Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo / Results of a surgical cricothyrotomy workshop with a pig trachea model

Introducción: Las últimas guías de la Difficult Airway Society recomiendan que todos los anestesiólogos deberían estar entrenados para la realización de una cricotiroidotomía quirúrgica (CtQ). El objetivo de este estudio es analizar los resultados de aprendizaje de un taller de CtQ mediante la evaluación de la tasa de éxito y el tiempo necesario para realizarla en un modelo de tráquea porcina. Material y métodos: Diseñamos un taller en el que cada alumno respondía un cuestionario con datos demográficos y conocimientos teóricos sobre el abordaje quirúrgico de la vía aérea. Durante la hora siguiente se revisaron aspectos teóricos. Se mostró el modelo y realizamos una CtQ siguiendo la técnica clásica. Después, en grupos de 3-4 alumnos con un instructor, los alumnos realizaron 6 CtQ cada uno. Registramos si la ventilación era correcta, el tiempo necesario para realizarla y la facilidad de realización evaluada por alumno e instructor. Finalmente, los alumnos respondieron un cuestionario de aspectos teóricos. Realizamos un análisis estadístico, considerando estadísticamente significativo un valor de p<0,05. Resultados: Llevamos a cabo 8 ediciones del taller, con 91 alumnos. Consiguieron hacer la CtQ y ventilar correctamente el 86% en el primer intento y el 92% en el sexto (p<0,0001). El tiempo necesario para hacer una CtQ pasó de 163 [107-211] a 70 [55-85] segundos (p<0,0001). Al final del taller los alumnos habían mejorado sus conocimientos teóricos (p<0,0001) y la percepción de facilidad de la técnica. Conclusión: El taller realizado mejora los conocimientos teóricos y la competencia en la realización de una CtQ

Background: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. Material and methods: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. Results: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. Conclusion: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy

Results of a surgical cricothyrotomy workshop with a pig trachea model. / Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo.

BACKGROUND: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. MATERIAL AND METHODS: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. RESULTS: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. CONCLUSION: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy.

Evaluación del videolaringoscopio TruviewPCD para la intubación de niños / Assessment of TruviewPCD videolaryngoscope for intubation in children

Objetivo. El objetivo de este estudio observacional y prospectivo fue evaluar la utilidad de TruviewPCD para la intubación pediátrica en la práctica clínica y generar datos para nuevos estudios. Material y método. Incluimos 86 niños consecutivos intervenidos de cirugía otorrinolaringológica, pediátrica o ambas, bajo anestesia general con intubación orotraqueal. Los niños que presentaban 2 o más criterios de dificultad para el manejo de la vía aérea se excluyeron del estudio. Realizamos análisis estadístico descriptivo. Resultados. Ochenta y tres pacientes se intubaron con TruviewPCD. Datos demográficos: edad 4,9 (2,8) años, peso 19,5 (7,7)kg. Setenta y nueve niños se intubaron en el primer intento y 4 en 2 intentos. El tiempo necesario para obtener la mejor visión glótica posible fue (media y desviación estándar) 10,8 (5,6)seg y el tiempo de intubación total (mediana y distancia intercuartil 25-75%) fue de 30 (27,9-37)seg. La intubación fue catalogada como fácil o muy fácil en 81 pacientes. No se registró ninguna complicación importante. Conclusiones. Concluimos que TruviewPCD es un buen dispositivo para el manejo de la vía pediátrica. Sería interesante disponer de un tamaño de pala intermedio, entre la 1 y la 2, ya que hay una diferencia considerable de tamaño entre ambas (AU)

Objective. The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. Material and method. A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. Results. Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. Conclusions. TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide (AU)

Assessment of TruviewPCD videolaryngoscope for intubation in children. / Evaluación del videolaringoscopio TruviewPCD para la intubación de niños.

OBJECTIVE: The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. MATERIAL AND METHOD: A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. RESULTS: Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. CONCLUSIONS: TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide.

Estudio clínico de la eficacia del «agua de 3 sulfatos» en la balanitis y la balanopostitis / Clinical study of the effectiveness of the «water of the 3 sulfates» on balanitis and balanoposthitis

Objetivos: La utilización del «agua de 3 sulfatos» (sulfato de cinc, cobre y alumínico-potásico) se cita en la literatura como un posible tratamiento para la balanitis y balanopostitis; ahora bien, no existen trabajos prospectivos que documenten su eficacia clínica. Pretendemos estudiar dicha eficacia. Material y método: Presentamos un estudio aleatorizado doble ciego sobre 50 pacientes con balanitis o balanopostitis en el que se comparan los resultados clínicos del «agua de 3 sulfatos» (30 pacientes) frente a una solución salina (20 pacientes). Los parámetros clínicos estudiados han sido: exudado, eritema, edema, escozor y prurito. Resultados: Una vez aplicados los test estadísticos, hemos observado que el «agua de 3 sulfatos» ha sido superior al suero salino en todos los parámetros clínicos estudiados, aunque las diferencias solo han sido significativas para el parámetro exudado. Conclusiones: El «agua de 3 sulfatos» se ha mostrado significativamente más eficaz que el suero fisiológico en la eliminación del exudado de las balanitis y balanopostitis agudas de nuestro estudio. La tolerabilidad de los tratamientos ha sido excelente

Objectives: Despite scientific literature mentions the application of 'water of the 3 sulfates' (copper sulphate, zinc sulphate and alum) as a treatment for acute balanitis and balanoposthitis, no clinical trials evaluating its efficacy have been found. In our study we evaluate the efficacy of this solution in acute balanitis and balanoposthitis. Material and methods: A double-blind randomized study was designed to compare the efficacy of 'water of the 3 sulfates' (intervention) with saline solution (control) in 50 patients (30 patients and 20 patients, respectively) who suffer from acute balanitis or balanoposthitis. Exudate, erythema, oedema, burning, and itching were the clinical parameters assessed. Results: for all clinical parameters assessed, the outcomes obtained with 'water of the 3 sulfates' are higher than control, although significant differences only have been found for exudate. Conclusions: in our study, the 'water of the 3 sulfates' is significantly more effective than saline solution for removing exudates in acute balanitis and balanoposthitis. Tolerability was excellent in both treatments

Clinical study of the effectiveness of the "water of the 3 sulfates" on balanitis and balanoposthitis.

OBJECTIVES: Despite scientific literature mentions the application of "water of the 3 sulfates" (copper sulphate, zinc sulphate and alum) as a treatment for acute balanitis and balanoposthitis, no clinical trials evaluating its efficacy have been found. In our study we evaluate the efficacy of this solution in acute balanitis and balanoposthitis. MATERIAL AND METHODS: A double-blind randomized study was designed to compare the efficacy of "water of the 3 sulfates" (intervention) with saline solution (control) in 50 patients (30 patients and 20 patients, respectively) who suffer from acute balanitis or balanoposthitis. Exudate, erythema, oedema, burning, and itching were the clinical parameters assessed. RESULTS: for all clinical parameters assessed, the outcomes obtained with "water of the 3 sulfates" are higher than control, although significant differences only have been found for exudate. CONCLUSIONS: in our study, the "water of the 3 sulfates" is significantly more effective than saline solution for removing exudates in acute balanitis and balanoposthitis. Tolerability was excellent in both treatments.

[Effect of LHRH agonists on testicular microcirculation with Doppler laser flowmetry]. / Acción de los agonistas LHRH sobre la microcirculación testicular medida mediante flujometria laser doppler.

The purpose of this paper is to present the changes that take place in testicular microcirculation measured by DLF during systemic administration of LHRH agonists. The essay includes a comparison with the variations registered in the volume of testicular interstitial fluid, the anatomopathological changes and the associated leucocyte demyeloperoxidase levels. We also examine the relationship between testicular microcirculation changes and plasma testosterone levels. To do this, 50 male Wistar rats were randomly divided into 5 groups, using 10 as control group and the remaining 40 distributed in 4 groups. Measurements were done at 2, 4, 8 and 24 hours after administration of Tryptorelin 0.4 mg i.v. We found that acute administration of an LHRH agonist causes a series of significant changes on testicular microcirculation. Testicular rhythmic microcirculatory flow, i.e., vasomotion, disappears. In turn, accumulation of PMN leucocytes associated to increased venular permeability takes places. Such pre- and postcapillary vascular changes lead to increased vascular permeability which results in increased volume of testicular interstitial fluid. This increased capillary permeability is responsible for the extensive interstitial oedema that would explain the serious histological changes seen on the seminiferous tubule with these drugs.

[Anatomopathologic changes in the testis following prolonged treatment with LHRH agonists. Experimental study in rats]. / Cambios anatomopatológicos en el testículo tras un tratamiento prolongado con agonistas LHRH. Estudio experimental en ratas.

Presentation of a study conducted on 20 male Wistar rats treated for 3 months with Leuprolide (LHRH agonist). Analysis of pathophysiological testicular changes resulting from the treatment and extent of recovery at 3 months of therapy discontinuation, relating those changes to testosterone plasma levels in peripheral blood. Serum testosterone fell to 1.17 +/- 0.30 ng/ml in the treated group, shifting to figures overlapping with normal values within 3 months of discontinuing treatment. Such decreased testosterone levels translate into significant testicular histological damage. Three months after interruption of treatment there is nearly complete recovery of such damage, with just around 10% tubules without spermatozoa, with unchanged germinal line. We conclude that the marked suppression in testosterone levels caused by LHRH agonists translates into a significant degeneration of the seminiferous tubule, which appears to be reversible 3 months after treatment discontinuation.

[Role of testosterone in the testicular microcirculatory changes produced in the rat by the administration of high doses of human chorionic gonadotrophin]. / Papel de la testosterona en las variaciones microcirculatorias testiculares producidas en la rata por la administración de altas dosis de gonadotrofina corionica humana.

A study was performed in 20 male Wistar rats weighing 250-300 gm; 10 comprised the control group and the other 10 were treated with 5 mg/day of cyproterone acetate which was given with the meal for 2 months. The rat testicular microcirculation was studied by laser Doppler flowmetry. Similarly, the testicular interstitial fluid volume and plasma testosterone in peripheral blood were determined. Within each of the two groups, 5 were studied without any pharmacologic stimulation and 5 at 4 hours following the administration of 100 IU subcutaneous HCG. The rats treated with cyproterone acetate had very low levels of serum testosterone (1.254 +/- 0.667) versus the control group (3.686 +/- 0.705), the difference being statistically significant (p < 0.05). Following administration of HCG, the microcirculation changes and the interstitial fluid were the same as those of the control group despite the blockade of the androgenic receptors by cyproterone acetate. The increase in testosterone levels therefore does not appear to mediate the testicular microcirculation changes produced by HCG.

[Testicular microcirculation in rats measured with laser-Doppler flowmetry]. / Microcirculación testicular en la rata medida mediante flujometría laser doppler.

Study carried out in 50 male Wistar rats distributed into 5 groups: baseline and at 2, 4, 8 and 24 hours after subcutaneous injection of Human Chorionic Gonadotropin, 100 IU. It was observed that testicular microcirculatory flow shows a rhythmical fluctuating pattern (5-10 fluctuations per minute), which becomes continuous at 4 hours but recovers at 24 hours. At the same time, there is an increased volume of testicular interstitial fluid that peaks at 8 hours, and returns to baseline levels at 24 hours. Serum testosterone values increase with HCG injection, reaching a peak at 4 hours (25.9 mg/ml), to return to nearly baseline levels at 24 hours (5.04 mg/ml). Disappearance of the rhythmical microcirculatory pattern, and the increase of interstitial fluid volume do not appear to be mediated by testosterone, since the raise in hormone levels, occurred after HCG administration, preceded the observed microcirculatory changes.