Crisis epiléptica y cefalea tras infiltración epidural lumbar con corticoides / Epileptic crisis and headache after a lumbar epidural steroid injection

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Ictus isquémico tras el recambio de una nutrición parenteral en un paciente postoperado / Ischaemic stroke in a post-surgical patient after replacement of a parenteral nutrition bag

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Alteraciones electrocardiográficas por hernia paraesofágica gigante / Electrocardiographic changes due to a giant para-oesophageal hernia

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¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea? / Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis?

La amiloidosis comprende un grupo de trastornos que se distinguen por el depósito de agregados fibrilares de inmunoglobulinas monoclonales de cadenas ligeras en diversos órganos, entre ellos, la laringe. A continuación presentamos el caso de un varón de 78 años derivado a nuestro hospital para tratamiento quirúrgico de una hernia umbilical estrangulada. El paciente presentaba disfonía y disfagia de 5 meses de evolución debido a la presencia de una amiloidosis laríngea. Se decidió realizar la intubación con el paciente despierto, sedado con remifentanilo y midazolan, utilizando el videolaringoscopio King Vision®. Las lesiones hemorrágicas que pueden acontecer en estos pacientes son debidas al depósito de agregados fibrilares de amiloide, que causan una fragilidad vascular que aumenta el riesgo de hemorragia durante la intubación. Por eso es importante que el anestesiólogo realice un cuidadoso manejo de la vía aérea en pacientes con esta entidad (AU)

Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them. A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision® video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients (AU)

Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis? / ¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea?

Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them. A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision® video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients.

Uso del videolaringoscopio King Vision® en una vía aérea difícil no esperada por un quiste vallecular gigante en un adulto, a propósito de un caso / Use of King Vision® videolaryngoscope in an unanticipated difficult airway in an adult patient with giant vallecular cyst, a case report

Los quistes laríngeos suelen ser asintomáticos y normalmente son un hallazgo casual durante una exploración laríngea rutinaria. Estos quistes, en adultos son raros y pueden tener consecuencias catastróficas en el paciente anestesiado si el manejo de la vía aérea no es el adecuado. A continuación, se describe el caso de una intubación difícil y el manejo de la misma, en un paciente adulto con un quiste de vallécula gigante, asintomático que se descubrió durante la inducción de secuencia rápida de una anestesia general en cirugía de urgencia. En conclusión, los quistes de vallécula pueden dificultar el manejo de la vía aérea. Es importante evitar las complicaciones asociadas a los repetidos intentos de intubación que pueden provocar edema de la vía aérea, sangrado y rotura del quiste con la consiguiente aspiración de su contenido, siendo el videolaringoscopio King Vision® una buena alternativa en estos casos. La disponibilidad de un otorrinolaringólogo es fundamental (AU)

Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital (AU)

Videolaringoscopio King Vision®, ¿una alternativa en la intubación del paciente despierto? / Videolaryngoscope King Vision™, an alternative in the intubation of the awake patient?

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Uso del Clarus Video System® en una vía aérea difícil en paciente con síndrome de Rett / Use of Clarus Video System® in expected difficult airway in a patient with Rett syndrome

El manejo de la vía aérea continúa siendo uno de los puntos clave en nuestra especialidad, ya que la dificultad o imposibilidad para la intubación orotraqueal supone la principal causa de morbimortalidad atribuible a la anestesia. El síndrome de Rett es una grave enfermedad neurológica, incapacitante. Presentamos el caso de una joven de 21 años afecta de síndrome de Rett, con un retraso psicomotor importante, y con criterios de vía aérea difícil, propuesta para una colecistectomía laparoscópica bajo anestesia general. Decidimos utilizar el Clarus Video System® para la intubación de la paciente como primera opción, logrando llevarla a cabo. El uso de los dispositivos ópticos está ganando protagonismo y encontrando un lugar en los más recientes algoritmos de manejo de vía aérea difícil. Queremos resaltar el papel creciente que estos dispositivos juegan en el manejo de la vía aérea difícil, por lo que realizamos una revisión de su situación actual en el manejo de la vía aérea difícil prevista (AU)

Difficult airway management remains one of the key points in our specialty, as the difficulty or impossibility of tracheal intubation is the main cause of morbidity/mortality attributable to anaesthesia. Rett syndrome is a severe and incapacitating neurological disease. We present the case of a 21-year-old girl affected by this syndrome, with significant psychomotor retardation and difficult airway predictors, who was scheduled to have a laparoscopic cholecystectomy under general anaesthesia. We decided on one attempt of Clarus Video System® fiberoptic intubation as primary intervention. Intubation was successfully performed with the help of this optical stylet. The use of optical stylets is gaining prominence and finding a place in the latest algorithms of difficult airway management. We highlight the growing role these devices play in managing difficult airway, therefore we review the current situation of videolaryngoscopes in the management of the predicted difficult airway (AU)

Use of Clarus Video System® in expected difficult airway in a patient with Rett syndrome. / Uso del Clarus Video System® en una vía aérea difícil en paciente con síndrome de Rett.

Difficult airway management remains one of the key points in our specialty, as the difficulty or impossibility of tracheal intubation is the main cause of morbidity/mortality attributable to anaesthesia. Rett syndrome is a severe and incapacitating neurological disease. We present the case of a 21-year-old girl affected by this syndrome, with significant psychomotor retardation and difficult airway predictors, who was scheduled to have a laparoscopic cholecystectomy under general anaesthesia. We decided on one attempt of Clarus Video System® fiberoptic intubation as primary intervention. Intubation was successfully performed with the help of this optical stylet. The use of optical stylets is gaining prominence and finding a place in the latest algorithms of difficult airway management. We highlight the growing role these devices play in managing difficult airway, therefore we review the current situation of videolaryngoscopes in the management of the predicted difficult airway.

Use of King Vision® videolaryngoscope in an unanticipated difficult airway in an adult patient with giant vallecular cyst, a case report. / Uso del videolaringoscopio King Vision® en una vía aérea difícil no esperada por un quiste vallecular gigante en un adulto, a propósito de un caso.

Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital.

La otorragia. Una complicación de la hemicolectomía laparoscópica / Otorrhagia. A complication of laparoscopic hemicolectomy

El creciente y rápido avance de la tecnología quirúrgica en las últimas décadas ha permitido el desarrollo de la cirugía laparoscópica. La cirugía «mínimamente invasiva» se ha popularizado en los últimos años, y sus fronteras no solo se limitan a los procedimientos ginecológicos, sino que se ha extendido al campo de la cirugía general, la ortopedia, el tórax y la urología. La insuflación de gas en la cavidad peritoneal y la posición del paciente se acompañan de cambios fisiológicos y complicaciones que no se presentan en la cirugía abierta. Presentamos el caso de una paciente que tras hemicolectomía izquierda laparoscópica presentó otorragia bilateral postoperatoria. El neumoperitoneo y la posición de Trendelenburg a más de 35° provocan alteraciones hemodinámicas que condicionan un aumento de la presión arterial y de la presión venosa central. La vascularización del conducto auditivo externo sufre directamente estas modificaciones, pudiendo aparecer otorragia postoperatoria después de una cirugía laparoscópica prolongada (AU)

The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. «Minimally invasive» surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy (AU)

[Otorrhagia. A complication of laparoscopic hemicolectomy]. / La otorragia. Una complicación de la hemicolectomía laparoscópica.

The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. "Minimally invasive" surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy.

Intubación nasal con fibrobroncoscopio en paciente con bocio tiroideo gigante / Nasal intubation with fibre bronchoscopy in a patient with a very large thyroid goitre

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