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 factor, 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.

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 factor, 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.

Efectividad de la ventilación de los diversos dispositivos extraglóticos durante las maniobras de reanimación. Revisión sistemática / Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review

INTRODUCCIÓN: El uso de dispositivos extraglóticos se ha difundido ampliamente en urgencias pre e intrahospitalarias debido a la facilidad de inserción y la reducción de las interrupciones en las maniobras de reanimación cardiopulmonar. Sin embargo, la mayoría de estos estudios no especifica si dichos dispositivos aseguran una ventilación adecuada durante la reanimación cardiopulmonar. Esta revisión sistemática tiene como objetivo principal determinar si existe evidencia que demuestre que los dispositivos extraglóticos permiten una ventilación efectiva durante la reanimación. MÉTODOS: Se han utilizado las bases de datos de MEDLINE y COCHRANE para buscar estudios elegibles publicados en inglés hasta el 30 de noviembre de 2018. Los estudios considerados elegibles fueron todos aquellos que han evaluado objetivamente el volumen tidal durante las maniobras de reanimación, en diversos dispositivos extraglóticos y en pacientes mayores de 18 años. RESULTADOS: Se identificaron 3.734 artículos, de los cuales 252 eran duplicados. Solo uno evaluó objetivamente la ventilación durante las maniobras de reanimación y presentó datos relevantes para esta revisión. En este ensayo de 470 pacientes, se realizó una espirometría en 51 pacientes. Solo el 4,48% de los pacientes sobrevivieron hasta el alta hospitalaria, sin embargo, no se evaluó la relación con la efectividad de la ventilación. CONCLUSIÓN: No existe evidencia científica que demuestre que los dispositivos extraglóticos proporcionan una ventilación efectiva durante las maniobras de reanimación. La evaluación mediante espirometría, impedancia torácica y ultrasonido podría ayudar a discernir la eficacia ventilatoria de los dispositivos extraglóticos durante la reanimación cardiopulmonar y aclarar si este factor está contribuyendo de manera negativa en las dificultades experimentadas para revertir el paro cardiorrespiratorio en los pacientes

INTRODUCTION: Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS: The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS: A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION: There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest

Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. / Efectividad de la ventilación de los diversos dispositivos extraglóticos durante las maniobras de reanimación. Revisión sistemática.

INTRODUCTION: Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS: The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS: A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION: There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.

El modelo del Vórtex: una aproximación diferente a una vía aérea difícil / The Vortex model: A different approach to the difficult airway

El aislamiento de la vía aérea es un área esencial en la anestesia. Los anestesiólogos se consideran los profesionales más expertos para resolver cualquier problema relacionado con una vía aérea difícil. Sin embargo, las complicaciones derivadas del manejo incorrecto de la vía aérea siguen siendo una de las causas más frecuentes de morbimortalidad asociada a la anestesia. La estrategia mediante algoritmos de tratamiento para resolver estas dificultades ha demostrado su fracaso debido a varios factores relacionados con su estructura y su aplicación clínica. El enfoque Vortex surge como una respuesta a las limitaciones encontradas en los algoritmos de manejo de una vía aérea difícil, utilizando una estrategia de ayudas para reducir la carga cognitiva y el error de fijación. Esta nueva estrategia puede representar una solución al problema de la dificultad de la vía aérea y, poder así, reducir la incidencia de complicaciones

Airway management is an essential area in anaesthesia, and anaesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails, due to several factors related to its structure and clinical application. The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce the complications rate

The Vortex model: A different approach to the difficult airway. / El modelo del Vórtex: una aproximación diferente a una vía aérea difícil.

Airway management is an essential area in anaesthesia, and anaesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails, due to several factors related to its structure and clinical application. The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce the complications rate.

Nueva evidencia en ventilación unipulmonar / New evidence in one-lung ventilation

La ventilación mecánica en cirugía torácica ha sufrido cambios significativos en los últimos años debido a la implantación de la ventilación protectora. Esta revisión analizará las estrategias ventilatorias recientes en la ventilación unipulmonar. Se realizó una búsqueda en MEDLINE utilizando el término MeSH «One-Lung Ventilation», incluyendo ensayos clínicos aleatorios, metaanálisis, revisiones y revisiones sistemáticas publicadas en los últimos 6 años. La búsqueda se realizó el 21 de marzo de 2017. Inicialmente se encontraron un total de 75 artículos. Después de la revisión del título y resumen se incluyeron 14 artículos. La ventilación protectora no es simplemente sinónimo de ventilación de bajo volumen tidal, sino que también incluye el uso rutinario de PEEP y la maniobra de reclutamiento alveolar. Las nuevas técnicas siguen discutiéndose, a saber: ajuste de PEEP, ratio inspiración:espiración, tipo ideal de anestesia durante ventilación unipulmonar y ventilación hipercápnica (AU)

Mechanical ventilation in thoracic surgery has undergone significant changes in recent years due to the implementation of the protective ventilation. This review will analyze recent ventilatory strategies in one-lung ventilation. A MEDLINE research was performed using Mesh term "One-Lung Ventilation" including randomized clinical trials, metanalysis, reviews and systematic reviews published in the last 6 years. Search was performed on 21st March 2017. A total of 75 articles were initially found. After title and abstract review 14 articles were included. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also includes routine use of PEEP and alveolar recruitment maneuver. New techniques are still in discussion namely PEEP adjustment, ratio inspiration:expiration, ideal type of anesthesia during one-lung ventilation and hypercapnic ventilation (AU)

New evidence in one-lung ventilation. / Nueva evidencia en ventilación unipulmonar.

Mechanical ventilation in thoracic surgery has undergone significant changes in recent years due to the implementation of the protective ventilation. This review will analyze recent ventilatory strategies in one-lung ventilation. A MEDLINE research was performed using Mesh term "One-Lung Ventilation" including randomized clinical trials, metanalysis, reviews and systematic reviews published in the last 6 years. Search was performed on 21st March 2017. A total of 75 articles were initially found. After title and abstract review 14 articles were included. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also includes routine use of PEEP and alveolar recruitment maneuver. New techniques are still in discussion namely PEEP adjustment, ratio inspiration:expiration, ideal type of anesthesia during one-lung ventilation and hypercapnic ventilation.

Difficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.

Klippel-Feil Syndrome (KFS) is a congenital defect characterized by the fusion of at least two cervical vertebrae. This article presents the case of a 12-year-old girl with KFS planned for scoliosis surgery. A short, rigid neck and limited mouth opening were predictors of difficult airway access. After failing multiple intubation attempts employing several devices, the case was postponed. Imaging tests showed lingual tonsil hypertrophy and a deviation of the tracheal axis, clarifying the causes of the failed intubation and suggesting new approaches for airway management. As far as we know, the association of KFS and lingual tonsil hypertrophy has not been reported before in the literature.

Gastro-Laryngeal Tube for endoscopic retrograde cholangiopancreatography: a preliminary report.

The Gastro-Laryngeal Tube is a modification of the Laryngeal Tube that provides a dedicated channel for the insertion of a gastroscope. In this study of 30 patients undergoing general anaesthesia for endoscopic retrograde cholangiopancreatography, we evaluated both the effectiveness of airway management with a Gastro Laryngeal Tube and the feasibility of performing it using the endoscopic channel. The Gastro Laryngeal Tube was inserted successfully in all patients, in 27 patients at the first attempt. The mean (SD) time to achieve an effective airway was 26 (6) s. Mean (SD) inspiratory and expiratory tidal volumes were 336 (57) ml and 312 (72) ml, respectively, and oropharyngeal leak pressure was 33.7 (2) cmH(2)O. These data suggest that the Gastro Laryngeal Tube is an effective and secure device for airway management and for use during performance of endoscopic retrograde cholangiopancreatography.

Recomendaciones para el manejo de la vía aérea difícil mediante dispositivos extraglóticos en el paciente adulto sometido a cirugía ambulatoria / No disponible

No disponible

[Effectiveness of adenosine as a pulmonary vasodilator during weaning from extracorporeal circulation after mitral valve replacement in a patient with severe pulmonary hypertension]. / Efectividad de la adenosina como vasodilatador pulmonar a la salida de la circulación extracorpórea tras recambio mitral en una paciente con hipertensión pulmonar grave.

A 75-year-old woman with mitral stenosis and tricuspid insufficiency underwent mitral valve replacement surgery. After insertion of a catheter into the pulmonary artery, upper respiratory system pressure was seen to rise above systemic arterial pressure. To relax the pulmonary vessel, we administered adenosine, a drug that is metabolized rapidly during its first pass through the lungs before hypotension or other adverse side effects occur systemically. Adenosine decreased pulmonary artery pressure and vascular resistance, optimizing right cardiac function with successful output to extracorporeal circulation.