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Resumen La Seccion de Via Aerea de la Sociedad Catalana de Anestesiologia, Reanimacion y Terapeutica del Dolor (SCARTD) presenta la actualizacion de las recomendaciones para la evaluacion y manejo de la via aerea dificil con el fin de incorporar los avances tecnicos y los cambios observados en la practica clinica desde la publicacion de la primera edicion en 2008. La metodologia elegida fue la adaptacion de 5 guias internacionales recientemente publicadas, cuyo contenido fue previamente analizado y comparado de forma estructurada, y el consenso de expertos de los 19 centros participantes. El documento final fue sometido a la valoracion de los miembros de la SCARTD y a la revision por parte de 11 expertos independientes. Estas recomendaciones estan pues sustentadas en la evidencia cientifica actualmente disponible y en un amplio acuerdo de los profesionales de su ambito de aplicacion. En esta edicion se amplia la definicion de via aerea dificil, abarcando todas las tecnicas de manejo, y se hace mayor hincapie en la valoracion de la via aerea y en la clasificacion en 3 categorias segun el potencial grado de dificultad y las consideraciones de seguridad adicionales, que guiaran la planificacion de la estrategia a seguir. La preparacion previa al manejo de la via aerea, no solo relativa al paciente y al material, sino tambien a la comunicacion e interaccion entre todos los agentes implicados, ocupa un lugar destacado en todos los escenarios incluidos en el presente documento. El texto refleja el aumento progresivo del uso de los videolaringoscopios y de los dispositivos de segunda generacion en nuestro entorno y promueve tanto su uso electivo como el uso precoz en la via aerea no prevista. Tambien recoge la creciente utilizacion de la ecografia como herramienta de apoyo en la exploracion y toma de decisiones. Se han abordado nuevos escenarios como el riesgo de broncoaspiracion y la extubacion considerada dificil. Finalmente, se trazan las lineas maestras de los programas de entrenamiento y formacion continuada en via aerea necesarios para garantizar la implementacion efectiva y segura de las recomendaciones.

The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.

Nowadays aspiration for a better quality of life includes a growing demand for lower noise air conditioners. There consequently seems to be a need for tools that would help manufacturers to understand both the generation of noise in a device and its propagation to the surrounding medium. In the present paper, we propose a modelling tool for making a global diagnosis of the propagation of mechanical and acoustical waves inside and from an existing air conditioner. We also use that tool to try to foresee the efficiency of a noise reduction solution.