Airway management of COVID-19 patients: A survey on the experience of 1125 physicians in Spain.

BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists. The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision. Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and healthcare workers. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

[Airway management of COVID-19 patients: a survey on the experience of 1125 physicians in Spain]. / Manejo de vía aérea en pacientes COVID-19: una encuesta sobre la experiencia de 1125 médicos en España.

BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists.The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision.Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and physicians. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19 / Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por 3 Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse, y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados postoperatorios

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Hipertensión arterial en el paciente quirúrgico. Adecuación de la medicación y criterios de suspensión / Arterial hypertension in the surgical patient. Medication adequacy and suspension criteria

La hipertensión arterial (HTA) es un factor de riesgo modificable para las enfermedades cardiovasculares, que puede tener un impacto en las complicaciones perioperatorias, en función del daño orgánico que sufre el paciente. El manejo perioperatorio del tratamiento farmacológico de la hipertensión arterial es un pilar fundamental en la valoración preanestésica previa a cualquier intervención. No parece razonable retrasar la cirugía únicamente por valores de la presión arterial (PA), aunque en pacientes con PA > 180/110mmHg la decisión de realizar una intervención quirúrgica electiva debe ser valorada cuidadosamente

Arterial hypertension (AHT) is a modifiable risk factor for cardiovascular diseases, which may have an impact on perioperative complications, depending on the organ damage suffered by the patient. The perioperative management of treatment of arterial hypertension, is a mainstay in the preoperative assesment prior to any intervention. It doesn't seem reasonable to delay surgery solely due to blood pressure values, although for patients with BP > 180/110mmHg, the decision to perform scheduled surgeries should be carefully assessed

Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico / Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement

El síndrome de vena cava superior (SVCS) resulta de la obstrucción de la vena cava superior, que origina una disminución del retorno venoso procedente de cabeza, cuello y extremidades superiores. Aunque la causa más frecuente siguen siendo procesos tumorales malignos, en los últimos años hemos visto un aumento de causas no tumorales, como trombosis de dispositivos intravasculares permanentes o causas iatrogénicas durante la cirugía cardiaca. Presentamos un caso de SVCS tras cirugía cardiaca tratado de forma satisfactoria mediante técnica endovascular y anticoagulación sistémica

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation

Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial / Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation

La trombosis intracardíaca es una complicación poco frecuente en los pacientes que reciben asistencia hemodinámica mediante una membrana de oxigenación extracorpórea venoarterial (ECMO-VA), pero conlleva una elevada mortalidad. Este caso clínico describe un paciente que tuvo un shock cardiogénico tras un infarto agudo de miocardio con elevación del ST (IAMCEST) y que presentó trombosis intracardíaca durante la asistencia con ECMO-VA en 2 ocasiones: la primera en relación con la colocación de una prótesis mitral mecánica y la segunda tras el recambio por una prótesis mitral biológica

Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve

Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement. / Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico.

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation.

Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation. / Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial.

Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve.

Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia / Survey on the practice of anaesthesiologists in inguinal hernia surgery in Galicia

Objetivos: Evaluar la preferencia en la técnica anestésica de los anestesiólogos para el manejo de la cirugía de hernia inguinal en Galicia. Material y métodos: A partir del Catálogo Nacional de Hospitales del Ministerio de Sanidad y Consumo, en Galicia, se remitió a los jefes de servicio de Anestesiología y coordinadores de las unidades de Cirugía Mayor Ambulatoria (CMA) una encuesta con 11 preguntas sobre la técnica anestésica elegida por los anestesiólogos en el manejo de los pacientes para cirugía de hernia inguinal, así como sus motivos. Resultados: La encuesta se envió a 11 hospitales: 8 con unidades de CMA y 3 comarcales. Contestaron 94 profesionales, un 56% con más de 10años de experiencia, que realizaban entre 8-10 procedimientos/mes (58%) en régimen ambulatorio (61,54%). La técnica anestésica más empleada fue la intradural en un 52,8%, frente a un 41,8% de la anestesia general. Los encuestados con más de 10años de experiencia prefirieron la anestesia raquídea en un 38,6% de los casos frente a los de menor experiencia (6,8%) (p=0,037). Uno de cada 4 que eligieron la anestesia general empleó bloqueos interfasciales guiados por ultrasonidos (27,5%). El anestésico local más empleado en la anestesia intradural fue la bupivacaína hiperbara (70,8%) a dosis superiores a 7mg. Conclusión: La anestesia intradural con bupivacaína hiperbara representó la técnica más elegida por los anestesiólogos para el manejo de la cirugía de hernia inguinal. Las técnicas anestésicas escogidas entre los diferentes hospitales no siguieron una distribución homogénea. En la encuesta presentada se mostró una tendencia a la elección de la técnica asociada a la experiencia del anestesiólogo

Objectives: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. Material and methods: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. Results: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. Conclusion: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist

Sedaciones: seguridad, competencia, eficiencia / Sedations: Safety, competency, efficiency

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Análisis prospectivo de las complicaciones, eficacia y grado de satisfacción en la sedación realizada por anestesiólogos en endoscopia digestiva / Prospective analysis of the complications, efficacy, and satisfaction level on the sedation performed by anaesthetists in gastrointestinal endoscopy

Objetivo: Describir las complicaciones que aparecen durante la anestesia/sedación en el ámbito de la endoscopia digestiva, comparando también procedimientos programados frente a urgentes. Métodos: Se diseñó un protocolo de pacientes y pruebas en los que siempre debe estar presente un anestesiólogo. Estos incluyen a pacientes ASA 3 y 4, pruebas complejas como polipectomías, colangiopancreatografía retrógrada endoscópica o ecoendoscopia, necesidad de sedación profunda o alteraciones anatómicas que dificulten el manejo de la vía aérea. Se analizó la seguridad con base a las complicaciones que se recogen a partir de los datos recogidos de forma automática directamente desde los monitores, tanto durante la sedación como en la unidad de recuperación. Se analizan los factores de riesgo asociados a las complicaciones cardiorrespiratorias, la eficacia en función de las pruebas completadas y el grado de satisfacción global a través de una entrevista empleando una escala de satisfacción. Resultados: Se estudió a 3.746 pacientes durante 7 años. La incidencia de complicaciones importantes durante la prueba fue baja, destacando las complicaciones hemodinámicas y respiratorias. Así encontramos una incidencia de hipoxemia del 3% en endoscopia programada frente al 5,7% en pruebas urgentes (p <0,05). También la hipotensión presenta diferencias significativas entre la sedación programada y urgente (6,4% vs. 18,8%, p <0,001). En nuestro estudio, no se ha suspendido ninguna prueba por mala tolerancia del paciente, y el grado de satisfacción es alto en más del 99% de los casos. Conclusión: La participación del anestesiólogo en la sedación para endoscopia digestiva ha demostrado en este estudio excelentes resultados en cuanto a seguridad y eficacia, principalmente en los pacientes más graves y pruebas complejas, y un alto grado de satisfacción

Objective: To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. Methods: A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. Results: The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. Conclusion: The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction

Survey on the practice of anaesthesiologists in inguinal hernia surgery in Galicia. / Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia.

OBJECTIVES: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. MATERIAL AND METHODS: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. RESULTS: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. CONCLUSION: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist.

Prospective analysis of the complications, efficacy, and satisfaction level on the sedation performed by anaesthetists in gastrointestinal endoscopy. / Análisis prospectivo de las complicaciones, eficacia y grado de satisfacción en la sedación realizada por anestesiólogos en endoscopia digestiva.

OBJECTIVE: To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. METHODS: A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. RESULTS: The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. CONCLUSION: The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction.

Calidad y seguridad del paciente en el código ictus, en el ámbito neurointervencionista / Quality and safety in endovascular therapy for acute ischemic stroke

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Hemotórax masivo derecho por rotura espontánea idiopática de una arteria frénica tras cirugía cardiaca / Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery

Presentamos el caso de un hombre de 35 años que en el postoperatorio de cirugía cardiaca presenta un hemotórax masivo y shock hipovolémico por rotura espontánea de una arteria frénica. Un rápido diagnóstico y una inmediata intervención son cruciales para el manejo del paciente

We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery, from spontaneous rupture of a phrenic artery. A quick diagnosis and immediate intervention is crucial to manage the patient