Vía aérea en situaciones de urgencia

Dosis optima de succinilcolina para intubar pacientes de emergencias: estudio retrospectivo comparativo The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study. Ezzat A, Fathi E, Zarour A, Singh R, Abusaeda MO, Hussien MM. Anesthesia, ICU & Pain Management, Hamad General Hospital, Doha, Qatar. Libyan J Med. 2011;6. doi: 10.3402/ljm.v6i0.7041. Epub 2011 Jul 14.  Abstract BACKGROUND: Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED(95). OBJECTIVES: To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. METHODS: This retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. RESULTS: Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients. CONCLUSION: Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139274/pdf/LJM-6-7041.pdf   Manejo de la Vía Aérea en Emergencias Dr. Pedro Charco Mora Anestesia en México 2008;20(1): 14-22 Resumen El manejo adecuado de la vía aérea en situaciones de urgencia y de prevención de aspiración es mandatorio en el tratamiento de los pacientes, y se requiere de médicos y personal paramédico con experiencia en el control de la vía aérea. Las dificultades en el control de la vía aérea se aumentan por fallas vitales, el riesgo de aspiración, y el potencial daño de la columna cervical, en los pacientes combativos, y el obvio riesgo de intubación traqueal difícil relativo al daño cervical. Este artículo de revisión describe los lineamientos para valorar al paciente y para asegurar la vía aérea de forma correcta. Palabras clave: Urgencias, manejo de la vía aérea. http://www.anestesiaenmexico.org/RAM9/RAM2008-20-1/005.pdf   Manejo de la vía aérea en el paciente politraumatizado Presentación en Power Points del Dr. Víctor Rodríguez Médico Especialista en Medicina de Emergencia y Desastres, Venezuela http://www.reeme.arizona.edu/materials/V%C3%ADa%20A%C3%A9rea%20en%20el%20Paciente%20Politraumatizado.pdf

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