| Vía aérea difícil en anestesia obstétrica |
José Guzmán
Rev Chil Anest, 2010; 39: 116-124
Las complicaciones derivadas del manejo de la vía aérea representan la principal causa de morbimortalidad materna de origen anestésico. No se trata sólo de intubación difícil y/o aspiración de contenido gástrico, sino también broncoespasmo, depresión respiratoria y trauma de la vía aérea, causas que han cobrado mayor importancia relativa en los últimos años. Se entiende por intubación difícil en obstetricia a la imposibilidad de intubar durante el tiempo de
relajación dado por una dosis de succinilcolina o bien al fracaso de dos buenos intentos.
http://www.sachile.cl/upfiles/revistas/4ce141c7805f9_guzman.pdf
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Parturienta obesa mórbida: retos para el anestesiólogo, incluyendo el manejo de la vía aérea difícil. ¿Que hay de nuevo? |
Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?
Rao DP, Rao VA.
Department of Anaesthesiology, Siddhartha Medical College, Government General Hospital, Government of Andhra Pradesh, Vijayawada, India.
Indian J Anaesth. 2010 Nov;54(6):508-21.
Abstract
The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia
http://www.ijaweb.org/article.asp?issn=0019-5049;year=2010;volume=54;issue=6;spage=508;epage=521;aulast=Rao
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| Cambios en la valoración de Mallampati durante el embarazo, parto y puerperio: ¿Se pueden predecir? |
Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted?
Boutonnet M, Faitot V, Katz A, Salomon L, Keita H.
Service d'Anesthésie, Hôpital Louis Mourier, 178 rue des Renouillers, F-92701 Colombes, France.
Br J Anaesth. 2010 Jan;104(1):67-70.
Abstract
BACKGROUND: An increase in Mallampati class is associated with difficult laryngoscopy in obstetrics. The goal of our study was to determine the changes in Mallampati class before, during, and after labour, and to identify predictive factors of the changes. METHODS: Mallampati class was evaluated at four time intervals in 87 pregnant patients: during the 8th month of pregnancy (T(1)), placement of epidural catheter (T(2)), 20 min after delivery (T(3)), and 48 h after delivery (T(4)). Factors such as gestational weight gain, duration of first and second stages of labour, and i.v. fluids administered during labour were evaluated for their predictive value. Mallampati classes 3 and 4 were compared for each time interval. Logistic regression was used to test the association between each factor and Mallampati class evolution.
RESULTS: Mallampati class did not change for 37% of patients. The proportion of patients falling into Mallampati classes 3 and 4 at the various times of assessment were: T(1), 10.3%; T(2), 36.8%; T(3), 51.7%; and T(4), 20.7%. The differences in percentages were all significant (P<0.01). None of the evaluated factors was predictive. CONCLUSIONS: The incidence of Mallampati classes 3 and 4 increases during labour compared with the pre-labour period, and these changes are not fully reversed by 48 h after delivery. This work confirms the absolute necessity of examining the airway before anaesthetic management in obstetric patients.
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