End-tidal desflurane concentration for tracheal extubation in adults. / Concentración al final de la espiración de desflurano requerida para la extubación en el paciente adulto.

OBJECTIVE: To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults. MATERIAL AND METHODS: After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg-1, fentanyl 2µg.kg-1, and rocuronium 0.6mg.kg-1 for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25µg.kg-1.min1. Neuromuscular function was monitored with train-of-four (TOF) nerve stimulation and acceleromyography. At the end of the surgery neuromuscular blockade was reversed with sugammadex 2-4mg.kg-1 in accordance with the TOF ratio. The concentration of desflurane at which extubation was attempted was determined by using Dixon's up-and-down method with 0.5% as a step size. Smooth extubation was defined as one without coughing, teeth clenching, gross purposeful movements, and no breath-holding or laryngospasm within 1min of tracheal extubation. RESULTS: It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults. CONCLUSION: Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.

Estabilidad cardiovascular en la microcirugía laríngea y recuperación postoperatoria precoz: comparación entre remifentanilo-sevoflurano vs. remifentanilo-propofol / Cardiovascular and emergence characteristics between sevofluraneremifentanil and propofol-remifentanil in microlaryngeal surgery

Introducción: La microcirugía laríngea es un proceso de corta duración que se asocia con un importante estímulo adrenérgico y frecuentemente realizada en cirugía de día. Diferentes técnicas anestésicas han sido empleadas para el control hemodinámico. Sin embargo, ningún estudio previo ha comparado la eficacia de la combinación sevoflurano y remifentanilo frente a propofol y remifentanilo en el control de la respuesta hemodinámica y parámetros de recuperación. Material y métodos: 37 pacientes ASA I-III con edades comprendidas entre 23-77 años y programados para microcirugía laríngea fueron incluidos en el estudio. Los pacientes fueron randomizados en dos grupos: grupo S-R (sevoflurano y remifentanilo); grupo P-R (propofol y remifentanilo). La infusión de remifentanilo se ajustó para mantener los valores hemodinámicos alrededor de un 20 % de los valores basales (dosis de 0,2 a 0,6 µg/kg/min). Se registraron los parámetros hemodinámicos cada 3 minutos desde la inducción y durante la inserción del laringoscopio rígido. Se compararon los tiempos de extubación, de orientación y de dolor postoperatorio entre ambos grupos. Resultados: No hubo diferencias entre ambos grupos en los parámetros basales. No hubo diferencias entre ambos grupos en la evolución de los valores hemodinámicos tras la inducción y durante la inserción (..) (AU)

Introduction: Laryngeal microsurgery is a short procedure associated with a huge adrenergic response. Different anaesthetics techniques and drugs have been used to try blunting these haemodynamic changes. No previous investigation has directly compared the combination of sevoflurane and remifentanil with that propofol and remifentanil in laryngeal microsurgery. We aimed to compare the haemodynamic responses and emergence characteristics between this two anaesthetic combinations. Material and methods: 37 patients, ASA status I-III, age 23-77 years, scheduled for elective laryngeal microsurgery were included in the study. They were randomly allocated in two groups: Group S-R (sevoflurane-remifentanil) and group P-R (propofol-remifentanil). Remifentanil infusion was adjusted to maintain haemodynamic values around 20 % of baseline. (From 0.2-0.6 µg.kg-1.min-1). Haemodynamic data were measured every 3 minutes from induction and during insertion of the operating laryngoscope. Extubation times, orientation and pain after surgery were recorded. Results: There were no significant differences during baseline. The haemodynamic parameters were similar between the two groups at induction and during insertion of the operating laryngoscope. Thee were no differences in remifentanil requirements between both groups, and the extubation time was similar. More patients had an Aldrete score of 10 at five minutes after extubation in SR group vs. PR group (100 vs. 67 %, p = 0.018). In PACU a higher (..) (AU)

Mascarilla Laríngea Supreme en colecistectomía laparoscópica y cirugía de mama / Supreme laryngeal mask in laparoscopic cholecystectomy and breast surgery

Introducción: la Mascarilla Laríngea Supreme TM (MLS) es un dispositivo supraglótico desechable nuevo, provisto de canal gástrico y con características en el diseño del manguito que permiten presiones de sellado superior a las de la mascarilla laríngea clásica. El objetivo del presente estudio es valorar la eficacia de la MLS en dos procedimientos de cirugía ambulatoria: en la colecistectomía laparoscópica y en la cirugía de mama. Material y métodos: estudio prospectivo, observacional, realizado en 100 pacientes en régimen ambulatorio, programados para colecistectomía laparoscópica y de mama, bajo anestesia general y empleo de la MLS. El objetivo del estudio fue valorar la eficacia y seguridad de la MLS en ambos procedimientos. Resultados: de los 100 pacientes, 65 fueron intervenidos de colecistectomía laparoscópica y 35 de cirugía de mama. La inserción de la MLS fue posible en todos los pacientes y en un 86% de los casos en el primer intento. La presión de sellado media fue de 30,02 ± 1,92 cm de H2O. No se objetivaron efectos adversos durante la ventilación ni con los cambios de posición del paciente. No fue preciso cambiar la MLS por otro dispositivo y ningún paciente requirió intubación orotraqueal. Conclusiones: la MLS es un dispositivo seguro y eficaz en el manejo de la vía aérea en pacientes intervenidos de colecistectomía laparoscópica y cirugía de mama, en régimen ambulatorio (AU)

Introduction: supreme laryngeal mask (MLS) is a new disposable supraglottic device, and gastric channel provided with design features which allow the sleeve sealing pressures higher than those of the classic laryngeal mask. The aim of this study is to assess the effectiveness of the MLS in two ambulatory surgical procedures: in laparoscopic cholecystectomy and breast surgery. Material and methods: prospective, observational study conducted in 100 patients undergoing ambulatory surgery, scheduled laparoscopy cholecystectomy and breast surgery, under general anesthesia with laryngeal mask. The aim of the present study was to evaluate the effectiveness and safety of the MLS in both procedures. Results: one hundred patients were included in the study, laparoscopic cholecystectomy (N = 65) and breast surgery (N = 35). In all patients the insertion of the LMS was accomplished and was inserted at the first attempt in 86% of cases. The average airway sealing pressure was 30.02 ± 1.92 cm H2O. No adverse effects were observed during ventilation or with changes in patient position. There was no need to change the MLS by another device and no patient required intubation. Conclusions: the MLS its safe and effective supraglottic device in the management of the airway in outpatient scheduled laparoscopic cholecystectomy and breast surgery (AU)