[Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient].

Inhaled anaesthetic induction with sevoflurane is very common in the pediatric population. Sevoflurane systemic effects are widely known, while not all the side effects are known. We present a four year-old child who developed a persistent supraventricular tachycardia after inhaled anaesthetic induction with sevoflurane. The arrhythmia did not end until sevoflurane was stopped and changed to an intravenous continuous perfusion of hypnotic drugs (propofol and remiphentanyl). The exact mechanism for such a causal relationship with sevoflurane administration is unknown, and possible diagnoses include atrioventricular nodal reentry tachycardia (AVNRT) and the existence of an accessory pathway. An episode of persistent supraventricular tachycardia with a clear causal relationship with sevoflurane administration is not found in the literature.

[An awake fiberoptic intubation protocol: descriptive retrospective assessment of safety and efficacy]. / Evaluación de la eficacia y seguridad de un protocolo de intubación mediante fibroscopio en paciente despierto. Estudio descriptivo retrospectivo.

BACKGROUND AND OBJECTIVE: Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital's awake fiberoptic intubation protocol. MATERIAL AND METHODS: For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol's key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients' diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. RESULTS: In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. CONCLUSION: Our hospital's protocol was followed in all cases and no post-implementation complications were detected.

Taquicardia supraventricular sostenida tras inducción anestésica inhalatoria con sevoflurano en paciente pediátrico / Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

La inducción anestésica inhalatoria con sevoflurano es muy empleada en la población pediátrica. Si bien los efectos sistémicos más comunes son ampliamente conocidos, no se conocen todos los efectos secundarios de este fármaco. Presentamos el caso clínico de un varón de cuatro años que desarrolló un episodio de taquicardia supraventricular sostenida tras la inducción anestésica con sevoflurano, que no cedió hasta que no se retiró el fármaco y se sustituyó el mantenimiento anestésico por una perfusión continua de fármacos hipnóticos intravenosos (propofol y remifentanilo). Desconocemos el mecanismo exacto por el que este episodio ha tenido una relación causal tan clara con la administración de sevoflurano; las posibilidades diagnósticas serían la taquicardia por reentrada intranodal o la existencia de una vía accesoria. No hemos encontrado en la literatura un episodio de taquicardia supraventricular mantenida con una relación causal directa con la administración de sevoflurano como en el caso que presentamos.(AU)

Inhaled anaesthetic induction with sevoflurane is very common in the pediatric population. Sevoflurane systemic effects are widely known, while not all the side effects are known. We present a four year-old child who developed a persistent supraventricular tachycardia af-ter inhaled anaesthetic induction with sevoflurane. The arrhythmia did not end until sevoflurane was stopped and changed to an intravenous continuous perfusion ofhypnotic drugs (propofol and remiphentanyl). The exact mechanism for such a causal relationship with sevoflurane administration is unknown, and possible diagnoses include atrioventricular nodal reentry tachycardia (AVNRT) and the existence of an accessory pathway. An episode of persistent supraventricular tachycardia with a clear causal relationship with sevoflurane administration is not found in the literature.(AU)

[Comparative study between thiopental and propofol in short-duration anesthesia]. / Estudio comparativo entre tiopental y propofol en anestesias de corta duración.

In a randomized study, 80 healthy unpremedicated female patients were included. For short gynaecological procedures (curettage) they were anaesthetized with either propofol 2 mg/kg (n = 40) or thiopentone 5 mg/kg (n = 40) in combination with nitrous oxide/oxygen (1/1). Supplementary doses of propofol (25 mg) or thiopentone (50 mg) were given when necessary during the procedure. Propofol caused a significant fall in arterial blood pressure (greater than thiopentone in diastolic pressure) and a decrease in heart rate (thiopentone did not change heart rate). Discomfort on injection was similar in both groups. Recovery times were shorter in propofol group: Patients opened their eyes at 1.3 minutes, were awake at 2.2 minutes and could seat with no help at 5.2 minutes. In the thiopentone group, there was a greater incidence of nausea. Propofol was associated with euphoria, "clear-headedness" and pleasant dreams more than thiopentone. We conclude that propofol is a good alternative to thiopentone in short operative procedures.

Comentarios al caso clínico "Mascarilla laríngea flexible en decúbito lateral y artritis reumatoide" / No disponible

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Comentarios al caso clínico "Mascarilla laríngea flexible en decúbito lateral y artritis reumatoide" / No disponible

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Evaluación de la eficacia y seguridad de un protocolo de intubación mediante fibroscopio en paciente despierto. Estudio descriptivo retrospectivo / An awake fiberoptic intubation protocol: descriptive retrospective assessment of safety and efficacy

Introducción y objetivo: El fibroscopio flexible para la intubación endotraqueal ocupa un puesto importante en las guías de manejo de la vía aérea difícil. El objetivo del presente estudio fue describir la eficacia y seguridad de un protocolo de intubación con fibroscopio en el paciente despierto en un hospital terciario. Material y métodos: Se diseñó un estudio retrospectivo observacional. Recogimos los datos de todas las intubaciones con fibroscopio en pacientes despiertos realizadas durante un periodo de 3 años tras la instauración del protocolo en nuestro centro. Los puntos más importantes del protocolo hacen referencia a la disposición del quirófano, el personal requerido y la sedación para la realización del procedimiento. Se recogieron las variables demográficas, la comorbilidad de los pacientes, la predicción de la posible dificultad de la vía aérea realizada en la consulta preanestésica, el cumplimiento del protocolo, los fármacos utilizados y las complicaciones registradas. Resultados: Durante el periodo de estudio se realizaron 634 intubaciones con fibroscopio, 473 pacientes (74,6%) tenían al menos un factor de riesgo de aspiración y 232 (36,5%) al menos alguna comorbilidad cardiovascular. En el 67% de los casos se preveía intubación difícil. En el 99% de los casos se usó remifentanilo mediante sistema Target Controlled Infusion (TCI) con una media de concentración efecto alcanzada de 2,9 ng/ml. En todos los casos se siguió el protocolo respecto al personal implicado y la disposición del quirófano. En ningún caso se registraron complicaciones respiratorias ni hemodinámicas durante la intubación con fibroscopio ni en el postoperatorio inmediato. Conclusión: El protocolo establecido en nuestro centro se siguió en el 100% de los casos y no hubo complicaciones tras la instauración del protocolo (AU)

Background and objective: Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital’s awake fiberoptic intubation protocol. Material and methods: For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol’s key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients’ diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. Results: In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. Conclusion: Our hospital’s protocol was followed in all cases and no post-implementation complications were detected (AU)

Recomendaciones para el manejo de la vía aérea difícil mediante dispositivos extraglóticos en el paciente adulto sometido a cirugía ambulatoria / No disponible

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Comentarios al caso clínico titulado “Síndrome neurológico transitorio tras bupivacaína hiperbara intradural. Un nuevo caso” / On the case report: "Transient neurological syndrome after spinal hyperbaric bupivacaine: a new case"

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