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Alonso Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Lloreda Herradón" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Blázquez Calvo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Miyagi Yonamine" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Alonso Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620300682" "doi" => "10.1016/j.redar.2020.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620300682?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192921000330?idApp=UINPBA00004N" "url" => "/23411929/0000006800000003/v1_202104020743/S2341192921000330/v1_202104020743/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192921000500" "issn" => "23411929" "doi" => "10.1016/j.redare.2020.06.013" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1221" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2021;68:143-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "148" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 344 "Ancho" => 1000 "Tamanyo" => 25660 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Different types of ultrasound transducers. Each transmits at a certain frequency. Image courtesy of General Electric Group.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Vives, A. Hernández, A.D. González, J. Torres, P. Cuesta, T. Villen, P. Carmona, D. Nagore, M. Serna, U. Bengoetxea, X. Borrat, G. García de Casasola, E. Sánchez, R. Campo, J. Mercadal" "autores" => array:16 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Vives" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hernández" ] 2 => array:2 [ "nombre" => "A.D." "apellidos" => "González" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Torres" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Cuesta" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Villen" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Carmona" ] 7 => array:2 [ "nombre" => "D." "apellidos" => "Nagore" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Serna" ] 9 => array:2 [ "nombre" => "U." "apellidos" => "Bengoetxea" ] 10 => array:2 [ "nombre" => "X." "apellidos" => "Borrat" ] 11 => array:2 [ "nombre" => "G." "apellidos" => "García de Casasola" ] 12 => array:2 [ "nombre" => "E." "apellidos" => "Sánchez" ] 13 => array:2 [ "nombre" => "R." "apellidos" => "Campo" ] 14 => array:2 [ "nombre" => "J." "apellidos" => "Mercadal" ] 15 => array:1 [ "colaborador" => "on behalf of the Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicines (SEMES)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620302267" "doi" => "10.1016/j.redar.2020.06.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620302267?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192921000500?idApp=UINPBA00004N" "url" => "/23411929/0000006800000003/v1_202104020743/S2341192921000500/v1_202104020743/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Anaesthetic management of transoral endoscopic thyroidectomy. A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "152" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Bermúdez-Triano, G. Fernández-Castellano, R. Guerrero-Domínguez, J.L. López-Romero, I. Benítez-Linero" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Bermúdez-Triano" "email" => array:1 [ 0 => "macbertri@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Fernández-Castellano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Guerrero-Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "López-Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "Benítez-Linero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital General Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo anestésico de la tiroidectomía endoscópica transoral. Reporte de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 131335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scars produced by trocars.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is a novel and minimally invasive procedure that allays many patient’s fears about the post-thyroidectomy scars that occur with the classical open approach.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this technique, thyroidectomy is performed through the natural orifice by placing three ports in the oral vestibule and carefully dissecting down to the sternal notch and the edges of both sternocleidomastoid muscles.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In this procedure, anaesthesia and airway management can be a challenge for the anaesthesiologist given the scant evidence in the literature. Results so far are encouraging: swallowing difficulties and postoperative pain are improved; patients recover faster and present fewer wound-related complications compared with the classic open approach.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">History, clinical findings, and diagnostic evaluation</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 53-year-old woman who presented with a tumour in the anterior part of the neck. She reported with no pain or other discomfort, and thyroid hormones were within normal ranges. We performed an ultrasound study that revealed a nodule measuring 4 × 3 × 2 cm. Fine needle aspiration was indicated, and led to a diagnosis of probable follicular neoplasm. We proposed an endoscopic hemithyroidectomy. The patient was a smoker of 20 pack-years and occasional drinker. The airway assessment show no predictors of difficult intubation (Mallampati I, TMD > 6.5 cm, cervical mobility greater than 35°).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Therapeutic intervention</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the operating room the patient was monitored with non-invasive blood pressure, peripheral oxygen saturation, electrocardiogram, bispectral index monitor (BIS) and TOF-watch. An 18 G line was placed in the left upper limb. Antibiotic prophylaxis was administered with amoxicillin–clavulanate 30 min before the start of the surgical incision. Anaesthesia was induced with 2 mg kg<span class="elsevierStyleSup">−1</span> propofol, 1 μg kg<span class="elsevierStyleSup">−1</span> fentanyl, and 0.6 mg kg<span class="elsevierStyleSup">−1</span> rocuronium combined with 4 mg dexamethasone, and the patient was intubated with a 7.5 flexible electromyographic cuffed endotracheal tube using a McGrath® video laryngoscope. Intubation was successful at the first attempt, with no incidents. The electrodes of the endotracheal tube were aligned with the vocal cords, and after placing the patient in cervical hyperextension, correct positioning of the endotracheal tube was confirmed with video laryngoscopy. The throat was carefully packed using Magill forceps. The patient received volume-controlled mechanical ventilation with sevoflurane 0.8–1.2 MAC and anaesthesia was maintained with continuous perfusion of remifentanil. The patient’s eyes and pressure points were protected and inadvertent hypothermia was prevented by means of a thermal blanket and fluid heater.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The oral cavity was washed with 2% aqueous chlorhexidine before starting surgery. Three trocars were placed in the lower vestibule, two lateral (both 5 mm) and one centrally (10 mm), followed by insufflation of up to 6 mmHg carbon dioxide (CO<span class="elsevierStyleInf">2</span>) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). During the intervention, the recurrent laryngeal nerve was unequivocally identified and monitored, and showed adequate transmission of evoked potentials after hemithyroidectomy. EtCO<span class="elsevierStyleInf">2</span> was maintained at between 35 and 40 mmHg. Before the end of the surgery, 50 mg dexketoprofen, 1 g paracetamol, 50 mcg fentanyl and 4 mg ondansetron were administered. Eduction was uneventful, and neuromuscular blockade was reversed with sugammadex, adjusting dosage by the TOF-watch. The surgical intervention was uneventful and lasted around 90 min.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Monitoring and results</span><p id="par0025" class="elsevierStylePara elsevierViewall">No postoperative bleeding complications or recurrent laryngeal nerve involvement were observed. Pain was satisfactorily controlled with non-steroidal anti-inflammatory drugs given every 8 h, with a visual analogue scale score of less than 5. Oral intake was started the afternoon of the intervention, and was uneventful.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Transoral endoscopic thyroidectomy via vestibular approach is a recently described procedure first described in 2015 by Dr. Anuwong<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in a series of 60 cases. More than 400 cases have been reported so far — complications are similar to those of conventional surgery, but it has the advantage of no visible scaring.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the growing demand, anaesthesiologists need to be familiar with this new approach to open thyroidectomy that improves cosmetic outcomes and speeds up recovery. However, there is scant information in the literature on anaesthesia management in TOETVA. We searched the Cochrane Library, ERIC (USDE), DOCUMED, IME-Biomedicina, MEDLINE, Pubmed, PubPsych and SciELo databases for suitable articles published in Spanish and English under the terms “Transoral Endoscopic Thyroidectomy” and “anesthesia” with no date limit, and found only 1 case report in which the authors choose nasal intubation with a preformed tube for airway management.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our patient was apprehensive about post-hemithyroidectomy scarring and voiced her concerns during the preoperative consultation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">She was scheduled for an endoscopic transoral vestibular approach because she met the surgical inclusion criteria (predicted gland width in diagnostic images ≤10 cm, thyroid volume outline <45 ml or dominant nodule dimension ≤50 mm, 3 or 4 Bethesda lesions, primary papillary microcarcinoma with no local or distant metastasis) and did not present exclusion criteria (history of radiation to the head, neck or upper mediastinum, history of neck surgery, recurrent goitre, documented lymph node or distant metastases, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goitre, or oral abscess).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Intubation was performed using a McGrath® video laryngoscope, inserting an electromyographic endotracheal tube to monitor the recurrent laryngeal nerve (RLN) at all times.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In TOETVA, dissection is performed in a top-down direction. This makes the RLN hard to identify, and injury to this nerve is one of the main concerns in this approach.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Electromyography requires the electrodes to be aligned in direct contact with the vocal cords,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and video laryngoscopy can be used to confirm the correct position of the endotracheal tube after the patient has been placed in cervical hyperextension.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is also important to tape the endotracheal tube to the corner of the mouth so that it does not shift during surgical manipulations, and to protect pressure points and the eyes with padding (gauze or a cloth). This is because the surgeons are positioned at the head and injuries can occur. Packing the throat can help prevent blood from entering the stomach and reduce the risk of vomiting and aspiration, although the dissection is performed on a submaxillary plane.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In our patient, we chose balanced general anaesthesia with sevoflurane and continuous perfusion of remifentanil and monitored depth of anaesthesia at each stage of surgery with BIS, although total intravenous anaesthesia is also an option. Inhalational and intravenous anaesthetic agents do not affect electromyographic responses, but the same is not true of muscle relaxants. However, partial neuromuscular blockade is compatible with an adequate electromyographic response,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> which is why a single dose of rocuronium is administered during induction (to improve intubation) and the depth of neuromuscular blockade is monitored by TOF in order to achieve partial block during anaesthesia maintenance (2 out of 4 train of four responses).</p><p id="par0065" class="elsevierStylePara elsevierViewall">With regard to etCO<span class="elsevierStyleInf">2</span> monitoring, CO<span class="elsevierStyleInf">2</span> absorption is higher in the extraperitoneal than the intraperitoneal space. However, in surgeries with such a small surgical field, CO<span class="elsevierStyleInf">2</span> absorption is usually minimal and no cases of embolism, significant respiratory acidosis or subcutaneous emphysema have been described. CO<span class="elsevierStyleInf">2</span> insufflation pressure is normally set at 6 mmHg, and should not exceed 10 mmHg. There are as yet no reports in the literature of conversion to open surgery due to increased airway pressure and/or difficulty in mechanical ventilation.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In terms of postoperative analgesia, vestibular incisions appear to be less painful than cutaneous incisions, and administration of non-steroidal anti-inflammatory drugs every 8 h is sufficient for pain management and minimizes opioid consumption.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Dual antiemetic prophylaxis with dexamethasone and ondansetron is important to ensure patient comfort and avoid surgical wound complications. The anti-inflammatory action of dexamethasone will also help prevent vestibular oedema.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, the aim of this case report is to describe the basic anaesthetic considerations in transoral endoscopic thyroidectomy. It is essential to use an electromyographic endotracheal tube to identify and monitor the integrity of the recurrent laryngeal nerve, and other monitors such as the TOF-watch or the bispectral index are also important to ensure adequate depth of anaesthesia and neuromuscular relaxation during surgery.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Patient perspective</span><p id="par0080" class="elsevierStylePara elsevierViewall">At the 2-week follow-up, the patient stated that she was satisfied with the cosmetic result and the rapid recovery.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1491447" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1354127" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1491446" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1354128" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case report" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "History, clinical findings, and diagnostic evaluation" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Therapeutic intervention" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Monitoring and results" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient perspective" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-22" "fechaAceptado" => "2020-01-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1354127" "palabras" => array:5 [ 0 => "Tiroidectomía endoscópica transoral" 1 => "Anestesia" 2 => "Neuromonitorización" 3 => "Nervio laríngeo recurrente" 4 => "Tubo endotraqueal con electromiografía" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1354128" "palabras" => array:5 [ 0 => "Transoral Endoscopic Thyroidectomy" 1 => "Anaesthesia" 2 => "Neuromonitoring" 3 => "Recurrent laryngeal nerve" 4 => "Electromyographic endotracheal tube" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel andminimally invasive procedure, free of visible scars and showing encouraging results in termsof rapid recovery and less postoperative pain. It consists of performing the thyroidectomythrough its natural orifice, using three ports in the oral vestibular area and carrying out acareful dissection to the sternal notch and the edges of both sternocleidomastoid muscles.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The objective of this article is to describe the different anesthetic implications that thissurgical technique entails, given that the evidence published to date in the literature is very limited. It is considered essential to control the recurrent laryngeal nerve using an endotrachealtube with electromyography to ensure its identification and integrity, as well as the use of othermonitors such as the TOF watch or the bispectral index to ensure adequate anesthetic depthand an optimal level of muscle relaxation.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La tiroidectomía endoscópica transoral por abordaje vestibular (TOETVA) constituyeun procedimiento novedoso y mínimamente invasivo, libre de cicatrices visibles y que presentaresultados alentadores en cuanto a la rápida recuperación y menor dolor posoperatorio. Consisteen realizar la tiroidectomía a través de su orificio natural, empleando tres puertos en el áreaoral vestibular y llevando a cabo una disección cuidadosa hasta la muesca esternal y los bordesde ambos músculos esternocleidomastoideos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El objetivo es describir las diferentes implicaciones anestésicas que conlleva esta técnicaquirúrgica, dado que la evidencia publicada hasta la fecha en la literatura es muy limitada.Se considera esencial la monitorización del nervio laríngeo recurrente mediante tubo endotra-queal con electromiografía para garantizar su identificación e integridad, así como la utilizaciónde otros monitores como el TOF-watch o el índice biespectral para asegurar una adecuadaprofundidad anestésica y un óptimo nivel de relajación muscular.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bermúdez-Triano M, Fernández-Castellano G, Guerrero-Domínguez R, López-Romero JL, Benítez-Linero I. Manejo anestésico de la tiroidectomía endoscópica transoral. Reporte de un caso. Rev Esp Anestesiol Reanim. 2021;68:149–152.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 131335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scars produced by trocars.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 111532 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> insufflation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA): reporte del primer caso en humanos realizado en Latinoamérica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. 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