RESUMEN

BACKGROUND: Incidence, clinical course, and fatality of spontaneous subarachnoid haemorrhage (SAH) are evolving, with prevalence of risk factors diminishing, implementation of early detection programs and strategies for priority aneurysm exclusion, technical refinement towards less invasive procedures, and improvements in neurocritical care. Modern epidemiological and prognostic data are lacking, especially in southern European and Mediterranean populations. METHODS: A prospective multicentre observational study on SAH was held in Catalonia, Northeast Spain, 2020-2022 (HSACat project). All public tertiary hospitals participated in a common registry. Primary endpoints were functional outcomes (modified Rankin Scale, mRS) and mortality at 12-months. Secondary aims included epidemiological data, flux of patients between referral and tertiary hospitals, diagnostic and treatment delays, and in-hospital complications. RESULTS: Of 550 SAH cases reported in Catalonia (2020-2022), 474 had a complete registry for analysis. Death rate was 20.6% during hospital admission and 26.9% at one year. Good functional outcome (mRS 0-2) was observed in 63.4%, 70.1% and 76.0% at 3, 6 and 12 months. Age at presentation was lower in men, smokers, and hypertensives (p<0.05). The female:male ratio was 3:2, except in non-aneurysmal group. Time from onset to tertiary-hospital admission was longer in rural than metropolitan zones (7.0h vs 4.7h, p<0.01). Aneurysm occlusion in the first 72h was achieved in 83.3%; mainly endovascularly (77.5%) than microsurgically (19.3%). CONCLUSION: Even when most patients received timely aneurysmal treatment, rates of case fatality are considerably high. Data provided by the HSAcat project may have public health repercussions and be used to guide prevention programs and screening strategies.

Asunto(s)

RESUMEN

OBJECTIVE: To describe the use, utility, safety, and effectiveness of the Proseal laryngeal mask for airway management in patients undergoing ventriculoperitonea shunting. PATIENTS AND METHODS: We retrospectively reviewed the records of all patients in whom the Proseal laryngeal mask was used during ventriculoperitoneal shunting between January 2006 and October 2009. Patient demographic characteristics, airway assessments, type of anesthesia, quality of ventilation, and perioperative complications were recorded. RESULTS: Of the 43 patients included, 8 (18.6%) had at least 1 difficult airway criterion. We were able to insert the Proseal laryngeal mask in all patients. Ventilation was optimal in 39 (91%) patients, with maintenance of end-expiratory carbon dioxide pressures between 35 and 40 mm Hg and airway pressures above 25 cm H2O throughout the procedures. Air leaks developed in 3 cases (7%) when the patient was placed in a lateral-cervical position for surgery; these patients required orotracheal intubation before surgery could begin. Mean duration of surgery was 53 minutes. Awakening occurred without incident in all cases. CONCLUSIONS: The Proseal laryngeal mask is useful for airway management in patients undergoing ventriculoperitoneal shunting. Due to the forced position of the neck, however, it may be necessary to reposition the mask or even proceed to orotracheal intubation in some cases. As is the case for other advanced uses, experience with the device is necessary. Material for managing a difficult airway should be on hand.

Asunto(s)

RESUMEN

OBJECTIVES: To compare the clinical behavior of the disposable Soft Seal laryngeal mask to the behavior of the reusable LMA Classic mask. METHODS: Patients were randomly assigned to 2 groups in which either the LMA Classic or the Soft Seal mask would be used. We assessed time required for positioning and number of attempts, seal pressure, fiberoptic bronchoscopic image, and complications. The masks were inserted by 2 anesthesiologists who were inexperienced in the use of laryngeal masks. We also compared compliance of the cuff in the laboratory. RESULTS: Sixty patients were enrolled. There were no differences in time required for insertion or number of attempts (first-try success, 83%). The mean (SD) seal pressure was greater in the Soft Seal group at 23 (4) cm H2O than in the LMA Classic group at 20 (4) cm H2O. There were no significant differences in the fiberoptic bronchoscopic images, ventilation, incidence of intraoperative complications, presence of blood on the cuff (LMA Classic, 6 out of 30 vs Soft Seal, 11 out of 29), or postoperative sore throat. In 3 patients in the Soft Seal group the laryngeal mask had to be replaced by an orotracheal tube. Cuff compliance in the laboratory was lower for the LMA Classic than for the disposable mask for all sizes assessed. CONCLUSIONS: Although the results suggest that the clinical behavior of the 2 masks is similar, the LMA Classic allowed for effective airway management in all of the cases assigned to it, whereas management was effective in 90% of the cases in which the Soft Seal mask was used. The inflatable cuff of the Soft Seal is more compliant in vitro and it provides a higher airway seal pressure than does the LMA Classic.

Asunto(s)

Asunto(s)