Mascarilla laríngea y embarazo

La mascarilla laríngea es efectiva (y probablemente segura) en parturientas sanas seleccionadas para cesárea electiva: estudio prospectivo de 1067 casos . The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases Tae-Hyung Han MD PhD FAAFP, Joseph Brimacombe MB CHB FRCAMD, Eun-Ju Lee MD, Hong-Seuk Yang MD PhD CAN J ANESTH 2001 / 48: 11 / pp 1117-1121 Purpose: To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia. Methods: Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N2O and 50% O2 and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO2 <94%, or end-tidal CO2 >45 mmHg. Postdelivery, vecuronium and fentanyl were administered. Results: An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO2 <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were $7 after five minutes. Conclusion: We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users. http://anesthesiology.med.miami.edu/documents/mm_articles/54.pdf   Intubación traqueal fallida obstétrica y soporte respiratorio con mascarilla laríngea ProSeal Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway. Keller C, Brimacombe J, Lirk P, Pühringer F. Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria. Anesth Analg. 2004 May;98(5):1467-70 Abstract The ProSeal laryngeal mask airway (ProSeal LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative respiratory support. Both laryngoscope-guided tracheal intubation and face mask ventilation failed, but a size 4 ProSeal LMA was easily inserted and high tidal volumes obtained. A gastric tube was inserted through the ProSeal LMA drain tube and 300 mL of clear fluid was removed from the stomach. There were no hemodynamic changes during ProSeal LMA insertion. Postoperatively, the patient was transferred to the intensive care unit, where she was ventilated via the ProSeal LMA for 8 h until the platelet count had increased and she was hemodynamically stable. Weaning and ProSeal LMA removal were uneventful. There is anecdotal evidence supporting the use of the LMA devices for failed obstetric intubation (19 cases) and for postoperative respiratory support (8 cases). In principle, the ProSeal LMA may offer some advantages over the classic LMA in both these situations. IMPLICATIONS: We report the successful use of the ProSeal laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrome. http://www.anesthesia-analgesia.org/content/98/5/1467.full.pdf+html   Uso de la mascarilla laríngea ProSeal para el mantenimiento durante cesárea urgente después de intubación traqueal fallida Use of a ProSeal laryngeal mask airway for airway maintenance during emergency Caesarean section after failed tracheal intubation. Awan R, Nolan JP, Cook TM. Royal United Hospital, Combe Park, Bath BA1 3NG, UK.timcook@ukgateway.net Br J Anaesth. 2004 Jan;92(1):144-6. Abstract We report the use of the ProSeal laryngeal mask airway to establish and maintain the airway during emergency Caesarean section when tracheal intubation had failed with conventional laryngoscopy and mask ventilation was difficult. The ProSeal laryngeal mask allowed controlled ventilation without gas leak and facilitated drainage of the stomach. http://bja.oxfordjournals.org/content/92/1/144.full.pdf+html  Vía aérea difícil en anestesia obstétrica Difficult Airway in Obstetric Anesthesia Sonia J. Vaida TMJ 2006, Vol. 56, No. 2-3 ABSTRACT The difficult airway in obstetric anesthesia represents an important problem, the incidence being eight times higher than in the non-pregnant population and the morbidity thirteen times higher. In these conditions, the trend in anesthesia for cesarian section is to avoid as much as possible general anesthesia and this trend can determinate a relative inexperience with the obstetric airway. In this review we will present the causes for difficult intubation in pregnant patients, the risks associated with this condition and the management of the difficult airway in a decision making protocol. We will also make a description of the supraglotic airway devices, with there indications, contraindications and limits. http://www.tmj.ro/pdf/2006_number_2_3_6979794659124497.pdf

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org