| La vía aérea en el perioperatorio |
Cortés-Peralta Aurelio
Médico Anestesiólogo Adscrito. Hospital General de Zona No.1 "Dr. Demetrio Mayoral Pardo"
Instituto Mexicano del Seguro Social. Oaxaca, Oax.
peraltidaa@gmail.com
Rev Eviden Invest Clin 2010; 3 (1): 37-50
El cuidado de la vía aérea en el perioperatorio del paciente quirúrgico es una gran responsabilidad del Anestesiólogo, el conocimiento anatómico y fisiológico es básico, en la visita preanestésica se realizará una evaluación meticulosa y dirigida a la vía respiratoria buscando cambios en las estructuras anatómicas de los pacientes, el análisis de los datos recopilados en el interrogatorio y exploración física determinan las medidas preventivas pertinentes que deben tomarse en cuenta para el manejo adecuado principalmente durante la inducción e intubación, la vía aérea difícil requiere una evaluación detenida para establecer guías, estrategias y algoritmos secuenciales para su manejo, con ello ayudará a prevenir las eventualidades; los cuidados durante el procedimiento anestésico-quirúrgico deben mantenerse
estrechos ante cualquier evento adverso, asimismo se continuará en el postanestesico, todo ello nos lleva a establecer el control adecuado y abatir la morbimortalidad.http://www.coloaxane.org/pdf/Viaaereaperioperatorio.PDF
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| Un algoritmo Nuevo para el manejo de la vía aérea difícil basado en el índice de El Ganzouri y en el videolaringoscopio GlideScope®. ¿Una nueva vista para intubación? |
A new difficult airway management algorithm based upon the El Ganzouri Risk Index and GlideScope® videolaryngoscope. A new look for intubation?
Caldiroli D, Cortellazzi P.
Department of Neuroanesthesia and Intensive Care, Neurologic Institute Carlo Besta, Milan, Italy - dcaldiroli@istituto-besta.it.
Minerva Anestesiol. 2011 May 24. [Epub ahead of print]
Abstract
BACKGROUND: An El Ganzouri risk index test (EGRI) score of seven and the ability to achieve difficult laryngeal exposure with the GlideScope® may represent a highly predictive decisional threshold. Hence, we hypothesized that a new difficult airways algorithm that is EGRI- and GlideScope®-based may enable tracheal intubation in every patient. METHODS: Thirteen staff practitioners trained in videolaryngoscopic intubation followed the algorithm from 2008 through 2010. Elective and emergency neurosurgical patients assessed as having an EGRI score of seven and higher underwent flexible fiberoptic bronchoscopy (FFB) intubation while conscious. Those with a score of six and lower were intubated with the GlideScope®, excluding patients with morbid obesity or pharyngo-laryngeal or neck tumors. A decision to perform alternative procedures, difficult laryngeal exposure (Cormack and Lehane (CL) grades III-IV), difficult ventilation and failure to intubate were recorded RESULTS: The decisional rule was applied in 6,276 patients and resulted in six FFB intubations in conscious patients. The overall incidence of CL grade III-IV views was 0.2%. Difficult videolaryngoscopy was found in 14 patients (0.14%) with a score of 6 and lower. Post-hoc examinations of FFB intubations revealed five difficult laryngeal exposures. The positive predictive value was 85.7%, while the negative predictive value was 99.9%. The incidence of difficult ventilation and difficult laryngeal exposure was 0.03%. Two patients with neck tumors were assigned to alternative procedures. CONCLUSION: Adherence to the decisional process of the algorithm and to GlideScope® videolaryngoscopy achieved successful tracheal intubation in our cohort of patients
http://www.minervamedica.it/en/freedownload.php?cod=R02Y9999N00A0265&sid=27600205074437
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| Un algoritmo para el manejo de la vía aérea modificado para los instrumentos ópticos modernos (laringoscopio Airtraq, LMA CTrach™): validación prospectiva de 2 años en pacientes para cirugía electiva ambdominal, ginecológica y del tiroides. |
An algorithm for difficult airway management, modified for modern optical devices (Airtraq laryngoscope; LMA CTrach™): a 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery.
Amathieu R, Combes X, Abdi W, Housseini LE, Rezzoug A, Dinca A, Slavov V, Bloc S, Dhonneur G.
Anaesthesia and Intensive Care Unit Department, Jean Verdier University Hospital of Paris, Bondy, France.
Anesthesiology. 2011 Jan;114(1):25-33.
Abstract
BACKGROUND: Because algorithms for difficult airway management, including the use of new optical tracheal intubation devices, require prospective evaluation in routine practice, we prospectively assessed an algorithm for difficult airway management that included two new airway devices. METHODS: After 6 months of instruction, training, and clinical testing, 15 senior anesthesiologists were asked to use an established algorithm for difficult airway management in anesthetized and paralyzed patients. Abdominal, gynecologic, and thyroid surgery patients were enrolled. Emergency, obstetric, and patients considered at risk of aspiration were excluded. If tracheal intubation using a Macintosh laryngoscope was impossible, the Airtraq laryngoscope (VYGON, Ecouen, France) was recommended as a first step and the LMA CTrach™ (SEBAC, Pantin, France) as a second. A gum elastic bougie was advocated to facilitate tracheal access with the Macintosh and Airtraq laryngoscopes. If ventilation with a facemask was impossible, the LMA CTrach™ was to be used, followed, if necessary, by transtracheal oxygenation. Patient characteristics, adherence to the algorithm, efficacy, and early complications were recorded. RESULTS: Overall, 12,225 patients were included during 2 yr. Intubation was achieved using the Macintosh laryngoscope in 98% cases. In the remainder of the cases (236), a gum elastic bougie was used with the Macintosh laryngoscope in 207 (84%). The Airtraq laryngoscope success rate was 97% (27 of 28). The LMA CTrach™ allowed rescue ventilation (n = 2) and visually directed tracheal intubation (n = 3). In one patient, ventilation by facemask was impossible, and the LMA CTrach™ was used successfully. CONCLUSIONS:
Tracheal intubation can be achieved successfully in a large cohort of patients with a new management algorithm incorporating the use of gum elastic bougie, Airtraq, and LMA CTrach™ devices.
http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2011&issue=01000&article=00016&type=abstract
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