Eficacia y seguridad de la mascarilla laríngea Protector (R) en procedimientos respiratorios invasivos / Efficacy and safety of the Protector (R) laryngeal mask in invasive respiratory procedures

Objetivos: Las pruebas respiratorias invasivas pueden ser realizadas bajo sedación profunda o preferentemente bajo anestesia general para facilitar su rea- lización y evitar complicaciones. Dichas pruebas requieren del manejo compartido de la vía aérea junto al neumólogo, por lo que tubos endotraqueales de gran calibre será necesarios para garantizar la ventilación. Una alternativa a la intubación sería la colocación de una mascarilla laríngea (ML). Pocos estudios recogen la realización de dichas pruebas con ML y no existe ningún estudio en el que se haya realizado con la ML Protector®. Esta ML presenta un gran canal calibre interno y la suficiente flexibilidad para poder realizarla reduciendo los riesgos de intubación. El objetivo de este estudio es demostrar la seguridad de la mascarilla laríngea Protector® para la realización de pruebas respiratorias invasivas.Metodología: Se reclutaron 55 pacientes consecutivos que fueron sometidos a pruebas respiratorias invasivas con la mascarilla laríngea Protector®. Resultados: La tasa de éxito con la ML Protector® ha sido del 92 % sin presentar complicaciones. La ventilación es garantizada con menores presiones pico que con un tubo endotraqueal, ningún paciente ha referido dolor de garganta y todos los pacientes fueron dados de alta como máximo a las 4 horas tras el procedimiento.Conclusiones: La realización de pruebas respiratorias invasivas con ML Protector® es seguro reduciendo las complicaciones asociadas a intubaciones con tubos de gran calibre y reduciendo las presiones para asegurar su ventilación. (AU)

Objective: Invasive respiratory tests can be performed under deep sedation or preferably under general anesthesia to facilitate their performance and avoid complications. These procedures require shared management of the airway with the pulmonologist, so large-caliber endotracheal tubes will be necessary to guarantee ventilation. An alternative to intubation would be the placement of a laryngeal mask. Few studies record the performance of such tests with LM and there are no studies in which it has been performed with LM Protector®. This LM presents a large internal caliber canal and sufficient flexibility to perform it, reducing the risks of intubation. The objective of this study is to demonstrate the safety of the Protector® laryngeal mask for invasive respiratory procedures. Method: Fifty-five consecutive patients who underwent invasive respiratory procedures with the Protector® laryngeal mask were recruited.Results: The success rate with the LM Protector has been 92 % without complications. Ventilation is guaranteed with lower peak pressures, no patient has reported a sore throat and all patients were discharged at most 4 hours after the procedure.Conclusions: Performing ventilatory respiratory procedures with LM Protector® is safe, reducing the complications associated with large-caliber tubes intubation. (AU)

Chemotherapy-induced emesis: management of early and delayed emesis in milder emetogenic regimens.

The objective of the present study was to examine the problem of the control of nausea and vomiting induced by non-cisplatin containing cyclophosphamide-based chemotherapy regimens in breast cancer patients. This was randomized, double-blind, parallel-group and placebo-controlled study comparing the efficacy of three antiemetic therapeutic regimens (ondansetron for 3 days, ondasetron plus metoclopramide, and ondansetron given in a single dose) in breast cancer patients receiving cyclophosphamide-based chemotherapy regimens on an outpatient basis. Both the primary and the secondary efficacy were measured. The primary efficacy variable was the number of emetic episodes (considering early and delayed emesis). The secondary efficacy variable measured was the quality of life. Two-by-two tables using the chi-square test and relative-risk concept were elaborated for statistical analysis. There was no difference between high-dose ondansetron and ondansetron plus metoclopramide among patients given CMF (cyclophosphamide, methotrexate, 5-fluorouracil). The single-dose ondansetron regimen showed the worst results. In patients given an FEC regimen (cyclophosphamide, epirubicin, 5-fluorouracil) the antiemetic efficacy was best for the high-dose ondansetron regimen, followed by the ondansetron plus metoclopramide regimen, and was worst for single-dose ondansetron administration. Despite the use of different antiemetic schedules, nausea and emesis are significant problems in patients receiving cyclophosphamide-based chemotherapy. Their adequate control should be the aim of any antiemetic approach.