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.

Propiedades tecnológicas y compuestos volátiles del charqui andino de alpaca (Vicugna pacos) recién elaborado y después de cinco meses de almacenamiento / Technological quality traits and volatile compounds of Andean alpaca (Vicugna pacos) charqui freshly prepared and after five months of storage

Se han determinado los valores de diversos parámetros de interés tecnológico (pH, capacidad de retención de agua, rendimiento, color, estabilidad oxidativa), así como el contenido de compuestos volátiles en el espacio de cabeza en el charqui andino de alpaca recién elaborado y el producto después de 5 meses de almacenamiento a 15 ºC, protegido con película impermeable al vapor de agua y de alta permeabilidad al oxígeno. Para el estudio se utilizaron 30 muestras de charqui de pierna de alpaca deshilachado procedente de 30 elaboradores de la región de Puno en Perú. Después del almacenamiento se observaron incrementos significativos en las pérdidas de sólidos durante la hidratación, el pH, las sustancias reactivas al ácido tiobarbitúrico y el color, respecto al producto recién elaborado. También se observó una disminución en el contenido en compuestos volátiles en el espacio de cabeza, que podría afectar de forma notoria al sabor del charqui (AU)

Selected technological quality traits (pH, water holding capacity, yield, colour and oxidative stability), and headspace volatile compounds in alpaca Andean charqui have been assessed. The determinations were carried out in both, fresh charqui and stored charqui (for 5 months at 15 ºC, packaged with a moisture impermeable and high oxygen permeability film). A total of thirty shredded charqui samples made from alpaca legs elaborated by thirty different producers from the Puno region in Peru were analysed. Stored charqui showed significantly higher values if total solids losses during hydration, pH, thiobarbituric acid substances and colour parameters than the fresh charqui. In addition, a decrease in most of the volatile compounds of headspace was detected after storage, which could be responsible for flavour time-related changes (AU)

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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Colecistitis enfisematosa debida a clostridium perfringens / No disponible

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[Supreme laryngeal mask airway vs the I-gel supraglottic airway in patients under general anesthesia and mechanical ventilation with no neuromuscular block: a randomized clinical trial]. / Estudio comparativo entre las mascarillas laríngeas Supreme e I-gel en pacientes con anestesia general sin bloqueo neuromuscular, con ventilación mecánica.

OBJECTIVE: The Supreme Laryngeal Mask Airway (SLMA) and the I-gel Supraglottic Airway (IGSA) are recently introduced devices incorporating a gastric channel. This study assessed the ease of insertion of the devices and their efficacy in mechanical ventilation. MATERIAL AND METHODS: Eighty-five patients undergoing major outpatient surgery under general anesthesia were randomized to 2 groups for intubation using the SLMA or the IGSA. After induction of general anesthesia, the assigned mask was inserted and positioning was checked with a fiberoptic scope. Ease of insertion was evaluated. Seal pressure was measured and the following ventilatory parameters were recorded 10, 30, and 60 minutes after the start of surgery: peak pressure, mean pressure, compliance, and the ratio of tidal volume to respiratory frequency. Conditions at the moment of inserting the nasogastric tube were also noted. RESULTS: First-attempt placement of the airway was possible in 95.2% of patients using the SLMA and in 86% using the IGSA (P = .147). The mean times required for placement were 27.1 seconds for the SLMA and 32.5 seconds for the IGSA (P = .195). The nasogastric tube was inserted on the first attempt in 97.6% of patients with an SLMA and in 85.7% of patients with an IGSA. The mean times required for tube insertion were 9.5 seconds through the SLMA and 22.1 seconds through the IGSA (P < .001). Seal pressure and compliance were similar in the 2 groups at the start of surgery and at 10, 30, and 60 minutes. The incidences of complications during surgery and at 90 minutes were likewise similar (P = .945 and P = .698, respectively). CONCLUSIONS: The SLMA and the IGSA are easy to put into position on the first attempt. It is easier to insert the nasogastric tube through the gastric channel of the SLMA. Both devices provide an effective seal and the incidences of complications were similar for both in the patients we studied.

Estudio comparativo entre las mascarillas laríngeas Supreme® e I-gel® en pacientes con anestesia general sin bloqueo neuromuscular, con ventilación mecánica / Supreme Laryngeal Mask Airway vs the I-gel Supraglottic Airway in patients under general anesthesia and mechanical ventilation with no neuromuscular block: a randomized clinical trial

OBJETIVO: La mascarilla laríngea Supreme(R) y la mascarillaI-gel(R) son dos dispositivos supraglóticos de recienteaparición que incorporan un canal de acceso gástrico.En este estudio valoramos la facilidad de inserción deldispositivo, así como la eficacia de ambos en ventilaciónmecánica controlada. MATERIAL Y MÉTODOS: Estudio prospectivo de 85pacientes intervenidos en cirugía mayor ambulatoriacon anestesia general. Se asignaron aleatoriamente a dosgrupos, grupo LMA-S pacientes a los que se coloca mascarillalaríngea Supreme(R) y grupo I-gel(R) pacientes a losque se colocó la mascarilla laríngea I-gel(R). Tras la inducciónde anestesia general se colocó la mascarilla asignaday se comprobó la posición con un fibrobroncoscopio.Se valoró la facilidad de inserción. Se midió la presión desellado y los siguientes parámetros ventilatorios: presiónpico (Pp), presión media (Pm), complianza, volumencorriente y frecuencia respiratoria (VT/FR) al inicio, y alos 10, 30 y 60 minutos de iniciada la intervención. Secomprobó asimismo las condiciones del paso de una sondanasogástrica.RESULTADOS: La LMA-S se colocó al primer intento en el95,2% de los pacientes, frente a 86% de los casos con I-gel(R) (p = 0,147). El tiempo medio de colocación fue de 27,1segundos con la mascarilla laríngea Supreme(R) frente a 32,5 segundos en el caso de la I-gel(R) (p = 0,195). La colocaciónal primer intento de la sonda nasogástrica en el grupoLMA-S fue del 97,6% frente al 85,7% de I-gel(R). El tiempomedio de colocación de la sonda nasogástrica para el grupoLMA-S fue de 9,5 segundos y de 22,1 segundos para elgrupo I-gel(R) (p < 0,001). No se evidenciaron diferenciasentre ambas mascarillas para las variables presión de selladoy complianza al inicio, y a los 10, 30 y 60 minutos, nitampoco entre los efectos secundarios intraoperatorios(p = 0,945) y dichos efectos a los 90 minutos (p = 0,698) (AU)

OBJECTIVE: The Supreme Laryngeal Mask Airway(SLMA) and the I-gel Supraglottic Airway (IGSA) arerecently introduced devices incorporating a gastricchannel. This study assessed the ease of insertion of thedevices and their efficacy in mechanical ventilation.MATERIAL AND METHODS: Eighty-five patients undergoingmajor outpatient surgery under general anesthesiawere randomized to 2 groups for intubation usingthe SLMA or the IGSA. After induction of generalanesthesia, the assigned mask was inserted and positioningwas checked with a fiberoptic scope. Ease of insertionwas evaluated. Seal pressure was measured and thefollowing ventilatory parameters were recorded 10, 30,and 60 minutes after the start of surgery: peak pressure,mean pressure, compliance, and the ratio of tidalvolume to respiratory frequency. Conditions at themoment of inserting the nasogastric tube were alsonoted.RESULTS: First-attempt placement of the airway waspossible in 95.2% of patients using the SLMA and in 86%using the IGSA (P=.147). The mean times required forplacement were 27.1 seconds for the SLMA and 32.5seconds for the IGSA (P=.195). The nasogastric tube wasinserted on the first attempt in 97.6% of patients with anSLMA and in 85.7% of patients with an IGSA. The meantimes required for tube insertion were 9.5 secondsthrough the SLMA and 22.1 seconds through the IGSA(P<.001). Seal pressure and compliance were similar inthe 2 groups at the start of surgery and at 10, 30, and 60 minutes. The incidences of complications during surgeryand at 90 minutes were likewise similar (P=.945 and P=.698, respectively).CONCLUSIONS: The SLMA and the IGSA are easy to putinto position on the first attempt. It is easier to insert thenasogastric tube through the gastric channel of theSLMA. Both devices provide an effective seal and theincidences of complications were similar for both in thepatients we studied (AU)

La Atención Primaria en España. Análisis histórico y retos de futuro / Primary Health Care in Spain. Historic analysis and future challenge

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