Válvula venosa yugular interna como causa de dificultad para acceso venoso central / Internal jugular venous valve as a cause of difficult central venous access

La canulación venosa central es un procedimiento habitual en el medio hospitalario, siendo la vena yugular interna uno de los vasos más frecuentemente escogido para realizar el acceso venoso central. La presencia de válvulas venosas en dicha vena es un hecho conocido al que habitualmente no se concede importancia durante la canulación venosa central. No obstante, las válvulas venosas pueden llegar a dificultar este procedimiento, incrementando la probabilidad de que ocurran complicaciones. Presentamos el caso de un paciente en el cual la presencia de una válvula venosa yugular interna impidió obtener un acceso vascular a través de este vaso

Central venous cannulation is a commonly performed procedure in the hospital setting, while the internal jugular vein is one of the most frequently used to perform central venous access. The presence of venous valves in the jugular veins is a well-known fact, albeit often neglected during central venous cannulation. However, venous valves can make this procedure difficult, increasing the chance of developing complications. We report the case of a patient in whom the presence of a valve in the internal jugular vein did not permit a vascular access to be obtained through this vessel

[Internal jugular venous valve as a cause of difficult central venous access]. / Válvula venosa yugular interna como causa de dificultad para acceso venoso central.

Central venous cannulation is a commonly performed procedure in the hospital setting, while the internal jugular vein is one of the most frequently used to perform central venous access. The presence of venous valves in the jugular veins is a well-known fact, albeit often neglected during central venous cannulation. However, venous valves can make this procedure difficult, increasing the chance of developing complications. We report the case of a patient in whom the presence of a valve in the internal jugular vein did not permit a vascular access to be obtained through this vessel.

Comentarios sobre el artículo «Canalización de una vía venosa periférica guiada con ecografía en un paciente quirúrgico» / Comments on the article “Ultrasound-guided peripheral intravenous catheterisation in a surgical patient”

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Hipertensión intracraneal idiopática: cesárea con anestesia epidural tras normalización de la presión del líquido cefalorraquídeo / Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal

La hipertensión intracraneal idiopática se diagnostica por exclusión y se caracteriza por su fisiopatología incierta y su frecuencia escasa; por lo tanto su manejo anestésico no está bien definido. Presentamos el caso de una gestante con esta alteración sin shunt lumboperitoneal, propuesta para cesárea no urgente, en la que realizamos drenaje y normalización de la presión de LCR antes de la realización de anestesia epidural con catéter. Creemos que puede ser una técnica eficaz para permitir un buen nivel de bloqueo y un gran bienestar para la paciente, así como para mejorar su recuperación postoperatoria (AU)

Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined.The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia.We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery (AU)

Comparación de las cánulas VAMA(R) y Berman(R) para la intubación fibroscópica orotraqueal en pacientes anestesiados / Comparison between VAMA(R) and Berman(R) cannulas for fibroscopic orotracheal intubation in anaesthetised patients

Objetivos. En la intubación fibroscópica, el hecho de gozar de una visión directa y en tiempo real, no nos asegura el correcto avance del tubo endotraqueal (TET) hasta su posición intratraqueal. El empleo de cánulas orales ayuda a la consecución de una vía aérea libre para el paso del fibroscopio y el TET. Comparamos la cánula VAMA(R) y la cánula Berman(R) en cuanto a tiempo necesario para la intubación, visión fibroscópica y facilidad de paso del TET. Pacientes y método. Noventa pacientes sin criterios de vía aérea difícil fueron randomizados en dos grupos, B y V, según el tipo de cánula empleada. Tras inducir anestesia general, se procedió a la intubación con fibroscopio flexible, midiendo tiempos de fibroscopia e intubación, intentos de fibroscopia, calidad de visión fibroscópica y grado de dificultad en el paso del TET. Resultados. No se obtuvieron diferencias estadísticamente significativas entre ambas cánulas, si bien, la tendencia apuntaba a menores tiempo de intubación (p=0,292) y menor dificultad al paso del TET (p=0,447). Con ambos dispositivos, la calidad de visión fue buena, encontrando únicamente algún grado de obstrucción en la vía aérea en el 22% de los pacientes. En ningún caso esta obstrucción fue total, por lo que todos los pacientes pudieron ser intubados correctamente. Conclusiones. La cánula VAMA® representa una alternativa eficaz a las clásicas cánulas de intubación fibroasistida. Además, su novedoso diseño ofrece ciertas ventajas para la correcta orientación del fibroscopio y la retirada de la cánula tras la intubación (AU)

Objectives. In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA® (V) and Berman® (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. Patients and methods. 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(R) (B) and VAMA(R) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. Results. No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA® group compared to the Berman® group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. Conclusions. The VAMA® cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation(AU)

[Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients]. / Comparación de las cánulas VAMA(®) y Berman(®) para la intubación fibroscópica orotraqueal en pacientes anestesiados.

OBJECTIVES: In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS: 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS: No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS: The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.

[Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal]. / Hipertensión intracraneal idiopática: cesárea con anestesia epidural tras normalización de la presión del líquido cefalorraquídeo.

Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined. The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia. We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery.

Migración de dispositivo para cierre percutáneo de comunicación interauricular a cavidades izquierdas / Migration to the left cavities of an interatrial communication closure device

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Intubación orotraqueal con laringoscopio óptico Airtraq(R) en pacientes acromegálicos / Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope

Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación (AU)

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route (AU)

[Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope]. / Intubación orotraqueal con laringoscopio óptico Airtraq en pacientes acromegálicos.

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.

Intubación orotraqueal con laringoscopio óptico Airtraq(R) en pacientes acromegálicos / Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope

Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación(AU)

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route(AU)

Comentarios al artículo "Uso del videolaringoscopio de McGrath junto con la gúía frova en el manejo de la vía aérea difícil" / No disponible

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Manejo de la vía aérea fácil y complicada con el laringoscopio óptico Airtraq® en manos inexpertas / Management of the easy or complicated airway by nonexperts using the AirTraq optical laryngoscope

OBJETIVO: Evaluar la utilidad del laringoscopio ópticoAirtraq®, evaluando sus indicaciones y beneficios, asícomo las posibles limitaciones de su empleo en una serieretrospectiva de pacientes.PACIENTES Y MÉTODOS: Revisión retrospectiva de losprimeros 124 pacientes de nuestro centro cuya intubaciónendotraqueal fue realizada con Airtraq®. Se tuvieronen cuenta variables anatómicas y demográficas delos pacientes, así como la exploración preoperatorio dela vía aérea. Tras la realización de la intubación con Airtraq® se recogieron datos en cuanto a su facilidad demanejo y calidad del procedimiento.RESULTADOS: En un 97,6% de los pacientes se consiguióuna intubación correcta y en sólo 3 (2,4%) pacientesfue imposible. La calidad de la laringoscopia fue óptimaen más del 95% de los casos. Las complicaciones eincidencias fueron mínimas.CONCLUSIÓN: El laringoscopio Airtraq® ha demostradoque facilita la intubación en aquellos casos en losque intentos previos de laringoscopia han sido infructuososy en pacientes con predictores evidentes de víaaérea difícil (VAD), incluso cuando fue empleado porpersonal no entrenado en su uso. La facilidad en suempleo y su relativa inocuidad, lo convierten en unpráctico dispositivo en distintos tipos de pacientes ysituaciones clínicas(AU)

OBJECTIVES: To evaluate the utility of the AirTraqoptical laryngoscope in a retrospective case series,assessing indications for use and benefits as well aspossible limitations.PATIENTS AND METHODS: Retrospective study of the first124 patients in whom we used the AirTraq for trachealintubation. Anatomical and demographic variables wererecorded in addition to preoperative findings onexamination of the airway. Ease in accomplishing themaneuver and quality of the procedure were assessedafter intubation with the AirTraq.RESULTS: The trachea was correctly intubated in97.6% of the patients. Intubation failed in only 3 (2.4%)patients. Laryngoscopic quality was optimal in over95% of the cases. There were few complications or otherevents.CONCLUSIONS: The AirTraq laryngoscope has beenshown to facilitate intubation even when nonexpert staffperform the maneuver in cases in which previousattempts at laryngoscopy have failed and in which adifficult airway is anticipated. Ease of use and relativesafety make the AirTraq a practical device for a varietyof patient types and clinical settings(AU)

[Management of the easy or complicated airway by nonexperts using the AirTraq optical laryngoscope]. / Manejo de la vía aérea fácil y complicada con el laringoscopio optico AirTraq en manos inexpertas.

OBJECTIVES: To evaluate the utility of the AirTraq optical laryngoscope in a retrospective case series, assessing indications for use and benefits as well as possible limitations. PATIENTS AND METHODS: Retrospective study of the first 124 patients in whom we used the AirTraq for tracheal intubation. Anatomical and demographic variables were recorded in addition to preoperative findings on examination of the airway. Ease in accomplishing the maneuver and quality of the procedure were assessed after intubation with the AirTraq. RESULTS: The trachea was correctly intubated in 97.6% of the patients. Intubation failed in only 3 (2.4%) patients. Laryngoscopic quality was optimal in over 95% of the cases. There were few complications or other events. CONCLUSIONS: The AirTraq laryngoscope has been shown to facilitate intubation even when nonexpert staff perform the maneuver in cases in which previous attempts at laryngoscopy have failed and in which a difficult airway is anticipated. Ease of use and relative safety make the AirTraq a practical device for a variety of patient types and clinical settings.

[Anesthetic management in a patient previously diagnosed with takotsubo cardiomyopathy]. / Manejo anestésico en una paciente previamente diagnosticada de síndrome de takotsubo.

Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the reported cases an emotional or physical stress event has been identified as a trigger, and perioperative stress has been suggested as the trigger in some of these cases. Outcome is favorable with the right treatment, though recurrences are possible. We report the anesthetic management of a 79-year-old woman with a previously diagnosed episode of Takotsubo cardiomyopathy, who was admitted to our hospital for total hip replacement. Care was taken to provide proper preoperative sedation before provision of hyperbaric spinal anesthesia, followed by sedation with intravenous propofol. Surgery and the early postoperative period were uneventful. We believe that minimizing perioperative anxiety should be a priority in these patients due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy.