Revista espanola de anestesiologia y reanimacion最新文献

Advanced airway management in pediatric anesthesia has undergone substantial development with the incorporation of emerging technologies and strategies tailored to the unique anatomy and physiology of children. This review provides a critical appraisal of the clinical utility of tools such as videolaryngoscopy, high-flow nasal cannula oxygen therapy, and supraglottic devices, as well as specific techniques including the Bailey maneuver, fiberoptic-assisted intubation, and one-lung ventilation. Relevant studies published up to March 2025 were identified through searches in PubMed, Embase, Scopus, and Web of Science. Current evidence supports the use of these resources to enhance safety and effectiveness in complex scenarios, underscoring the importance of individualized device selection and specialized training. The integration of these strategies into tailored protocols represents a key step toward optimizing airway management in pediatric patients.

Objectives: In patients with cervical spine injury, glottic visualization is difficult in the head-neutral position. The role of external laryngeal manoeuvres, such as backward-upward-rightward pressure (BURP) and jaw thrust in intubation outcomes remains unclear. We compared the effects of jaw thrust and BURP on the quality of glottic view with the head in a neutral position during C-MAC videolaryngoscopy.

Methods: In this self-controlled study, glottic view was assessed in 120 adult patients using a C-MAC videolaryngoscope with no manoeuvre, BURP, or jaw thrust. After induction, endotracheal intubation was performed according to Grupo allocation. Screenshots of the best glottic view were taken each time to assess the percentage of glottic opening (POGO) score, modified Cormack-Lehane (MCL) grade, and glottic opening area en píxeles cuadrados. Intubation times, ease of intubation, haemodynamics, and complications were also recorded.

Results: POGO scores (mean[DE]) were significantly higher with BURP (72.7[19.9]) and jaw thrust (60[26.3]) manoeuvres compared to no manoeuvre (25[26.9];P < 0.0001). Glottic opening area en píxeles cuadrados (P < 0.001) and MCL grades (P = 0.043) were considerably higher after the application of laryngeal manoeuvres. There were no significant differences in the duration of laryngoscopy and intubation times between Grupos; however, intubation was significantly easier with BURP (P = 0.021) and jaw thrust (P = 0.032).

Conclusion: External manoeuvres, such as BURP and jaw thrust, should improve glottic view during C-MAC videolaryngoscopy in patients with the head in a neutral position.

Background: In 2010, the World Health Organization (WHO) called for global implementation of Patient Blood Management (PBM) programs to optimize transfusion practices and reduce variability in blood utilization. This study examines the evolution of red cell, platelet, and plasma consumption in Iberia (Spain and Portugal), comparing trends within the region and with European benchmarks like the United Kingdom, Germany, and Italy.

Methods: National transfusion activity reports from Spain, Portugal, the United Kingdom (2011-2023) were analyzed. Key metrics included transfusion rates per 1,000 inhabitants for red cells, platelets, and fresh frozen plasma. Statistical analyses were performed using Kruskal-Wallis tests and ANOVA to identify differences between countries and over time.

Results: From 2011 to 2023, red cell transfusion rates decreased by 30% in the UK, 6% in Spain, and 15% in Portugal. Germany showed a modest decline, while Italy maintained stable rates exceeding 40 units per 1,000 inhabitants. Platelet and plasma consumption exhibited distinct patterns, with Portugal showing a steeper decline compared to Spain, and the UK maintaining the lowest overall rates. Platelet consume is clearly increasing.

Conclusions: The analysis reveals significant differences in blood component utilization across Iberia and Europe, reflecting varying levels of PBM adoption. Despite WHO and Council of Europe recommendations, Iberian countries lag behind the UK in reducing red cell transfusion rates. These findings underscore the need for uniform PBM implementation to harmonize practices and optimize resource use, not only Red Cell Concentrates. The creation of the Iberian task-force (section of the Ibero-American PBM Society (SIAPBM) could be an opportunity to create the necessary awareness in our countries and become a meeting point between America and Europe.

Submental intubation, first described in 1986, is an effective alternative to tracheostomy in patients with complex facial fractures in whom nasotracheal intubation is contraindicated and orotracheal intubation would interfere with the surgical field. We report the case of a 38-year-old man with a history of morbid obesity who suffered a panfacial fracture with involvement of the frontal sinuses and intracranial communication after falling from a second floor. Nasotracheal intubation was contraindicated, and orotracheal intubation would have interfered with the planned intermaxillary fixation. We first performed fibreoptic orotracheal intubation, which was then surgically converted to submental intubation. No intraoperative or postoperative complications occurred, and the patient's evolution was favourable, with only minimal scarring in the submental region. Recent literature has confirmed that this technique is safe and is associated with less morbidity and better aesthetic outcomes than tracheostomy. This case highlights the need to consider submental intubation as a priority airway management option in complex panfacial fractures.

Patent foramen ovale (PFO) has an approximate prevalence of 25% in the adult population, being normally an asymptomatic condition. During liver transplant (LT), a PFO can enable the passing of embolic material to systemic circulation and cause ischemic events. Prophylactic closing of a PFO is not currently indicated in patients who are to undergo LT. Close haemodynamic monitoring is recommended in this type of cases in order to diagnose a paradoxical embolism and give an adequate treatment if necessary. We present a case of a patient with a diagnosis of PFO who, during a LT, shows clinical findings compatible with a pulmonary and systemic embolism, requiring haemodynamic support and leaving a mild neurological sequelae at discharge.

Introduction: Tracheal intubation using direct laryngoscopy with a Macintosh blade remains the standard technique in the operating room. However, this method requires precise anatomical alignment and direct visualization of the glottis, which can be challenging for anesthesia residents with limited experience. Multiple intubation attempts are associated with an increased risk of complications. Videolaryngoscopy allows indirect visualization of the glottis and enables real-time supervision and feedback during the procedure, potentially improving safety and facilitating learning. Although videolaryngoscopy has shown benefits in difficult airway scenarios and in experienced hands, evidence is limited on whether it improves first-pass success and reduces complications when used by anesthesia residents in patients without predicted airway difficulty. The aim of this study is to compare first-pass intubation success with videolaryngoscopy versus direct laryngoscopy when performed by anesthesia residents in the operating room.

Methods and analysis: The VILARE trial is a prospective, multicenter, randomized, open-label study. A total of 1008 adult patients undergoing elective or urgent surgery under general anesthesia, without predictors of difficult airway, will be randomized to undergo tracheal intubation using either a standard Macintosh direct laryngoscope or a Macintosh videolaryngoscope on the first attempt. All tracheal intubations will be performed by anesthesia residents. The primary endpoint is successful intubation on the first attempt. Secondary outcomes time for successful tracheal intubation, attempts for successful intubation, laryngoscopic vision with the modified Cormack-Lehane scale, need of adjuvant airway devices for intubation, subjective difficulty of intubation, and complications during tracheal intubation (e.g., desaturation, dental trauma).

Ethics and dissemination: The study protocol was approved November 28, 2024, by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2024/394).and was registered into the Clinicaltrials.gov clinical trials registry with No. NCT06842082. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If videolaryngoscopy improves first-attempt intubation success and reduces complications in anesthesia residents, its use may be recommended as the first-line device in anesthesia training programs.

Trial registration number: ClinicalTrials.gov Registry: NCT06842082.