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array:24 [ "pii" => "S2341192918300064" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "842" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:160-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617301640" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.06.006" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "842" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:160-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 56 "formatos" => array:2 [ "HTML" => 41 "PDF" => 15 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "164" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 161645 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Videolaringoscopia indirecta. Se puede observar infiltración difusa por sustancia amiloide (flechas) que distorsionan cuerda vocal izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. España Fuente, G. Mella Pérez, B. Laserna Cocina, J.L. González González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "España Fuente" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Mella Pérez" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Laserna Cocina" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "González González" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300064" "doi" => "10.1016/j.redare.2018.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300064?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301640?idApp=UINPBA00004N" "url" => "/00349356/0000006500000003/v2_201803170457/S0034935617301640/v2_201803170457/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918300118" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.010" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "844" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:165-9" "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">Case report</span>" "titulo" => "The importance of bilateral monitoring of cerebral oxygenation (NIRS): Clinical case of asymmetry during cardiopulmonary bypass secondary to previous cerebral infarction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "165" "paginaFinal" => "169" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importancia de la monitorización bilateral de la oxigenación cerebral: caso clínico de asimetría durante el bypass cardiopulmonar secundaria a infarto cerebral previo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2015 "Ancho" => 2904 "Tamanyo" => 347038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Multimodal neuromonitoring NIRS-BIS. During CPB the NIRS shows some asymmetry between cerebral hemispheres (high oxygen consumption in the right hemisphere). SrO<span class="elsevierStyleInf">2</span>–Regional cerebral tissue oxygenation; CPB–cardiopulmonary bypass; MUF–modified ultrafiltration.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Matcan, P. Sanabria Carretero, M. Gómez Rojo, L. Castro Parga, F. Reinoso-Barbero" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Matcan" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Sanabria Carretero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gómez Rojo" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Castro Parga" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Reinoso-Barbero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301664" "doi" => "10.1016/j.redar.2017.06.008" "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/S0034935617301664?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300118?idApp=UINPBA00004N" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300118/v3_201803240409/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300052" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.004" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "841" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:154-9" "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">Case report</span>" "titulo" => "Isolated limb perfusion with cytostatic drug leakage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "159" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfusión aislada de extremidad inferior con fuga de quimioterapéutico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1558 "Ancho" => 1447 "Tamanyo" => 342928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Monitoring of possible leakage into systemic circulation using portable gamma camera (top). The graph (below) shows the gradual increase in the radiotracer activity in the systemic circulation that indicates cytostatic leakage from the right lower extremity (slope).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Zarazua, P. Paredes, F. Gahete-Santiago, R. Rull, A. Blasi, J. Balust" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Zarazua" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Paredes" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Gahete-Santiago" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Rull" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Blasi" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Balust" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301639" "doi" => "10.1016/j.redar.2017.06.005" "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/S0034935617301639?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300052?idApp=UINPBA00004N" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300052/v3_201803240409/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "164" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. España Fuente, G. Mella Pérez, B. Laserna Cocina, J.L. González González" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "España Fuente" "email" => array:1 [ 0 => "lorenespana@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Mella Pérez" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Laserna Cocina" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "González González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario San Agustín, Avilés, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2287 "Ancho" => 1667 "Tamanyo" => 281829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Computerised axial tomography of the neck showing submucosal amyloid infiltration in the subglottic area, resulting in stenosis of the laryngeal lumen. (B) Nuclear magnetic resonance image. Sagittal section, showing amyloid deposit (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Amyloidosis is characterised by the deposition of amyloid, which is an amorphous material with a protein structure that produces alterations and clinical manifestations in the affected organ or organs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The amyloid substance is composed of amino acid sequences, very similar to those of the amino-terminal residues of light kappa or lambda polypeptide chains of immunoglobulins. It is an amorphous, eosinophilic material that microscopically appears pink on haematoxylin–eosin staining and shows green birefringence with Congo red staining when observed under polarised light.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Amyloidosis affecting the head and neck area is a rare diagnosis, with the exception of the tongue, which is the target organ of primary systemic or multiple myeloma-related amyloidosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 78-year-old man with a BMI of 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">−2</span> who was admitted to the Emergency Department due to a strangulated umbilical hernia. His personal history included ankylosing spondylitis with onset 20 years previously, arterial hypertension, type 2 diabetes mellitus and dyslipidaemia which was being treated in the home with sinvastatin, enalapril and metformin. Five months earlier he observed the onset of significant dysphonia and dysphagia and was diagnosed with diffuse amyloidosis of posterior commissure and left arytenoids forming an amorphous mass with left vocal cord and subglottic involvement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). He was under follow-up by the Otolaryngology Department, and had been scheduled for excision of the subglottic lesion using CO<span class="elsevierStyleInf">2</span> laser microlaryngoscopy. The patient had been evaluated by the Internal Medicine Department, and amyloidosis-related involvement of other organs had been ruled out.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Examination of the airway revealed a thyromental or Patil distance of 5<span class="elsevierStyleHsp" style=""></span>cm, retrognathia, significant limitation of cervical flexoextension and Mallampati-Samsoon score of 3<span class="elsevierStyleSmallCaps">.</span></p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was transferred to the operating room for emergency median laparotomy and was told that awake intubation with sedation and local anaesthesia would be required. Being very cooperative and pain free, he accepted. Non-invasive arterial pressure, electrocardiogram, pulse oximetry, neuromulscular blockade and bispectral index monitoring was started. The patient was premedicated with intravenous atropine (0.9<span class="elsevierStyleHsp" style=""></span>mg), followed by administration of 4<span class="elsevierStyleHsp" style=""></span>ml lidocaine 5% spray, 1<span class="elsevierStyleHsp" style=""></span>mg of intravenous midazolam, and continuous infusion of remifentanil at a dose of 0.08<span class="elsevierStyleHsp" style=""></span>μg/kg<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span> along with 8<span class="elsevierStyleHsp" style=""></span>ml 1% lidocaine gargle. Following administration of the spray, oxygen at 2 l<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span> was administered through nasal cannulas during the entire procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">For intubation, we used the King Vision<span class="elsevierStyleSup">®</span> videolaryngoscope (Ambu, Indianapolis, IN, USA) with a channelled number 3 blade, achieving intubation at the first attempt using a flexible metal 6<span class="elsevierStyleHsp" style=""></span>mm Mallinckrodt tube. Tube insertion was uneventful and caused no airway damage. Good visualisation of the glottis was achieved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Indirect laryngoscopy was very well tolerated by the patient, who remained awake throughout the procedure. We had prepared a fibreoptic bronchoscope as a back-up measure if intubation failed. The airway management team was made up of 2 anaesthesiologists with more than 9 years of experience in difficult airway management and more than 80 successful intubations with this video laryngoscope. The King Vision<span class="elsevierStyleSup">®</span> was removed when correct intubation was confirmed by auscultation and observation of the capnography curve on the monitor. No haemodynamic changes, desaturation, laryngeal lesions or lesions nor bleeding occurred during the procedure.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Once intubated, anaesthesia was induced using propofol 2<span class="elsevierStyleHsp" style=""></span>mg/kg<span class="elsevierStyleSup">−1</span>, fentanyl 0.2<span class="elsevierStyleHsp" style=""></span>μg/kg<span class="elsevierStyleSup">−1</span> and rocuronium 0.6<span class="elsevierStyleHsp" style=""></span>mg/mg<span class="elsevierStyleSup">−1</span>. Anaesthesia was maintained with 1.5–2% sevoflurane, guided by the bispectral index, and 50% oxygen/air, rocuronium and fentanyl. Surgery lasted approximately 2.5<span class="elsevierStyleHsp" style=""></span>h. Intestinal resection was performed by means of medial laparotomy. When the abdominal surgery was complete, another surgical team consisting of 3 otolaryngologists performed excision of the subglottic lesion. The procedure was uneventful. The patient was transferred to the post anaesthesia recovery unit, where he remained intubated for 24<span class="elsevierStyleHsp" style=""></span>h until the inflammation and oedema of the airway subsided. Extubation was performed by 2 anaesthesiologists with experience in difficult airway management, in the presence of an otolaryngologist, using a Cook extra-firm airway exchange catheter (Cook Critical Care, Bloomington, IN, USA). Before extubation, the cuff leak test was performed to assess airway calibre with the available reintubation equipment (difficult airway trolley), following the latest recommendations of the American Society of Anesthesiologists (ASA). Once the patient presented an adequate level of consciousness and was able to respond to verbal commands, breathe spontaneously and maintains adequate gas exchange (with SatO<span class="elsevierStyleInf">2</span> of 99%, tidal volume of 7<span class="elsevierStyleHsp" style=""></span>ml/kg, a respiratory rate of 12 breaths per minute, and a T<span class="elsevierStyleInf">4</span>/T<span class="elsevierStyleInf">1</span> ratio of over 0.9), he was extubated without incident.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The otolaryngologist was present at both intubation and extubation in order to resolve other airway complications, such as oedema and haemorrhage that would have required an emergency cricothyrotomy.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Amyloidosis encompasses a group of disorders characterised by the deposition of abnormal amounts of extracellular protein in various organs. It can be localised or systemic, primary or secondary; nowadays, however, the disease is classified according to laboratory findings. Localised amyloidosis occurs in several sites, most frequently in the genitourinary tract, respiratory tract and skin. Laryngeal amyloidosis is an uncommon, usually primary, presentation. In 77% of cases, airway involvement is multifocal, and diagnosis requires an array of studies. Laryngeal amyloidosis represents 0.68% of benign tumours of the larynx. It usually affects individuals between 40 and 60 years of age, predominately men (3:1). The onset is manifested by dysphonia that may develop into stridor, dyspnoea, dysphagia or hemoptysis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In the case of pulmonary involvement, the presence of nodular parenchyma and pleural infiltrates can cause pulmonary hypertension.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The lesions may take on a diffuse or granulomatous<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> appearance, reminiscent of squamous cell cancer. This latter is the main differential diagnosis, and can only be distinguished from amyloidosis by immunocytochemistry. This entity was first described in 1875 by Burow and Neumann.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Care must be taken in the anaesthetic and particularly the airway management of these patients, since serious, potentially life-threatening complications can occur during anaesthesia induction<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The deposits of amyloid material can form a mass that obstructs the airway and hampers ventilation and intubation at the time of induction. This is why it is essential to maintain spontaneous ventilation and avoid the use of muscle relaxants<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Amyloidosis can also cause haemorrhagic lesions, and deposits of this amorphous proteinaceous material make the vasculature of the laryngeal mucosa particularly susceptible to bleeding and oedema. Chow et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> describe a case of massive airway haemorrhage as a complication of laryngeal amyloidosis, which caused the death of the patient.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Given the existence of these mucosa-infiltrating stenosing deposits in the airway coupled with the patient's anatomical limitations, we decided to perform awake intubation. In all available algorithms, the recommended gold standard for treating known difficult airway is still flexible fibreoptic bronchoscopy, which preserves spontaneous ventilation. The success of this procedure depends on the experience of the operator and the patient's cooperation. However, the technique can become complicated in the presence of airway obstruction secondary to mass effect or poor vision due to bleeding. These complications can occur in amyloidosis, and can lead to acute loss of the airway and failed intubation<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>. In our case, we successfully performed intubation with a King Vision<span class="elsevierStyleSup">®</span> video laryngoscope at the first attempt. This device has been shown to give a clear view of the glottis and a high success rate in orotracheal intubation in the hands of an experienced operator. The King Vision<span class="elsevierStyleSup">®</span> video laryngoscope consists of a high-resolution screen that provides an excellent view of the glottis without the need for tracheal axis alignment. We use a number 3 channelled blade to facilitate insertion of the endotracheal tube.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Although this particular laryngoscope is not widely used, several recent studies have reported its benefits in awake intubation in patients with difficult airway<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>. Like other difficult airway management methods, successful video laryngoscopy requires expertise and training, but uses fewer resources and is associated with a shorter learning curve than fibreoptic bronchoscopy. The use of video laryngoscopy in patients with laryngeal amyloidosis has not hitherto been described in the literature. It is important to highlight the role of new generation videolaryngoscopes, with their excellent glottic vision, in difficult airway management. Successful intubation using these devices is highly operator-dependent. Video laryngoscopes help improve glottic vision, but this does not necessarily imply easier or faster intubation.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The latest difficult airway algorithms published by the ASA in 2013 recommends the use of videolaryngoscopes as first choice in patients with suspected difficult airway. The guidelines, however, do not specify which of the many videolaryngoscopes available today should be used, since these devices have yet to be compared in a controlled study. We chose the King Vision<span class="elsevierStyleSup">®</span> on the basis of our experience with this device, and kept a fibreoptic bronchoscope as back-up if intubation should fail, as it can also be used in an awake patient. In the event of airway complications that could have jeopardised airway patency and adequate oxygenation, such as oedema and haemorrhage, we would have considered performing a cricothyrotomy. Supraglottic devices and laryngeal masks, which are also mentioned in the latest ASA algorithm, would not have solved this problem due because, due to the obstructive nature of the amyloid mass, blind insertion could have aggravated the haemorrhage and oedema. Ultrasound is a powerful tool that can accurately identify the cricothyroid membrane and prepare the area for surgical access, and would have been the only strategy for maintaining oxygenation if our first-choice intubation technique had failed. Another, though less common, option would be a prophylactic cricothyroid puncture.</p><p id="par0085" class="elsevierStylePara elsevierViewall">A smaller diameter endotracheal tube than would normally correspond should be used,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> and several even smaller sizes together with an aspiration cannula should be on hand. All the material needed for an emergency infraglottic airway should also be prepared, and an otolaryngologist should be present at both intubation and extubation.</p><p id="par0090" class="elsevierStylePara elsevierViewall">It is essential to assess the degree of airway obstruction, the extent of the lesions, and to decide whether to perform the excision using microsurgery before manipulating the airway for any other intervention<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>. In our case, however, this was not possible due to the urgent nature of the surgery. CO<span class="elsevierStyleInf">2</span> laser microlaryngoscopy is effective in the treatment of localised laryngeal amyloidosis, and is associated with a very low rate of recurrence<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0095" class="elsevierStylePara elsevierViewall">All patients diagnosed with laryngeal amyloidosis should be evaluated for multiple myeloma or systemic involvement. Awake intubation is the safest option in this type of patient. Difficult airway management, maintaining adequate oxygenation and preserving spontaneous ventilation at all times are still the main challenges faced by anaesthesiologists, because the only alternative in the event of failure to secure airway access would be to perform an emergency surgical airway.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed conform to the ethical standards of the responsible human experimentation committee and are in accordance with the World Medical Association and the Declaration of Helsinki.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1008343" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec968017" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1008342" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec968018" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-10" "fechaAceptado" => "2017-06-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec968017" "palabras" => array:6 [ 0 => "Laryngeal amyloidosis" 1 => "Larynx" 2 => "Awake intubation" 3 => "Video-laryngoscopy" 4 => "Anaesthesia" 5 => "Difficult airway" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec968018" "palabras" => array:6 [ 0 => "Amiloidosis laríngea" 1 => "Laringe" 2 => "Intubación despierto" 3 => "Videolaringoscopio" 4 => "Anestesia" 5 => "Vía aérea difícil" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5 months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision<span class="elsevierStyleSup">®</span> video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La amiloidosis comprende un grupo de trastornos que se distinguen por el depósito de agregados fibrilares de inmunoglobulinas monoclonales de cadenas ligeras en diversos órganos, entre ellos, la laringe.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A continuación presentamos el caso de un varón de 78 años derivado a nuestro hospital para tratamiento quirúrgico de una hernia umbilical estrangulada. El paciente presentaba disfonía y disfagia de 5 meses de evolución debido a la presencia de una amiloidosis laríngea. Se decidió realizar la intubación con el paciente despierto, sedado con remifentanilo y midazolan, utilizando el videolaringoscopio King Vision<span class="elsevierStyleSup">®</span>. Las lesiones hemorrágicas que pueden acontecer en estos pacientes son debidas al depósito de agregados fibrilares de amiloide, que causan una fragilidad vascular que aumenta el riesgo de hemorragia durante la intubación. Por eso es importante que el anestesiólogo realice un cuidadoso manejo de la vía aérea en pacientes con esta entidad.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: España Fuente L, Mella Pérez G, Laserna Cocina B, González González JL. ¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea? Rev Esp Anestesiol Reanim. 2018;65:160–164.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2287 "Ancho" => 1667 "Tamanyo" => 281829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Computerised axial tomography of the neck showing submucosal amyloid infiltration in the subglottic area, resulting in stenosis of the laryngeal lumen. (B) Nuclear magnetic resonance image. Sagittal section, showing amyloid deposit (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1250 "Ancho" => 1666 "Tamanyo" => 222727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Indirect videolaryngoscopy. Diffuse amyloid infiltration (arrows) can be seen distorting the left vocal cord.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La amiloidosis en el área otorrinolaringológica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. 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Shigematsu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Anesth" "fecha" => "1999" "volumen" => "11" "paginaInicial" => "339" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10470639" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300064/v3_201803240409/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000003/v3_201803240409/S2341192918300064/v3_201803240409/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300064?idApp=UINPBA00004N" ]
