A Comparison of the Asleep-Awake Technique and Monitored Anesthesia Care During Awake Craniotomy: A 10-Year Analysis.

Background Awake intracranial surgery with direct electrical stimulation (DES) is considered the gold standard for the resection of tumors affecting the eloquent areas of the brain. Awake craniotomy is a challenge for the anesthesiologist, as the patient's active cooperation is required throughout the operation. There are two frequent techniques, one is asleep-awake-asleep (AAA), and the other is called monitored anesthesia care (MAC). The AAA technique is the longer standing of the two and comprises general anesthesia followed by intraoperative awakening, which is necessary for neurological monitoring. In the present study, a comparison was made between the asleep-awake (AA) technique, a variation of the AAA anesthesia technique, and the MAC, which consists of a sedation that makes it possible to control pain and anxiety. Unlike the AA technique, the MAC does not involve the use of invasive airway devices. Objective The main objective was to contrast the two anesthetic management techniques for awake brain surgery used in our hospital. Methods A retrospective observational single-center study was performed consisting of a review of patient clinical records. The study sample comprised all patients above 18 years of age undergoing brain surgery through awake craniotomy between January 2013 and December 2022 at the Miguel Servet University Hospital (HUMS) in Zaragoza (Spain). Results Of the 79 patients included in the study, 39 were operated under AA anesthesia while the remaining 40 were operated under the MAC procedure. The main age of the participants was 52.8 years, the mean height was 169 cm, and the mean weight was 74.2 kg. No statistically significant differences were observed with respect to the patients' baseline characteristics, except for obesity which was more prevalent in the MAC group. In the MAC group, the airway was managed by means of nasal cannulas in all cases, with conversion to general anesthesia being required in only one instance. In the AA group, the laryngeal mask (LM) was used in 89.7% of the patients, and the endotracheal tube (ETT) in 10.3%. The surgical and anesthetic procedure duration was 15 and 20 minutes shorter in the MAC group, respectively. A reduction of almost 20 minutes in the anesthetic procedure and 15 minutes in the surgical one was observed. Tachycardia, desaturation, and airway complications were observed in four, five, and four patients respectively in the AA group but in none of the patients in the MAC group. The mean stay in the intensive care unit (ICU) and the mean postoperative hemoglobin levels between both groups were insignificant. Conclusions Both techniques analyzed in this study turned out to be equally safe and effective for brain tumor surgery in awake patients.

Relación entre la autoeficacia percibida en primíparas y la visita guiada al paritorio / Relationship between the self-efficacy perceived in first-time mother and the guided visit to the delivery room

INTRODUCCIÓN: El parto es considerado uno de los acontecimientos más importantes en la vida de la mujer. Una adecuada información ayuda a disminuir su ansiedad, miedo e incertidumbre y favorece una vivencia más satisfactoria del embarazo y orientación hacia el parto normal. OBJETIVO: Evaluar la relación entre el nivel de autoeficacia percibida en primíparas y la realización de la visita guiada al paritorio. METODOLOGÍA: Se seleccionaron 150 primíparas, las cuales se dividieron en "caso", aquellas que asistieron a la visita guiada al paritorio del hospital, y en "control", aquellas que no asistieron a dicha actividad. RESULTADOS: No se encontraron resultados estadísticamente significativos entre ambos grupos que demostrasen una mayor autoeficacia en el grupo expuesto a la visita frente al no expuesto. El grupo control demostró tener mayores conductas de evitación para afrontar el momento del parto. CONCLUSIONES: La visita guiada al paritorio no influye significativamente en la autoeficacia percibida en la vivencia del parto, pero el grado de satisfacción es ligeramente superior en las mujeres que acudieron a la visita guiada que en las que no acudieron

INTRODUCTION: Childbirth is one of the most important event in a woman's life. Adequate information helps to reduce anxiety, fear, and uncertainty and favours a more satisfactory pregnancy experience and orientation towards normal delivery. OBJECTIVE: To evaluate the relationship between the level of self-efficacy perceived in primiparas and the conduct of the guided visit to the delivery room. METHODOLOGY: 150 primiparas were selected, which were divided into "cases", those who attended the guided visit to the hospital ward, and in "control", those who did not attend said activity. OUTCOMES: No statistically significant results were found between both groups that showed a higher self-efficacy in the group exposed to the visit compared to the non-exposed group. The control group showed greater avoidance behaviours to cope with the time of delivery. CONCLUSIONS: The guided visit to the delivery room does not significantly influence the self-efficacy perceived in the experience of the delivery, but the degree of satisfaction is slightly higher in the women who attended the guided tour than those who did not attend

Dispositivo supraglóticos. Estado de la cuestión / Supraglotic devices. State of the art

Introducción. Los dispositivos supraglóticos (DSG) se diseñaron para facilitar la intubación endotraqueal (IET), pueden insertarse correctamente con menor grado de formación y ofrecen una gran tasa de éxito de inserción al primer intento. Objetivo. Nombrar los DSG más utilizados en España, describir sus características principales, ventajas e inconvenientes y detallar su técnica de inserción. Metodología. Se analizaron los 30 trabajos más relevantes obtenidos en la búsqueda de la literatura biomédica realizada en las bases de datos PubMed, The Cochrane Library, Web of Science y Scopus. De los 30 trabajos consultados había un caso clínico, tres revisiones sistemáticas, tres guías clínicas, tres artículos de revisión, cinco metaanálisis, siete artículos originales y ocho ensayos clínicos aleatorizados. Resultados. La mascarilla laríngea (ML) no produce cambios hemodinámicos importantes durante su colocación y retirada. Para insertar la ML Fastrach(R) no es necesario movilizar la cabeza del paciente y se puede colocar con una sola mano desde cualquier posición. La ML Supreme(R) produce menor riesgo de desarrollar ronquera, tos y laringoespasmo durante el despertar de una anestesia general en comparación con el tubo endotraqueal. La ML I-Gel(R) permite la IET a través suyo y cuenta con un canal gástrico para la introducción de una sonda nasogástrica. Conclusiones. Los DSG constituyen un método seguro y efectivo en el manejo de la vía aérea en diferentes situaciones. Las enfermeras que han recibido una hora de formación son capaces de utilizar los DSG con altas probabilidades de éxito al primer intento (AU)

Introduction. Supraglottic devices (SGD), designed to facilitate endotracheal intubation (EIT), can be correctly inserted with less training and offer a high rate of success on the first try of insertion. Objective. Name the most frequently SGD used in Spain, describe their main characteristics, advantages and disadvantages, and detail their technique of insertion. Methodology. The 30 most relevant papers obtained after a biomedical literature search using PubMed, The Cochrane Library, Web of Science and Scopus databases, were analyzed. Among the 30 texts consulted, there was one clinical case, three systematic reviews, three clinical guidelines, three literature review articles, five meta-analyses, seven original articles and eight randomized clinical trials. Results. The laryngeal mask airway (LMA) does not produce significant hemodynamic changes during its placement and removal. To insert LMA Fastrach(R) it’s not necessary to mobilize the patient's head and it can be placed using one hand from any position. The ML Supreme(R) produces lower risk of hoarseness, cough and laryngospasm during the awakening from general anesthesia compared to the endotracheal tube. ML I-Gel(R) allows for EIT and has a gastric channel for the introduction of a nasogastric tube. Conclusions. SGD are a safe and effective method of airway management in different situations. Nurses receiving one hour of training are able to use SGD with high success probabilities on the first try (AU)