Sergi Sabaté - Academia.edu (original) (raw)

Papers by Sergi Sabaté

Revista española de anestesiología y reanimación, 2009

Los algoritmos de manejo de la via aerea dificil (VAD) comprenden un conjunto de estrategias orga... more Los algoritmos de manejo de la via aerea dificil (VAD) comprenden un conjunto de estrategias organizadas para facilitar la eleccion de las tecnicas de ventilacion e intubacion con mas probabilidad de exito y menor riesgo de lesion de la via aerea. Las recomendaciones estan basadas en la revision exhaustiva y sistematica de la evidencia disponible y en la opinion de los expertos. La meta es garantizar la oxigenacion del paciente en una situacion de potencial riesgo vital, rapidamente cambiante, que exige una toma de decisiones agil. Su objetivo principal es disminuir el numero y la gravedad de los incidentes criticos asi como las complicaciones que se pueden producir durante el abordaje de la via aerea. Los objetivos secundarios son promover una evaluacion adecuada de la via aerea y el aprendizaje y entrenamiento de las diferentes tecnicas de control de la via aerea. Desde hace unos anos, diversas sociedades nacionales de Anestesiologia (Americana, Francesa, Canadiense, Alemana, Italiana) han editado sus algoritmos de manejo de la via aerea. Tambien se han creado sociedades internacionales especificas para promocionar la practica segura del manejo de la via aerea mediante la investigacion y la educacion, como la SAM (Society for Airway Management, www.sam.zorebo.com), la DAS (Difficult Airway Society, www.das.uk.com) y la EAMS (European Airway Management Society, www.eams.eu.com). De estas, la ASA (American Society of Anesthesiology) y la DAS han publicado recientemente sus algoritmos y muchas instituciones y Servicios de Anestesiologia han hecho sus propias versiones. Esta diversificacion responde a la necesidad de adaptar las estrategias recomendadas a los recursos humanos y materiales de cada entorno, los conocimientos y experiencia personales asi como a las caracteristicas de los pacientes. Aunque no hay estudios que comparen la efectividad de los diferentes algoritmos, los expertos coinciden en que su uso y una correcta planificacion mejoran los resultados del manejo de la via aerea. Sin embargo, la influencia de las guias sobre la practica clinica es dificil de definir, compleja de analizar y variable en el tiempo. Un diseno esmerado, unido a campanas de difusion periodicas, facilitaria su aprendizaje y retencion pudiendo mejorar su efectividad. Algunos algoritmos tienen estructura de arbol e incluye multiples opciones para cada situacion. Este es el caso del algoritmo de la ASA, en los que el listado de tecnicas y dispositivos opcionales aparece en un anexo. Esta disposicion no es facil de recordar, como se refleja en varios estudios realizados tanto entre residentes como especialistas. Por otro lado, el algoritmo de la DAS tiene un diseno de diagrama de flujo con planes secuenciales y un numero limitado de opciones y tecnicas en cada punto. Comprende tres diagramas de control de la VAD no prevista para las situaciones de anestesia electiva, induccion de secuencia rapida y situacion de ventilacion e intubacion imposible, pero no contempla la VAD prevista. El algoritmo de manejo de la VAD que presentamos se proyecto con la intencion de abarcar la valoracion preoperatoria de la via aerea, el desarrollo de diferentes esquemas de control de la VAD, en situaciones que requieren abordajes especificos (situacion de reanimacion y emergencias, ventilacion unipulmonar, pediatria y obstetricia) y el abordaje de la extubacion de este tipo de pacientes. Hasta hoy se han desarrollado los esquemas de actuacion para la evaluacion preoperatoria de la via aerea y el manejo de la situacion de VAD prevista y no prevista. El objetivo de este trabajo es difundir el algoritmo de evaluacion y manejo de la via aerea dificil adoptado por la Societat Catalana d’Anestesiologia, Reanimacio i Terapeutica del Dolor (SCARTD).

Revista española de anestesiología y reanimación, May 1, 2012

Náuseas y vómitos; Postoperatorio; Profilaxis farmacológica Resumen Objetivo: Valorar la eficienc... more Náuseas y vómitos; Postoperatorio; Profilaxis farmacológica Resumen Objetivo: Valorar la eficiencia de la profilaxis antiemética farmacológica en pacientes sometidos a una intervención quirúrgica, bajo anestesia general, en diferentes grupos de riesgo de náuseas y vomitos postoperatorios (NVPO). Material y métodos: Se diseñó un estudio multicéntrico aleatorio prospectivo observacional de cohortes. Se estudiaron 1.239 pacientes procedentes de 26 hospitales sometidos a cirugía programada con anestesia general. Fueron registradas las características poblacionales, los factores de riesgo de NVPO, la técnica anestésica, el tipo de cirugía, la duración, la fluidoterapia, la profilaxis antiemética administrada y la incidencia de NVPO en las primeras 24 h. Se realizó un análisis estratificado (riesgo bajo, moderado y alto) encaminado a evaluar la asociación entre profilaxis y NVPO mediante un modelo de regresión logística ajustado por propensity score. Posteriormente, se calculó en cada uno de los estratos el número de pacientes que es necesario tratar (NNT), para evitar un episodio de NVPO. Resultados: La incidencia de NVPO en el estrato de bajo riesgo fue del 21,6% sin profilaxis y del 8,6% con profilaxis, en el de riesgo moderado fue del 31,3% frente al 17,7% y en el de alto riesgo del 46,5% frente al 32,7%. Hubo un efecto protector de la profilaxis de forma significativa en los 3 estratos (odds ratio entre pacientes tratados y no tratados) y el NNT (IC del 95%) fue de 7 (5-11) en el estrato de bajo riesgo, 7 (5-13) en el de riesgo moderado y 6 (4-16) en el de riesgo elevado. Conclusiones: La eficiencia de la profilaxis antiemética farmacológica en pacientes sometidos a cirugía con anestesia general fue similar en todos los grupos de riesgo. La privación de profilaxis antiemética en los pacientes de bajo riesgo puede no estar justificada por criterios

Current Opinion in Anesthesiology, Apr 1, 2014

This review of progress toward reliable prediction of postoperative pulmonary complications (PPCs... more This review of progress toward reliable prediction of postoperative pulmonary complications (PPCs) discusses risk assessment against the background of patient management strategies, clinical outcomes, and cost of healthcare. Among the variety of conditions grouped as PPCs are pneumonia, aspiration pneumonitis, respiratory failure, reintubation within 48 h, weaning failure, pleural effusion, atelectasis, bronchospasm, and pneumothorax. PPC incidence rates range from 2 to 40% depending on context. These events increase mortality, postoperative length of stay, ICU admissions, hospital readmissions, and costs. PPC-associated mortality varies, but can reach as high as 48% in some contexts. ICU admission rates are between 9.5 and 91% higher in patients with PPCs. The mean increase in PPC-related postoperative length of stay is approximately 8 days. The cost of surgery can be two-fold to 12-fold higher when PPCs develop. Strategies proposed to reduce the impact of modifiable risk factors include alcohol and smoking abstinence before surgery, shortening the duration of surgery, and physiotherapy and incentive spirometry techniques; however, little scientific evidence supports them at this time. PPCs are associated with a higher incidence of life-threatening events and higher costs. Reliable PPC risk-stratification tools are essential for guiding clinical decision-making in the perioperative period. The care team can act on modifiable factors and optimize vigilance over nonmodifiable ones. It would be useful to focus resources on determining whether low-cost preemptive interventions improve outcomes satisfactorily or new strategies need to be developed.

Regional Anesthesia and Pain Medicine, Sep 1, 2005

Annales Francaises D Anesthesie Et De Reanimation, May 1, 2008

Objectif.-Le but de cette étude était de décrire la pratique anesthésique en Catalogne, Espagne, ... more Objectif.-Le but de cette étude était de décrire la pratique anesthésique en Catalogne, Espagne, en 2003. Type d'étude.-Une enquête transversale a été menée de façon prospective sur 14 jours choisis au hasard au cours de l'année 2003. Méthodes.-Un questionnaire pour chaque intervention anesthésique fournissait les informations sur les caractéristiques du patient, la technique, ainsi que l'intervention pour laquelle l'anesthésie était nécessaire. Les résultats ont été extrapolés à la population et exprimés sous forme de taux d'intervention annuel pour 100 habitants. Résultats.-Chacun des 131 centres identifiés (55,7 % privés, 44,3 % publiques) a participé. À partir des 23 136 questionnaires complétés et collectés lors de l'expertise, il a été estimé que 603 189 interventions anesthésiques furent réalisées. Le taux annuel d'anesthésie réalisée était de neuf pour 100 habitants. Les femmes représentaient 58 % de la population. L'âge moyen des patients était de 52 ans et 39,3 % des interventions ont été réalisées pour à des patients de plus de 60 ans. Le pourcentage de patients de classe 3 ou plus sur l'échelle American Society of Anesthetists (ASA) était de 26,7 %. La pratique anesthésique a été divisée entre les interventions associées à de la chirurgie (78,4 %), à l'obstétrique (11,3 %) et les autres non chirurgicales (10,4 %). Les patients ambulatoires ont été estimés à 34,3 % et les patients en urgence à 20,3 %. L'anesthésie régionale à été la plus fréquente (41,4 %), avec une utilisation largement répandue du bloc spinal en tant que technique d'anesthésie régionale. Le nombre d'anesthésistes pour 100 000 habitants a été estimé à 12,5. Conclusion.-Les femmes, les patients âgés, ainsi que les personnes avec un état physique nettement altéré représentent une population ayant un très fort besoin d'information en ce qui concerne les interventions obstétricales, orthopédiques et ophtalmologiques. Ces besoins doivent être pris en compte dans l'organisation des services et dans la formation du personnel.

Anesthesiology, May 1, 2015

Body, References) 2 Support was provided by Grant 071210-2007 from Fundació La Marató de TV3 (Cat... more Body, References) 2 Support was provided by Grant 071210-2007 from Fundació La Marató de TV3 (Catalan public television network marathon foundation, Barcelona, Spain). The findings of this study were partially presented at the Euroanaesthesia Congress,

European Journal of Anaesthesiology, Jun 1, 2012

clearance from the cy toplasm for these small Ca 2+ loads. Injury decreased the recovery constant... more clearance from the cy toplasm for these small Ca 2+ loads. Injury decreased the recovery constant (10±6 sec, n=63) compared to control neurons (16±8 sec, n=86, P< 0.001). This indicates accelerated function of PMCA in a xotomized neurons. Conclusion(s): PMCA function is upregulated in DRG neurons af ter painful nerve injury, which may provide an explanation for the decrease in cy toplasmic [Ca 2+ ]. Since this [Ca 2+ ] decrease leads to greater repetitive firing in these neurons, PMCA hyperactivity may represent an important contribution to the pathogenesis of neuropathic pain.

Anesthesiology, Sep 1, 2013

498 September 2013 C RITICAL care planning for surgical patients is not an easy task because it i... more 498 September 2013 C RITICAL care planning for surgical patients is not an easy task because it involves anticipating the risk of adverse effects in most of the vulnerable patients we have treated. The difficulty arises from the unpredictability of complications that emerge both during surgery and afterwards in patients admitted to critical care units for periods that may extend over many days and weeks. Wherever resources are already stretched to the limit, decision-making becomes more burdensome because of the high cost of critical care. In this issue of AnesThesIoLogy, Wanderer et al.1 propose an intraoperative prediction model for unplanned admission to the critical care unit. The authors examined more than 70,000 anesthetic records with more than 4,500 events (unplanned admissions), giving them sufficient leeway to test a large number of hypothetical predictors. Through bootstrapping, they provided assurance against overfitting of the model and strengthened the finding of internal validity. The performance of the model was compared with that of the surgical Apgar score2 using an interesting series of time-dependent receiver-operating characteristic curves with an acceptable discrimination value at 1 h before case end. sensitivity, specificity, and predictive values of the model were calculated for a threshold of 5% of predicted probability of unplanned admission. The optimal cut points based on the areas under the curves can be disputed, as the authors do not report the criteria for their choice. Alternative cutoffs might well be considered in the interest of avoiding excessive dichotomization and establishing an intermediate gray zone, as suggested by Ray et al.3 Furthermore, because predictive values can be severely affected by prevalence, likelihood ratios would have shed further light.3 In this study, a positive and negative likelihood ratio of approximately 4 and 0.17, respectively, have a moderate degree of predictive usefulness. The nine predictors found to be associated with hemodynamic events are consistent with what others have emphasized, that hemodynamic instability appears to play a key role in postoperative outcome.4–9 Arterial oxygen saturation as measured by pulse oximetry (specifically, a decrease in the ratio of arterial oxygen saturation to the fraction of inspired oxygen) was among the predictors, consistent with its recently identified implication in respiratory complications.10 Three predictors are factors well known before surgery (American society of Anesthesiologists class, age, and high-risk surgery); but although these factors can be considered in preoperative risk prediction and critical care planning, they may also bear a relation to intraoperative complications. emergency operation proved to be another predictor of unplanned admission, unsurprisingly, because it is recognized that emergency status involves higher risk. But the fact that Wanderer et al.1 classified admissions as unplanned for all patients who underwent an emergency operation deserves a comment: it is anomalous to define a candidate predictor in terms of the dependent variable, the outcome of interest. When a factor is defined in this way, its involvement in the model may be overestimated. Although that categorical decision may be logical from an administrative standpoint within a hospital, from a medical point of view the destination of many emergency patients could be planned before surgery, and if these cases had been defined differently in this study, the model may well have been different. A Race against Time

European Journal of Anaesthesiology, Feb 1, 2019

, for the PERISCOPE group M of the European Society of Anaesthesiology (ESA) Clinical Trial Netwo... more , for the PERISCOPE group M of the European Society of Anaesthesiology (ESA) Clinical Trial Network BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/ or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 8C; leucocyte count more than 12 000 ml À1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO 2 values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P ¼ 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia. TRIAL REGISTRATION NCT 01346709 (ClinicalTrials.gov).

BJA: British Journal of Anaesthesia, Oct 1, 2014

† Chronic kidney disease is an important risk factor for perioperative complications. † In a post... more † Chronic kidney disease is an important risk factor for perioperative complications. † In a post hoc analysis of a previous outcomes study, estimated glomerular filtration rate (eGFR) was assessed as a predictor of complications after non-cardiac surgery. † Major adverse cardiovascular and cerebrovascular events correlated inversely with preoperative eGFR. † This index of kidney function is useful for cardiovascular risk assessment in non-cardiac surgery. Background. Chronic kidney disease is an independent predictor of perioperative cardiovascular morbidity and mortality. We analysed the preoperative estimated glomerular filtration rate (eGFR) as a risk factor for perioperative major adverse cardiovascular and cerebrovascular events (MACCE) in non-cardiac surgery. Methods. In a post hoc analysis of the ANESCARDIOCAT database, patients were classified into six stages of eGFR calculated with the abbreviated Modification of Diet in Renal Disease Study and the Chronic Kidney Disease Epidemiology Collaboration equations: .90 (1), 60-89.9 (2), 45-59.9 (3a), 30-44.9 (3b), 15-29.9 (4), and ,15 (5) ml min 21 1.73 m 22. We analysed differences in MACCE, length of hospital stay, and all-cause mortality between eGFR stages. Results. The eGFR was available in 2323 patients. Perioperative MACCE occurred in 4.5% of patients and cardiac-related mortality was 0.5%. Five hundred and forty-three (23.4%) patients had an eGFR of ,60 ml min 21 1.73 m 22 and 127 (5.4%) had an eGFR below 45 ml min 21 1.73 m 22. Logistic regression analysis showed that MACCE increased with eGFR impairment (P,0.001), with a marked increase from stage 3b onwards (odds ratio 1.8 vs 3.9 in 3a and 3b, respectively, P¼0.047). All-cause mortality was not related to eGFR (P¼0.071), but increased substantially between stages 3b and 4. The length of stay correlated with eGFR (P,0.001). Conclusions. Perioperative MACCE increase with declining eGFR, primarily when ,45 ml min 21 1.73 m 22. We recommend the use of preoperative eGFR for cardiovascular risk assessment.

European Journal of Anaesthesiology, Jul 1, 2015

For the PERISCOPE group* * Members of the PERISCOPE (Prospective Evaluation of a RIsk Score for p... more For the PERISCOPE group* * Members of the PERISCOPE (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe) group are listed in the Appendix.

European Journal of Anaesthesiology, Mar 1, 2014

Airway assessment and management are cornerstones of anaesthesia, yet airway complications remain... more Airway assessment and management are cornerstones of anaesthesia, yet airway complications remain an important source of morbidity. We performed a before-and-after evaluation of a collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. A prospective, multicentre before-and-after evaluation of a collaborative intervention. Collaborative intervention to improve adherence to airway assessment and management guidelines in patients scheduled for surgery under general anaesthesia. Data were collected on 21 consecutive days before and after the intervention. Anaesthetists with staff or residency positions at 22 hospitals. Patients aged 18 years or older undergoing nonemergency surgery were recruited. Establishing a learning network that included local leaders, meetings to share experiences and knowledge, interactive sessions and provision of printed materials on airway assessment and management. Clinical airway management for general anaesthesia was provided by the anaesthetists participating in the study. Outcomes were the completion of airway assessment at the preanaesthetic visit, rates of unanticipated difficult airway, algorithm adherence and related airway complications. The study included 3753 patients (1947 preintervention and 1806 postintervention). The percentage of patients with a complete airway assessment increased from 25.1% preintervention to 48.4% postintervention (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The incidences of unanticipated difficult airway were 4.1% before the intervention and 3% after it (P = 0.433). Rates of adherence to the algorithms for anticipated and unanticipated difficult airway management were similar in the two periods. The incidences of related adverse events were also similar. The collaborative intervention was effective in improving airway assessment but not in changing difficult airway management practices.

Anesthesia & Analgesia, Apr 12, 2023

Revista Española de Anestesiología y Reanimación (English Edition), 2020

The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management... more The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.

TH Open, 2020

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) p... more Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24–48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03–2.4]) and DOAC-fre...

Revista Española de Anestesiología y Reanimación, 2020

Resumen La Seccion de Via Aerea de la Sociedad Catalana de Anestesiologia, Reanimacion y Terapeut... more Resumen La Seccion de Via Aerea de la Sociedad Catalana de Anestesiologia, Reanimacion y Terapeutica del Dolor (SCARTD) presenta la actualizacion de las recomendaciones para la evaluacion y manejo de la via aerea dificil con el fin de incorporar los avances tecnicos y los cambios observados en la practica clinica desde la publicacion de la primera edicion en 2008. La metodologia elegida fue la adaptacion de 5 guias internacionales recientemente publicadas, cuyo contenido fue previamente analizado y comparado de forma estructurada, y el consenso de expertos de los 19 centros participantes. El documento final fue sometido a la valoracion de los miembros de la SCARTD y a la revision por parte de 11 expertos independientes. Estas recomendaciones estan pues sustentadas en la evidencia cientifica actualmente disponible y en un amplio acuerdo de los profesionales de su ambito de aplicacion. En esta edicion se amplia la definicion de via aerea dificil, abarcando todas las tecnicas de manejo, y se hace mayor hincapie en la valoracion de la via aerea y en la clasificacion en 3 categorias segun el potencial grado de dificultad y las consideraciones de seguridad adicionales, que guiaran la planificacion de la estrategia a seguir. La preparacion previa al manejo de la via aerea, no solo relativa al paciente y al material, sino tambien a la comunicacion e interaccion entre todos los agentes implicados, ocupa un lugar destacado en todos los escenarios incluidos en el presente documento. El texto refleja el aumento progresivo del uso de los videolaringoscopios y de los dispositivos de segunda generacion en nuestro entorno y promueve tanto su uso electivo como el uso precoz en la via aerea no prevista. Tambien recoge la creciente utilizacion de la ecografia como herramienta de apoyo en la exploracion y toma de decisiones. Se han abordado nuevos escenarios como el riesgo de broncoaspiracion y la extubacion considerada dificil. Finalmente, se trazan las lineas maestras de los programas de entrenamiento y formacion continuada en via aerea necesarios para garantizar la implementacion efectiva y segura de las recomendaciones.

Retina, 2018

Purpose: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and i... more Purpose: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap for treating myopic macular hole without retinal detachment. Methods: Twenty-eight eyes of 28 patients undergoing vitrectomy with either ILM peeling (n = 16) or inverted ILM flap technique (n = 12) were included. Outcomes were myopic macular hole closure by optical coherence tomography and visual acuity at 6 months and at the end of follow-up. Results: Closure of myopic macular hole was achieved in 13 eyes (81.2%) of the ILM peeling group and in 11 eyes (91.7%) of the inverted ILM flap group. The median length of follow-up was 18 months in the peeling group and 10.3 in the inverted group. There were not statistically significant differences between restoration of the external limiting membrane, external limiting membrane and ellipsoid zone, and none of both layers between the two groups. The median best-corrected visual acuity (logarithm of minimal angle of resolution) a...