Comment to: Snakebite management in a pediatric patient: More doubts than certainties

Navarro Suay, R.; Aedo Martín, D.; García Cañas, R.; de Vicente Cano, E.

doi:10.1016/j.redare.2021.07.002

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"apellidos" => "de Vicente Cano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentarios al artículo: Manejo de una mordedura de ofidio en un paciente pediátrico: más dudas que certezas" ] ] "textoCompleto" => "First of all, we would like to congratulate the authors of “Snakebite management in a paediatric patient: More doubts than certainties”, a letter recently published in the Spanish Journal of Anesthesiology and Resuscitation<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. This, in our opinion, is an extremely interesting clinical case that describes the diagnosis and treatment of a situation that, though rare, in not unknown in real life practice. It has also provided a review of snakebite management.As military doctors, we occasionally have to treat civilians during international humanitarian deployments to natural disasters, such as hurricane Mitch in Central America, the tsunami in Indonesia, the floods in Mozambique or the earthquake in Turkey. The need to treat paediatric patients increases significantly in these situations, and we have at times had to treat children with injuries similar to those described in the case report of reference. Our experience with snake bites among soldiers in the line of duty is also very limited (as snake repellents are used both individually and collectively)<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>.We would like to briefly draw the authors’ attention to two specific aspects of the diagnosis and treatment of these patients.In our military hospital we have started to use near infrared light spectrometry (NIRS-Monitor Invos™ Covidien-Somanetics, USA) to measure tissue oxygenation in patients with suspected compartment syndrome<a class="elsevierStyleCrossRef" href="#bib0020">4</a>. This is a simple, painless technique that provides real-time numerical measurements. In paediatric patients it also has two other advantages: first, tissue can be analysed to a greater depth, because the different in body size between a child and an adult allows the NIRS to penetrate deeper into the tissue; and secondly, it can facilitate diagnosis, because children are sometimes incapable of describing their symptoms<a class="elsevierStyleCrossRef" href="#bib0025">5</a>. Added to this, NIRS can discriminate between the different muscle compartments and identify the compartment with the greatest involvement. This means that fasciotomy can be targeted to the most damaged tissue, and NIRS can even distinguish between compartment lesion and tissue necrosis.From a therapeutic point of view, the hospital antivenom supply chain must be flexible enough to ensure deliveries are made without undue delay. The isolation inherent to international deployments has taught us to be self-sufficient and to include antivenom in our medical supplies. Tertiary level referral hospitals or those located in areas where snakes are common could consider taking this step.Finally, we thank the Spanish Journal of Anesthesiology and Resuscitation for giving us the opportunity to discuss case reports published in the journal, since this undoubtedly helps improve the diagnosis and perioperative treatment of our patients.FundingThe authors declare that they have not received funding for this study." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Navarro Suay R, Aedo Martín D, García Cañas R, de Vicente Cano E. Comentarios al artículo: Manejo de una mordedura de ofidio en un paciente pediátrico: más dudas que certezas. Rev Esp Anestesiol Reanim. 2021;68:54–55." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo de una mordedura de ofidio en un paciente pediátrico: más dudas que certezas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Sanjuan" 1 => "L. Álvarez-Baena" 2 => "D. Callejo" 3 => "A. Romera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Rev Esp Anestesiol." "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Envenenamiento por mordedura de Vipera palaestinae (Werner, 1938)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Pita Pita" 1 => "J.T. Mingo Regulez" 2 => "T.J. Ruiz Ibañez" 3 => "J.R. Notario Pérez" 4 => "M.C. Ruiz Moreno" 5 => "D. Lozano Benito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Sanid mil." "fecha" => "2010" "volumen" => "66" "paginaInicial" => "33" "paginaFinal" => "38" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual de animales peligrosos, tóxicos y ponzoñosos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Pérez Romero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2010" "editorial" => "Editorial Ministerio de Defensa" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of oxygen tissue monitoring in patients with compartment síndrome: two clinical cases and literatura review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Aedo-Martín" 1 => "R. Navarro-Suay" 2 => "R. García-Cañas" 3 => "M. Fernández-Gayol" 4 => "R. Vethencourt-Koifmann" 5 => "F.J. Areta-Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/milmed/usy270" "Revista" => array:6 [ "tituloSerie" => "Mil Med." "fecha" => "2019" "volumen" => "184" "paginaInicial" => "e475" "paginaFinal" => "e495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30371908" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oximetría cerebral transcutánea, casos clínicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Sanabria Carretero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2010" "editorial" => "Compañía Española de Reprografía y Servicios" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006800000007/v1_202109090556/S2341192921001062/v1_202109090556/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006800000007/v1_202109090556/S2341192921001062/v1_202109090556/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192921001062?idApp=UINPBA00004N"]

ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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Vol. 68. Issue 7.