BACKGROUND: Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging.
METHODS: A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed.
RESULTS: Between May 2015 and October 2018 7patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5of the 7patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6of the 7patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed.
CONCLUSIONS: HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.

CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy) disease is an inherited systemic arterial disease that affects the small and medium calibre cerebral vessels. Around 500 families are affected in the world, most of them in Europe. It is characterised by migraine attacks, subcortical dementia, neuropsychiatric disorders, and recurrent ischaemic strokes. The objective of this article is to describe, for the first time in the literature, the management by general anaesthesia of an intracranial neurosurgical procedure in a patient with CADASIL disease. Continuous monitoring of blood pressure is considered essential, as well as the maintenance of normocapnia and normothermia to avoid the development of new cerebrovascular accidents. This disease is relevant due to its anaesthetic implications and the few publications to date.

OBJECTIVE: Regional anaesthesia (RA) has gained popularity due to its numerous benefits and increasing safety. Yet, often patients refuse this procedure and prefer general anaesthesia (GA). This study aimed to investigate variables (demographic factors, safety perception of GA and RA, patients\' fears, anxiety, and knowledge) related to patients\' anaesthetic preference.
METHODS: Participants were patients aged 18 years or more proposed to an anaesthesia appointment for preoperative assessment. Patients completed a written questionnaire before meeting the anaesthesiologist. The questionnaire asked about their preferences, fears and perceptions about RA.
RESULTS: One hundred and 2patients agreed to participate. Mean age was 52.6±13.5 years, 57.8% were female and 44.5% had at least 12 years of education. Given the choice, 54.0% would prefer GA and 20.7% said they would refuse RA if proposed by the anaesthesiologist. Among patients who already experienced neuroaxial anaesthesia, 40.0% said they did not wish to repeat it. Patients who preferred GA over RA perceived GA to be safer than RA and expressed more anxiety towards being awake during surgery and more fear of feeling pain during surgery, of having back pain, and of needle puncture. Results also suggested that patients are unaware of RA\'s real risks and benefits.
CONCLUSIONS: Knowing patients\' fears is essential for the anaesthesiologist address their patients\' needs. Anaesthesiologists should work on improving general population perspective and knowledge about RA.

OBJECTIVE: Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy.
METHODS: 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled.
RESULTS: The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events.
CONCLUSIONS: Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.

This review aims to give an overview of the current state of monitoring depth of anaesthesia and detecting the moment of loss of consciousness, from the first clinical signs involved in anaesthesia to the latest technologies used in this area. Such techniques are extremely important for the development of automatic systems for anaesthesia control, including preventing intraoperative awareness episodes and overdoses. A search in the databases Pubmed and IEEE Xplore was performed using terms such anaesthetic monitoring, depth of anaesthesia, loss of consciousness, as well as anaesthesia indexes, namely BIS. Despite the several methods capable of monitoring the hypnotic state of anaesthesia, there is still no methodology to accurate detect the moment of loss of consciousness during induction of general anaesthesia.

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare entity that is characterised by its onset in healthy children at 2-4 years of age. It is a complex syndrome that includes, among other symptoms, rapid weight gain with hyperphagia, hypothalamic dysfunction, central hypoventilation, and autonomic dysregulation. The case is presented of a 10-year-old boy with a diagnosis of ROHHAD syndrome undergoing insertion of a port-a-cath under general anaesthesia, who developed complications during the anaesthetic procedure related to his illness. The peri-operative management of these patients represents a challenge for the anaesthetist, given the involvement of multiple systems and the frequent respiratory comorbidities associated with them. A summary is presented of some of the implications and anaesthetic considerations that must be taken into account in the management of these patients.

Cardiovascular complications, in particular perioperative myocardial infarctions, are central contributors to morbidity and mortality after non-cardiac surgery. We present a case of a 41-year-old male, smoker and dyslipidemic, who underwent bimaxillary orthognathic jaw surgery with the development of an acute coronary syndrome in the immediate postoperative period. We managed to early diagnose the myocardial infarction and promptly performed a percutaneous transluminal coronary angioplasty, resulting in a positive outcome.

An FDA alert in December 2016 on the safety of general anesthesia and sedations in patients less than 3 years of age and pregnant women has raised doubts in relation to the attitude that professionals implicated in these procedures should adopt in relation to these specific group of patients. Confronted with this situation, the following medical scientific societies: Sociedad Española de Anestesia y Reanimación (SEDAR), Sociedad Española de Cirugía Pediátrica (SECP), Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y Sociedad Española de Neonatología (SENeo), have established a working group to analyze and clarify the safety of these techniques. In the present article we conclude that at present both general anesthesia and profound sedation are considered safe procedures because there is no evidence of the opposite in studies with human beings. However, this ascertained safety should not obviate the problem which still needs to be followed with attention, especially in patients less than 3 years of age undergoing anesthetic procedures for more than 3 hours or prolonged sedation in the Neonatal or Pediatric Intensive Care Units.

OBJECTIVE: Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery.
METHODS: Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen\'s d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9.
RESULTS: There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005.
CONCLUSIONS: The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units.

OBJECTIVE: The aim of this study was to evaluate the brain damage caused by inhaled sevoflurane, by determining the concentration of serum S100B protein before and after the exposure to this drug as the only anaesthetic agent.
METHODS: Paediatric patients undergoing general anaesthesia for the conduct of a nuclear magnetic resonance were included in the study. A venous blood sample was taken from each patient before (basal sample) and after (post-exposure sample) administering the general anaesthesia. The concentration of serum S100B protein was determined in the basal (S100Bb) and post-exposure sample (S100Bp).
RESULTS: A total of 72 patients were included in the study, with a mean patient age of 2 to 13 years (median=6), 28 males and 44 females. S100Bp values (median=66.5ng/L) were significantly lower (P=.0059) than those of S100Bb (median=84.0ng/L). The median of the difference between S100Bp and S100Bb was -11.0ng/L.
CONCLUSIONS: Inhaled sevoflurane at low doses causes a decrease of serum S100B protein levels, hence, this drug could have a neuroprotective effect in the central nervous system.