Letter to the Editor
Reply to letter: Response to the letter “Anaesthesia management of accidental extubation in the prone position”
Respuesta a la carta: Contestación a la carta «Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono»
Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, Spain
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Bosch, M. Sadurní, S. Pacreu" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Bosch" "email" => array:1 [ 0 => "laiaboschduran@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Sadurní" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Pacreu" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a la carta: Contestación a la carta «Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank Benatar et al. for their interest in our article, and for their comments, and take this opportunity to comment on some of their observations.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the literature, repositioning the patient in the supine position may not be necessary as a first option.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> This is because securing the airway with a laryngeal mask airway (LMA) while the patient remains prone is an effective strategy. In all 3 published cases describing the emergency placement of a laryngeal mask due to accidental extubation in the prone position,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a> the authors recommend this strategy as the first line of treatment, because in the prone position the soft tissues of the oropharynx are easily displaced, facilitating placement of the LMA.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Spond et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> recently published a case of accidental extubation in a patient with Klippel–Feil syndrome, and recommend a preoperative briefing on the steps to be taken in the case of accidental extubation. These authors suggest the LMA as the first option, provided the patient does not meet difficult airway (DA) criteria.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Turning the patient supine is not without its risks. Exposure of the dura mater during surgery drastically increases the risk of infection at the surgical site. Furthermore, during placement of spinal instrumentation, turning a patient may compromise the stability of the spine and result in paraplegia.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We fully agree with the authors that fibre optic intubation in the prone patient has its limitations, insofar as it is not the ideal position for this technique and the manoeuvre is time-consuming, given the urgency of the situation. In fact, we could be critised for wasting time in attempting to replace the orotracheal tube under fibreoptic vision. This triggered cardiac arrest due to hypoxaemia, despite successful placement of the Fastrach<span class="elsevierStyleSup">®</span> laryngeal mask.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since accidental extubation in the prone position is an emergency situation, we designed our algorithm to serve as a plan of action to facilitate decision making by differentiating between DA and normal airway. We agree that, in patients with DA, it is reasonable to turn the patient to the supine position.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe the decision should be based on the characteristics of the patient and the context in which extubation occurs, with the ultimate objective being to act rapidly to ensure patient safety.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bosch L, Sadurní M, Pacreu S. Respuesta a la carta: Contestación a la carta «Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono». Rev Esp Anestesiol Reanim. 2017;64:601.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual case of airway rescue in prone position with the ProSeal laryngeal mask airway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Brimacombe" 1 => "C. 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