispensable for improving clinical outcomes and resulted in the widespread revascularization techniques. There is no clear answer as to which anesthetic modality to use in ischemic stroke patients undergoing neuro-endovascular procedures. The purpose of this systematic review is to conduct a qualitative analysis of systematic reviews and meta-analyses (RSs & MAs) comparing general anesthesia and non-general anesthesia methods for cerebral endovascular interventions in acute ischemic stroke patients. We developed a protocol with the inclusion and exclusion criteria for matched publications and conducted a literature search in PubMed and Google Scholar. The literature search yielded 52 potential publications. Ten relevant RSs & MAs were included and analysed in this review. The decision about which anesthesia method to use for endovascular procedures in managing acute ischemic stroke patients should be made based on the patient's personal characteristics, pathophysiological phenotypes, clinical characteristics, and institutional experience.

[Evaluation of the quality of anesthetic recovery in postoperative patients]. / Evaluación de la calidad de recuperación anestésica en pacientes postoperados.

Background: Comprehensive health care includes the evaluation of satisfaction in patient care and the quality of medical services. High-precision instruments have been used to assess the quality of recovery after anesthesia (QoR), such as the QoR-15 questionnaire, a validated and accurate assessment tool that considers aspects of emotionality, physical and psychological well-being, pain, and autonomy. Objective: To assess QoR in postoperative patients who underwent anesthesia. Material and methods: Observational, descriptive, cross-sectional study, carried out from March to August 2022. 80 patients from 18 to 70 years who underwent an anesthetic procedure and to which the anesthetic quality QoR-15 questionnaire was administered 24 hours after surgery were included. Descriptive statistics were performed according to the Shapiro-Wilk test. For quantitative variables it was used Mann-Whitney U, and for qualitative variables chi-squared; it was considered significant a value of p < 0.05. Results: The 80 patients obtained a QoR-15 score of 122.06 (52-147), and their QoR was considered good. Anesthetic recovery quality in patients undergoing regional anesthetic techniques was excellent in 42.5% and 10% had balanced general anesthesia, p = 0.011. Conclusions: QoR was higher with regional anesthetic techniques. Quality assessment through validated tools allows objective evaluation and monitoring of the care process in medical services.

Introducción: la atención sanitaria integral incluye la satisfacción en la atención del paciente y la calidad de servicios médicos. Se han empleado instrumentos con alta precisión para evaluar la calidad de recuperación anestésica (CRA), como el cuestionario validado QoR-15, el cual considera aspectos sobre emocionalidad, bienestar físico y psicológico, dolor y autonomía física. Objetivo: evaluar la CRA en pacientes postoperados sometidos a anestesia. Material y métodos: estudio observacional, descriptivo, transversal, realizado de marzo a agosto de 2022. Se incluyeron 80 pacientes de 18 a 70 años sometidos a procedimiento anestésico y a quienes se les aplicó el cuestionario de calidad anestésica QoR-15 a las 24 horas de postoperados. Se empleó estadística descriptiva de acuerdo con la prueba de Shapiro-Wilk. Las variables cuantitativas se analizaron con U de Mann-Whitney y las cualitativas con chi cuadrada; se consideró significativo un valor de p < 0.05. Resultados: los 80 pacientes obtuvieron 122.06 (52-147) puntos en el cuestionario QoR-15 y su CRA se consideró como buena; en los pacientes sometidos a técnicas anestésicas regionales la CRA fue excelente en 42.5% y 10% tuvieron anestesia general balanceada, p = 0.011. Conclusión: la CRA fue mayor con las técnicas anestésicas regionales. La evaluación de la calidad mediante herramientas validadas permite su evaluación objetiva y hacer seguimiento del proceso de atención en los servicios médicos.

Brain MRI without anesthesia in children less than 3 months old.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p = 0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6 min (range, 6-30 min). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Phelan-McDermid and general anesthesia with different hypnotics.

Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disease, caused by an autosomal dominant mutation due to the terminal deletion of 22q13, leading to a defect in the SHANK3 protein. We present the clinical case of a 12-year-old patient with this syndrome, who underwent three interventions that required general anesthesia. In none of them did she present intraoperative or postoperative complications.

Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study.

BACKGROUND AND OBJECTIVE: Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. METHODS: A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4h between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. RESULTS: 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients' demographics. During the first 24h post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27-56.2). Emergent surgery and age were also found to be risk factors. CONCLUSION: 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.

Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases.

OBJECTIVE: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS: Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS: No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05%. CONCLUSIONS: Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.

Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report.

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.

Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. / Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos.

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.

Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3,132 cases. / Uso de hidrato de cloral a dosis única de 70mg/kg como hipnótico en resonancia magnética nuclear. Estudio prospectivo de 3.132 casos.

OBJECTIVE: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS: Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS: No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. CONCLUSIONS: Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.

General anesthesia vs. sedation in transcatheter aortic valve implantation (TAVI): retrospective study of the incidence of acute kidney injury. / Anestesia general vs. sedación en el implante de válvula aórtica transcatéter (TAVI): estudio retrospectivo de la incidencia de lesión renal aguda.

INTRODUCTION AND OBJECTIVES: Anesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anesthetic approach and mortality was also assessed. MATERIALS AND METHODS: A retrospective, single-center, observational study was conducted at the Centro Hospitalar Universitário de São João, a Portuguese reference center. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anesthesia (GA) and sedation. RESULTS: One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p < 0.001). Regarding postoperative outcomes, there were no significant differences in AKI incidence (20.8 vs. 12.0%, p = 0.319) and mortality. A significant association was found between postoperative AKI and preexisting chronic kidney disease (CKD), preoperative heart failure functional class, intraoperative hypotension, longer length of stay in level II unit, longer hospital stay and worsening of previous CKD stage. CONCLUSIONS: It was not possible to established association between the anesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs.

Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. / Manejo anestésico en neurocirugía de paciente con síndrome de Eisenmenger y síndrome de Down. Reporte de un caso.

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.

General anesthesia in infants: neurobiological and neuropsychological concerns.

General anesthetics are crucial drugs for surgical interventions, which are indicated to induce analgesia, diminish pain, and reduce anxiety in order to facilitate invasive procedures. In pediatric patients, benefits of general anesthetics also include abolishment of motility. Besides their probed benefits on surgery, the recent warning of the Food and Drug Administration (FDA) on the use of general anesthetics in children yielded a controversy on their potential neurotoxic effects. In this review, the main facts of the cerebral development are studied, and the available evidence concerning the use of general anesthesia on the neuropsychological development of children is analyzed. Most of the studies found were uncontrolled retrospective cohorts for which conclusions are difficult to obtain. However, a few group of controlled studies, including the Mayo Anesthesia Safety in Kids study (MASK), have partially supported the FDA warning. Cumulated evidence appears to support the safety use of general anesthetics, but no conclusive data supporting that it may induce massive effects on the cognitive development of exposed children has been reported. Important evidence suggests that specific cognitive functions may result altered under long-term expositions. Such data must be considered for those involved in anesthetic procedures.

La anestesia general es una herramienta imprescindible para el proceso quirúrgico, ya que disminuye el dolor, reduce la ansiedad y genera inconsciencia. Sin ella, las cirugías serían dolorosas, riesgosas y emocionalmente traumáticas. La reciente emisión de una alerta sobre el uso de fármacos anestésicos en niños menores de 3 años por parte de la Food and Drug Administration (FDA) de los Estados Unidos generó controversia en torno a sus posibles efectos negativos. En este artículo se abordan los principales hitos del desarrollo neurobiológico del niño y se revisan las posibles consecuencias neuropsicológicas del uso de anestesia general en esta población. La mayoría de los reportes que abordan este tema son de tipo retrospectivo y arrojan resultados controversiales por sus inherentes dificultades metodológicas. Sin embargo, el estudio prospectivo sobre seguridad del uso de anestesia general en niños de la Clínica Mayo (MASK, Mayo Anesthesia Safety in Kids), junto con otros estudios a gran escala, han confirmado algunos datos obtenidos en los estudios experimentales que dieron sustento a la alerta emitida por la FDA. Así, las evidencias hasta ahora publicadas sugieren que el uso de anestesia general es seguro para el desarrollo cognitivo general del niño, aunque evidencian también alteraciones focalizadas en procesos cognitivos específicos que deben ser consideradas por el médico y la familia ante un procedimiento quirúrgico-anestésico.

Brain MRI without anesthesia in children less than 3 months old. / Resonancia magnética cerebral sin anestesia en niños menores de 3 meses.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy. / Manejo anestésico perioperatorio de pacientes con mesotelioma maligno pleural intervenidos mediante cirugía citorreductora y quimioterapia intratorácica.

INTRODUCTION: Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging. PATIENTS AND METHODS: A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed. RESULTS: Between May 2015 and October 2018 7patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5of the 7patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6of the 7patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed. CONCLUSIONS: HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.

Current practice of rapid sequence induction in adults: A national survey among anesthesiologists in Spain. / Práctica actual de la inducción de secuencia rápida en adultos: una encuesta nacional entre anestesiólogos en España.

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.

General or regional? Exploring patients' anaesthetic preferences and perception of regional anaesthesia. / ¿General o regional? Preferencias anestésicas de los pacientes y su percepción sobre la anestesia regional.

INTRODUCTION AND OBJECTIVES: Regional anaesthesia (RA) has gained popularity due to its numerous benefits and increasing safety. Yet, often patients refuse this procedure and prefer general anaesthesia (GA). This study aimed to investigate variables (demographic factors, safety perception of GA and RA, patients' fears, anxiety, and knowledge) related to patients' anaesthetic preference. MATERIAL AND METHODS: Participants were patients aged 18 years or more proposed to an anaesthesia appointment for preoperative assessment. Patients completed a written questionnaire before meeting the anaesthesiologist. The questionnaire asked about their preferences, fears and perceptions about RA. RESULTS: One hundred and 2patients agreed to participate. Mean age was 52.6±13.5 years, 57.8% were female and 44.5% had at least 12 years of education. Given the choice, 54.0% would prefer GA and 20.7% said they would refuse RA if proposed by the anaesthesiologist. Among patients who already experienced neuroaxial anaesthesia, 40.0% said they did not wish to repeat it. Patients who preferred GA over RA perceived GA to be safer than RA and expressed more anxiety towards being awake during surgery and more fear of feeling pain during surgery, of having back pain, and of needle puncture. Results also suggested that patients are unaware of RA's real risks and benefits. CONCLUSIONS: Knowing patients' fears is essential for the anaesthesiologist address their patients' needs. Anaesthesiologists should work on improving general population perspective and knowledge about RA.

General anesthesia considerations in CADASIL disease. / Consideraciones para anestesia general en la enfermedad de CADASIL.

CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy) disease is an inherited systemic arterial disease that affects the small and medium calibre cerebral vessels. Around 500 families are affected in the world, most of them in Europe. It is characterised by migraine attacks, subcortical dementia, neuropsychiatric disorders, and recurrent ischaemic strokes. The objective of this article is to describe, for the first time in the literature, the management by general anaesthesia of an intracranial neurosurgical procedure in a patient with CADASIL disease. Continuous monitoring of blood pressure is considered essential, as well as the maintenance of normocapnia and normothermia to avoid the development of new cerebrovascular accidents. This disease is relevant due to its anaesthetic implications and the few publications to date.