[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.

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)

Propuesta sobre las competencias en Anestesiología, Reanimación y Terapéutica del Dolor de un graduado de Medicina. Consenso del profesorado de las universidades de Cataluña / No disponible

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

La vía intranasal es una vía de administración transmucosaque aporta como ventajas la facilidad de administración,es incruenta, bien aceptada por el paciente ycarece de efecto de primer paso hepático. La mucosanasal supone una superficie extensa muy vascularizadarecubierta por epitelio ciliar pseudoestratificado, secretorade moco sometido a un movimiento mucociliar quepuede determinar el tiempo de contacto entre los fármacosy la superficie. Los factores que influyen en la absorciónson de tipo anatómico, fisiológico y otros relacionadoscon las propiedades del fármaco y los sistemas deadministración.Revisamos los artículos publicados sobre el uso de fentanilo,meperidina, diamorfina y butorfanol utilizadospor vía intranasal para el tratamiento del dolor agudo.Los efectos adversos sistémicos son similares a los descritospara la vía intravenosa, siendo los más frecuentessomnolencia, náuseas y vómitos. En cuanto a los efectosadversos locales, se ha descrito sensación de quemazóncon meperidina y mal sabor

Intranasal drug administration is an easy, well-tolerated,noninvasive transmucosal route that avoids first-passmetabolism in the liver. The nasal mucosa provides anextensive, highly vascularized surface of pseudostratifiedciliated epithelium. It secretes mucus that is subjected tomucociliary movement that can affect the time of contactbetween the drug and the surface. Absorption is influencedby anatomical and physiological factors as well as byproperties of the drug and the delivery system.We review the literature on intranasal administrationof fentanyl, meperidine, diamorphine, and butorphanolto treat acute pain. The adverse systemic effects aresimilar to those described for intravenousadministration, the most common being drowsiness,nausea, and vomiting. Local effects reported are aburning sensation with meperidine and a bad taste

Parálisis facial tras anestesia epidural / Facial paralysis after epidural anesthesia

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Comentarios al artículo titulado "Traqueostomía de emergencia para resolver una vía aérea difícil no conocida" / Comments on the article "Emergency tracheostomy to resolve an unforeseen difficult airway"

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[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.

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

INTRODUCCIÓN: El presente trabajo valora la seguridady eficacia del bloqueo continuo del nervio tibial posterioren el tobillo, mediante la infusión domiciliaria porelastómero de ropivacaína al 0,375%, en pacientes intervenidosde hallux valgus en cirugía ambulatoria (CMA).MATERIAL Y MÉTODO: Se compara la analgesia oralconvencional de la unidad de CMA, metamizol 575 mgVO c/6h (AC) con la analgesia perineural (AP), infusióncontinua a 5 mL h-1 de ropivacaína 0,375% en nerviotibial posterior, en dos grupos de 20 pacientes, distribuidosaleatoriamente. Intervenciones realizadas bajo anestesiaintradural con mepivacaína hiperbara e infiltraciónintra-articular con bupivacaína al 0,25%. Ambos gruposutilizaron tramadol 50 mg VO c/8h como analgésico derescate. El servicio de atención domiciliaria realizó loscontroles: valoración del dolor según la escala analógicavisual (EVA 0-10), calidad sueño, necesidad de analgesiade rescate, aceptación de la técnica, incidencias y efectossecundarios, a las 12, 24 y 48 h de la intervención. Trabajodescriptivo, comparaciones mediante prueba U deMann Whitney; para el análisis de calidad del sueño ynecesidad de analgesia se utilizó el test de tendencia linealChi cuadrado.RESULTADOS: El grupo AP presentó valores de EVAsignificativamente menores a las 4 h, 12 h y 24 h y menornecesidad de analgesia de rescate. No diferencias en calidaddel sueño (p=0,07). No incidencias ni efectos secundarios.No hubo casos de reingreso. Los pacientes manifestaronun alto grado de aceptación de la técnica.CONCLUSIÓN: La analgesia perineural continua domiciliariase muestra efectiva y segura en nuestro ámbito

INTRODUCTION: This trial assessed the safety and efficacyof a continuous posterior tibial nerve block in theankle provided in the patient’s home by elastomericpump infusion of 0.375% ropivacaine after ambulatoryhallux valgus surgery.MATERIAL AND METHODS: Patients were randomizedto 2 groups of 20 each to receive either the conventionaloral analgesia prescribed by our team after outpatientsurgery (metamizole 575 mg/6 h p.o.) or perineuralanalgesia with a continuous infusion of 5 mL.h-1 of0.375% ropivacaine in the posterior tibial nerve. Surgerywas performed under hyperbaric spinal anesthesiawith mepivacaine and an injection of 0.25% bupivacaineinto the joint. Both groups also received 50 mg/8 hp.o. of tramadol as rescue analgesia. Assessment duringvisits by the home care team 12, 24, and 48 hours aftersurgery included the following variables: pain on avisual analog scale (VAS, 0-10), sleep quality, need forrescue analgesia, acceptance of the technique, sideeffects and adverse events. Descriptive statistics werecalculated and comparisons were performed with theMann-Whitney U test; sleep quality and need for rescueanalgesia were compared by applying the ÷2 statisticwith a test of linear trend.RESULTS: The perineural analgesia group had significantlylower VAS scores at 4, 12, and 24 hours and lessneed for rescue analgesia. No differences in sleep qualitywere found (P0.07). The incidence of side effectsdid not differ, and there were no readmissions. Thepatients expressed a high level of acceptance of thetechnique.CONCLUSION: Continuous perineural analgesia in thehome setting was found to be effective and safe in ourpatients

Tramadol, una puesta al día tras 28 años de uso / Tramadol, an update after 28 years

Tramadol es un fármaco analgésico con un doble mecanismo de acción, que actúa sobre los receptores opioides e inhibe la recaptación de monoaminas. Se ha demostrado su eficacia por diversas vías de administración y es ampliamente utilizado. Sus principales vías metabólicas son la O-desmetilación que da lugar a un metabolito activo M1 y la N-desmetilación. Debido a que en su metabolismo están implicadas varias isoformas del citocromo P-450, tramadol está sometido a una serie de interacciones farmacológicas con fármacos de uso corriente como ondansetrón o metoclopramida. Está indicado en el tratamiento del dolor agudo. Se ha administrado también en el manejo de diversoso tipos de dolor crónica, en anestesia y en otras indicaciones poco conocidas (patología neurológica, psiquiétrica, etc.). Está indicado en el tratamiento del dolor agudo postoperatorio en adultos y en otras formas de dolor agudo. Se ha administrado también en el manejo de diversos tipos de dolor crónico, en anestesia y en otras indicaciones poco conocidas (patología neurológica, psiquiétrica, etc.). La utilización de tramadol se acompaña de una serie de efectos adversos siendo los más frecuentes las naúseas, los vómitos y la sensación de mareo. Aunque hay algún caso de dependencia, se trata de un fármaco muy seguro. No se ha descrito ninguna muerte atribuible a tramadol

Tramadol is an analgesic with a double-action mechanisms. It act on µ opioid receptors and inhibits noradrenalina and serotonine re-uptake. Its efficiency has been demonstrated with different methods of administration. Its principal metabolic pathways are O-desmethylation which produces an active metabolite called M1 and N-desmethylation. Because various P-450 cytochrome isoforms are implicated in its metabolism, tramadol undergoes a series of pharmacological interactions with current drugs as ondasetron or metoclopramide. Tramadol is indicated in the treatment of acute postoperative pain in adults and also other forms of acute pain. It has also been used in the management of different types of chronic pain, in anaesthesia and other lesser known indications (neurological pathology, psychiatric, etc). Tramadol has several side-effects such as nausea, vomiting and dizzines. Although there have been some reports about dependency on the drug, it is believe to be quite safe. No death have been attribuded to tramadol use

[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.

¿Mascarilla laríngea Fastrach o mascarilla laríngea ProSeal en el manejo de la vía aérea difícil en urgencias extrahospitalarias? / Urgent management of the difficult airway outside the hospital: Fastrach or Proseal laryngeal mask?

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Descubrimiento de un caso de siringomielia tras una infiltración epidural / Syringomyelia discovered after epidural infusion

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Catéter epidural anudado espontáneamente / Spontaneous kinking of an epidural catheter

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[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.