Presión del globo del tubo endotraqueal y de la mascarilla laríngea durante anestesia- Se requiere una vigilancia obligatoria

Presión del globo del tubo endotraqueal y de la mascarilla laríngea durante anestesia- Se requiere una vigilancia obligatoria Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need. Rokamp KZ, Secher NH, Moller AM, Nielsen HB. BMC Anesthesiol. 2010 Dec 3;10(1):20. [Epub ahead of print] Abstract BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. RESULTS: In the 119 patients provided with an endotracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured.CONCLUSION: For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery. . Artí­culo en PDF Manejo urgente de la vía aérea Emergency airway management. Gudzenko V, Bittner EA, Schmidt UH. Department of Anesthesiology, Critical Care, and Pain Management, Massachusetts General Hospital, Gray-Bigelow 444, 55 Fruit Street, Boston, MA 02114, USA. Respir Care. 2010 Aug;55(8):1026-35. Abstract Emergency airway management is associated with a high complication rate. Evaluating the patient prior to airway management is important to identify patients with increased risk of failed airways. Pre-oxygenation of critically ill patients is less effective in comparison to less sick patients. Induction agents are often required, but most induction agents are associated with hypotension during emergency intubation. Use of muscle relaxants is controversial for emergency intubation, but they are commonly used in the emergency department. Supervision of emergency airway management by attending physicians significantly decreases complications. Standardized algorithms may increase the success of emergency intubation. Attention should be paid to cardiopulmonary stability in the immediate post-intubation period. Artí­culo en PDF Aspectos organizacionales del manejo de la vía aérea difícil. Piense globalmente y actúe localmente Organizational Aspects of Difficult Airway Management. Think Globally, Act Locally Ulrich Schmidt, M.D., Ph.D., Matthias Eikermann, M.D., Ph.D., Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts Anesthesiology 2011; 114:3- 6 In 1858, Eugène Bouchut, a pediatrician from Paris, published a series of seven cases of successful orotracheal intubation to bypass laryngeal obstruction resulting from diphtheria. His presentation was reportedly not well received by the French Academy of Sciences because of safety concerns. Today, millions of tracheal intubation procedures are performed every year, and in emergent situations, the procedure still carries a high risk of complications of up to 30%. Accordingly, new information that could potentially lead to improved outcome of tracheal intubation is important. In this issue of Anesthesiology, four groups of clinical researchers 2-5 present important new insight that might help improve the safety of patients undergoing emergency tracheal intubation. The work of Combes et al and Martin et al focused on emergent intubation, whereas Amathieu et al. and Aziz et al report on their experiences with new devices to manage a difficult airway in the operating room. Leer artículo

Atentamente Dres. Enrique Hernández-Cortes, Juan C. Flores-Carrillo y Víctor M. Whizar-Lugo. Ings. Ana I. Whizar-Figueroa, Victor M. Whizar-Figueroa Anestesiología y Medicina del Dolor www.anestesia-dolor.org