The role of local inflammation in complications associated with intubation in pediatric patients: A narrative review.

Although the most important primary local inflammatory response factor to intubation is not yet clear, it is known that it may be directly attributed to the presence of trauma during intubation or the response of oral bacterial flora present in the trachea. It is known that prolonged intubation is associated with worse outcomes, but other underlying systemic issues, such as sepsis and trauma, are also associated with this result. Likewise, patients who require advanced airway management and excessive manipulation are more likely to experience complications. There are various inflammatory mediators that are generated during orotracheal intubation, many of which can be considered targets for therapies to help reduce inflammation caused by intubation. However, there is little evidence on the management of the inflammatory response induced by orotracheal intubation in pediatric patients. Therefore, the aim of this narrative review is to highlight the intubation associated complications that can arise from poorly controlled inflammation in intubated pediatric patients, review the proposed pathophysiology behind this, and discuss the current treatments that exist. Finally, taking into account the discussion on pathophysiology, we describe the current therapies being developed and future directions that can be taken in order to create more treatment options within this patient population.

Impact of the SARS-CoV-2 pandemic on Colombian anesthesiologists: Survey study / Impacto de la pandemia por SARS-CoV-2 en anestesiólogos colombianos. Estudio de encuesta

Abstract Introduction: The practice of anesthesiology during the COVlD-i9/SARS-CoV-2 pandemic has had a psychological impact, and has been associated with ethical dilemmas, work overload, and occupational risk. Objective: To understand different problems affecting anesthesiologists, in particular with regards to professional ethics in the decision-making process, increased personal workload, and the potential risk in terms of their own safety and health, as a consequence of working during the COVlD-19 pandemic. Methods: Observational, descriptive, cross-sectional study. A survey was administered to anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), to enquire about work hours, occupational safety, prevention standards and strategies, and ethical aspects involved in decision making during the COVID-19 pandemic. Results: 218 anesthesiologist participated in the survey. Most of the respondents felt that there was not a significant increase in their workload, except for those in critical care (42.5 %; n = 17). Most of the participants believe that leisure time is not enough. 55.96 % (n = 122) of the participants said they felt moderately safe with the biosecurity measures, but with a higher risk of contagion versus other practitioners, with 72.9 % (n = 159) responding that they used their own money to buy personal protection equipment (PPE). There was also evidence that one fourth of the respondents has faced ethical dilemmas during the resuscitation of SARS-CoV-2 - infected patients. Conclusions: The information gathered is a preliminary approach to the situation arising in Colombia as a result of the pandemic; it is clear that anesthesiologists perceive higher associated lack of safety due to different factors such as higher risk of infection, shortage of PPEs and burnout, inter alia. Hence we believe that it is fundamental to acknowledge the work of all anesthesiologists and understand the impact that the pandemic has had on this group of professionals.

Resumen Introducción: El ejercicio de la anestesiología durante la pandemia por COVID-i9/SARS-CoV-2 ha tenido un impacto psicológico y ha estado asociado a dilemas éticos, aumento en la sobrecarga y riesgo laboral. Objetivo: Comprender distintos problemas en los que se han visto envueltos los médicos anestesiólogos, en especial los relacionados con su ética profesional en el proceso de tomar decisiones, el aumento en la carga personal y el posible riesgo de su seguridad y salud como consecuencia de su labor durante la pandemia por COVID-19. Métodos: Estudio observacional, descriptivo, de corte transversal. Por medio de una encuesta, aplicada a anestesiólogos afiliados a la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), se indagó acerca de jornadas laborales, seguridad laboral, normas y estrategias de prevención, y aspectos éticos vinculados con la toma de decisiones durante la pandemia por COVID-19. Resultados: Participaron 218 anestesiólogos. La mayoría de los encuestados consideró que no hubo aumento significativo en su carga laboral, excepto aquellos que ejercen en cuidado crítico (42,5 %; n = 17). La mayoría de los participantes consideran que el tiempo de descanso no es suficiente. Un 55,96 % (n = 122) de los participantes, refieren sentirse moderadamente seguros con las medidas de bioseguridad, pero con un mayor riesgo de contagio frente a otros profesionales, con un 72,9 % (n = 159) y manifestaron haber invertido de sus propios recursos para la adquisición de elementos de protección personal (EPP). Así mismo, se evidenció que una cuarta parte de los entrevistados se ha enfrentado a dilemas éticos durante la reanimación de pacientes infectados por SARS-CoV-2. Conclusiones: La información obtenida hace un acercamiento inicial a la problemática generada en Colombia por la pandemia, donde es evidente que los anestesiólogos perciben una mayor inseguridad asociada, debido a diversos factores como mayor riesgo de infección, insuficiencia de EPP y burnout, entre otros. Por ende, creemos que es fundamental reconocer el trabajo de todos los anestesiólogos, y comprender el impacto que la pandemia ha tenido en estos profesionales.

Cobertura radicular con el procedimiento de colgajo de avance coronal en combinación con injerto de tejido conectivo autólogo: Revisión bibliográfica y reporte de caso

l procedimiento de cobertura radicular para tratar recesiones gingivales es el tratamiento ideal según la literatura actualizada, siendo más utilizado el colgajo de avance coronal con diferentes resultados clínicos y estéticos que ponen en duda si realizar este procedimiento sumando a un injerto de tejido conectivo se van a obtener resultados más predecibles y más estéticos en cuanto a la eliminación del defecto. En este reporte un paciente de 24 años de edad, masculino, refiere hipersensibilidad y disconformidad estética en la zona de la recesión gingival. En este caso se utilizará el cubrimiento radicular con colgajo de avance coronal más injerto de tejido conectivo autólogo. A los seis meses de sanado el paciente refiere mejoras en cuanto a: sensibilidad, control de placa y estética.

he root coverage procedure to treat gingival recessions is the best line of treatment, being the most used the coronal advanced flap. There have been multiple clinical and aesthetic results that cast doubt on whether this procedure by adding a connective tissue graft will be a more predictable and more aesthetic regarding defect removal. In this case report a patient 24-year-old male refers hypersensitivity and aesthetic discomfort in the area of gingival recession. An autologous graft with a coronal flap advancement of connective tissue will be used. After six months of healing the patient reports improvements in: sensitivity, plaque control and aesthetics.

Anestesia en embarazada para traqueostomía urgente por hemangioma sangrante en lengua / Anesthesia for emergency tracheostomy due to bleeding hemangioma of the tongue in a pregnant patient

Paciente embarazada de 20 años de edad con diagnóstico de hemangioma cavernoso en lengua, labios y cuello, con sangrado activo. Fue programada para traqueostomía de emergencia bajo anestesia general. La inducción anestésica fue planeada con intubación despierta con fibrobroncoscopio acorde a los algoritmos de vía aérea difícil de ASA, siendo la vía aérea manejada con tubo endotraqueal número 5,5 Fr bajo infusión de remifentanilo a 0,02-0,05 µg/kg/min para sedación y se aplicó anestesia local en la vía aérea superior para disminuir el dolor y el reflejo nauseoso, mientras respiraba espontáneamente. La intubación traqueal fue realizada exitosamente. Posterior a una hora de cirugía con 200 cc de pérdidas sanguíneas, la paciente fue trasladada a la sala de cuidados posoperatorios. Su vía aérea fue manejada con tubo número 7,5 Fr y se realizó traqueostomía sin lesionar el hemangioma en cuello. Posteriormente fue programada para embolectomía de los vasos del hemangioma y luego será programará para escisión quirúrgica. En este caso la intubación en paciente despierto con fibrobroncoscopia bajo infusión con remifentanilo fue segura y útil para el abordaje del paciente con hemangioma sangrante en vía aérea.

We present the case of a 20-year-old pregnant patient diagnosed with cavernous hemangioma in her tongue, lips and neck with active bleeding. An emergency tracheostomy under general anesthesia was scheduled. Anesthesia was planned for conscious intubation with a fibrobronchoscope suited for the difficult airway management ASA algorithms. The airway was managed with a number 5.5 Fr. endotracheal tube under 0.02-0.05µg/kg/min remifentanyl infusion. The patient was sedated and given local anesthesia in the upper airway to reduce pain and gag reflex during spontaneous breathing. Intubation was successful. Having a total blood loss of 200 cc, the patient was taken to the postoperative care room hour after surgery. The airway was managed with a tracheostomy procedure using a number 7.5 Fr tube and without damaging the hemangioma. She was then scheduled for a vessel embolectomy and surgical removal. In this case, conscious intubation with remifentanyl was safe and adequate for the approach of the patient with bleeding airway hemagioma.

The social organization of search and rescue : Evidence from the Guadalajara gasoline explosion

This research uses information from the Guadalajara gasoline explosion of 22 April, 1992, to show the importance of social organization in search and rescue activities. Information is obtained from forty three victims that had been buried alive by the explosion throughout the impact area, and twenty two volunteers who had participated in the direct rescue phase. They reported on their own experience during SAR and the experience of victims and rescued by these volunteers. Volunteers social identies in peer groups, extended families, the neighborhood, and the Catholic Church structured their search and rescue activities. Chances of people surviving the blast were directly proportional to the presence among the searchers of a person or persons who cared for the victim and who knew the victim's likely location. The behavior of the victims was market by the continuation of preexisting motivational, normative, and value orientations. Victims acted cooperatively during entrapment. Most of the victims that were rescued alive were rescued during the first two hours inmediately after the explosion. The article concludes with the implication of the study for collective behavior and disaster research and planning (AU)