[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter]

OBJECTIVE

The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment.

MATERIAL AND METHODS

We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia.

RESULTS

The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement.

CONCLUSION

Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

[Airtraq optical laryngoscopy]

Endotracheal intubation using direct laryngoscopy continues to be the "gold standard" amongst all the techniques for isolating the airway. Generally this is a secure manoeuvre, but it might become a situation of extreme emergency when dealing with an unexpected difficult airway. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a new tool for use with the patient. The fact that it is easy to learn to use and simple to handle makes it a practical device in many situations where managing the airway is indicated. Its advantages over the Macintosh laryngoscope have been demonstrated in patients with an airway that it is difficult to manage and in adverse situations outside the surgical setting, when endotracheal intubation has been achieved in a simple way following unsuccessful attempts with conventional laryngoscopes. The greatest benefits in using the Airtraq laryngoscope have been shown in patients with a pronounced limitation of cervical mobility, and in those where the airway is distorted for anatomical reasons, such as pregnant women and obese patients.