| Inducción anestésica de secuencia rápida en obstetricia: ¿Que tan segura es? |
Rapid-sequence induction of anesthesia in obstetric women: how safe is it?
Asai T.
Department of Anesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan, asait@takii.kmu.ac.jp
J Anesth. 2012 Jun;26(3):321-3. Epub 2012 May 19.
A 35-year-old woman, 154 cm, 86 kg, with placenta previa and preeclampsia, had massive bleeding after consuming a lunch. She was immediately transferred to the operating room, where an anesthesiologist was called in. She was morbidly obese, having large breasts and a low-pitched voice (indicative of laryngeal edema), and the view of the oropharynx was obscured (Mallampati score 4). Awake tracheal intubation was attempted, but the patient refused to open her mouth. General anesthesia was induced as a rapid sequence, and tracheal intubation was attempted, but failed twice. A senior anesthesiologist was called in and accomplished intubation. Cesarean section was started. Soon after this, it was found that the tube was wrongly inserted into the esophagus. The tube was taken out and mask ventilation was attempted, but this was difficult. Arterial hemoglobin oxygen saturation rapidly decreased to 70 % with cardiac arrhythmia. Nevertheless, the baby was successfully taken out and the mother started to breathe. As the operation would continue, the laryngeal mask airway was inserted. The mother vomited and aspirated.
http://www.springerlink.com/content/7g6ut4877qv12400/fulltext.pdf
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| Intubación difícil no anticipada en obstetricia |
The unanticipated difficult intubation in obstetrics.
Mhyre JM, Healy D.
Department of Anesthesiology, The University of Michigan Health System, L3622 Women's Hospital, 1500 E. Medical Center Dr., SPC 5278, Ann Arbor, MI 48109-5278, USA. jmmhyre@umich.ed
Anesth Analg. 2011 Mar;112(3):648-52.
Abstract
In this focused review, we discuss an algorithm specifically for the unanticipated difficult intubation in obstetrics. This generic algorithm emphasizes a standardized and prespecified sequence of interventions to provide safe, efficient, and effective airway management for the emergency obstetric surgical patient. Individual institutions and anesthesia providers are encouraged to use this framework to select specific pieces of equipment for each step, and to create regular opportunities for all obstetric anesthesia providers to become facile with each airway device and to integrate the algorithm under simulated conditions.
http://www.anesthesia-analgesia.org/content/112/3/648.full.pdf
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| Parturienta obesa morbida: Retos para el anestesiólogo incluyendo el manejo de la vía aérea difícil en obstetricia. ¿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.
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| Cambios en la clasificación de Mallampati durante el embarazo, parto y después del embarazo: ¿Pueden ser previstos? |
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.
http://bja.oxfordjournals.org/content/104/1/67.full.pdf |
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