Mascarilla laríngea y reflujo gastroesofágico

Encuesta del uso electivo de mascarilla laríngea en presencia de enfermedad por reflujo gastroesofágico Survey of Elective Laryngeal Mask Airway Use in the Presence of Gastroesophageal Reflux Disease Allison J. Lee and Keith A. Candiotti Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Leonard M. Miller.School of Medicine, Miami, FL, USA The Open Anesthesiology Journal, 2010, 4, 1-4 Abstract: Concern exists about the potential risks of pulmonary aspiration with the laryngeal mask airway (LMA) due to its inability to provide a tight seal at the larynx. The safety of LMA use in the presence of gastroesophageal reflux disease (GERD) is unclear, as GERD is presumed to increase the risk of aspiration under anesthesia. VA Anesthesiologists were surveyed regarding their practices in the setting of mild, moderately severe and severe symptoms of GERD. Approximately half responded that they would use a standard LMA in a patient with GERD as long as symptoms are mild. Nineteen percent would not use the LMA in any patient with a history of GERD. Keywords: Laryngeal Mask Airway (LMA), Gastroesophageal Reflux Disease (GERD), Survey, Pulmonary Aspiration, General Anesthesia. http://www.benthamscience.com/open/toatj/articles/V004/1TOATJ.pdf    ¿La mascrailla laríngea ProSeal previene la aspiración del fluido regurgitado? Does the ProSeal laryngeal mask airway prevent aspiration of regurgitated fluid? Keller C, Brimacombe J, Kleinsasser A, Loeckinger A. Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria. Anesth Analg. 2000 Oct;91(4):1017-20. Abstract In this randomized, cross-over cadaver study, we determined whether a new airway device, the ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK), prevents aspiration of regurgitated fluid. We studied five male and five female cadavers (6-24 h postmortem). The infusion set of a pressure-controlled, continuous flow pump was inserted into the upper esophagus and ligated into place. Esophageal pressure (EP) was increased in 2-cm H(2)O increments. This was performed without an airway device (control) and over a range of cuff volumes (0-40 mL) for the classic laryngeal mask airway (LMA), the PLMA with the drainage tube clamped (PLMA clamped) and unclamped (PLMA unclamped). The EP at which fluid was first seen with a fiberoptic scope in the hypopharynx (control), above or below the cuff, or in the drainage tube, was noted. Mean EP at which fluid was seen without any airway device was 9 (range 8-10) cm H(2)O. EP at which fluid was seen was always higher for the PLMA clamped and LMA compared with the control (all, P<0.0001). The mean EP at which fluid was seen for the PLMA unclamped was similar to the control at 10 (range 8-13) cm H(2)O. For the PLMA unclamped, fluid appeared from the drainage tube in all cadavers at 10-40 mL cuff volume and in 8 of 10 cadavers at zero cuff volume. Mean EP at which fluid was seen above the cuff was similar for the PLMA clamped and LMA at 0-30 mL cuff volume, but was higher for PLMA clamped at 40-mL cuff volume (81 vs 48 cm H(2)O, P = 0.006). Mean EP at which fluid was seen below the cuff was similar at 0-10 mL cuff volume, but was higher for the PLMA clamped at 20, 30, and 40 mL cuff volume (62, 68, 73 vs. 46, 46, 46 cm H(2)O, respectively, P<0.04). For the PLMA clamped and the LMA, fluid appeared simultaneously above and below the cuff at all cuff volumes. We concluded that in the cadaver model, the correctly placed PLMA allows fluid in the esophagus to bypass the pharynx and mouth when the drainage tube is open. Both the LMA, and PLMA with a closed drainage tube, attenuate liquid flow between the esophagus and pharynx. This may have implications for airway protection in unconscious patients http://www.anesthesia-analgesia.org/content/91/4/1017.full.pdf+html    Reflujo gastroesofágico durante la anestesia general. Comparación entre: máscara laríngea, combitube y tubo orotraqueal. Dr. Bernardo Bokser, Dr. Hernán Fernández-Cerrotti Rev Mexicana de Anestesiología Vol. 30. No. 1 Enero-Marzo 2007;40-42 RESUMEN Objetivo: Comparar máscara laríngea, combitube y tubo orotraqueal, en cuanto a su capacidad para evitar el reflujo gástrico mediante la medición del pH endotraqueal. Material y métodos: Cuarenta y cinco pacientes (n = 45) bajo anestesia general para cirugía electiva, ASA I y II, mayores de 18 años, con ventilación espontánea y en decúbito dorsal, divididos aleatoriamente en tres grupos homogéneos, máscara laríngea (n = 15), combitube (n = 15) y tubo orotraqueal (n = 15). Premedicados con midazolam 0.1 mg/kg y fentanyl 1-2 γ/kg. Inducidos con tiopental sódico 4-6 mg/kg y succinilcolina 1 mg/kg habiendo precurarizado con bromuro de pancuronio 0.8 mg/kg. Mantenimiento con isofluorano 2-2.5% y fentanyl 2-3 γ/kg; no se utilizó ningún otro relajante muscular. A los 30' de comenzada la cirugía se realizó la medición del pH, utilizando una sonda endoscópica para obtener una muestra de secreción traqueobronquial. La medición se realizó mediante una tira reactiva (Spezialindikator pH 2.0-9.0 Merck). Resultados: El pH promedio en la tráquea de los pacientes del grupo máscara laríngea fue 6.57 (ds ± 0.65), en los del grupo combitube fue 8.33 (ds ± 0.24) y en los del grupo tubo orotraqueal fue 8.33 (ds ± 0.75). Conclusión: El combitube ha demostrado ser un dispositivo tan eficaz como el tubo orotraqueal para evitar el reflujo gastroesofágico, no ocurriendo lo mismo con la máscara laríngea. Palabras clave: Reflujo gástrico, máscara laríngea, combitube, tubo endotraqueal, pH endotraqueal. http://www.medigraphic.com/pdfs/rma/cma-2007/cma071h.pdf

Atentamente Dr. Juan Carlos Flores-Carrillo Anestesiología y Medicina del Dolor www.anestesia-dolor.org