sábado, 26 de julio de 2014

La vía aérea es siempre una incógnita a la que todo médico se enfrenta con frecuencia variable. Normal o difícil, es un reto que debemos de manejar en forma correcta. Hoy se inicia una serie de envios con información elemental y novedosa de los índices predictivos que se deben de utilizar al evaluar la vía aérea de cada paciente. Deseamos le sean de utilidad. The airway is always a question to which every physician faces with varying frequency. Normal or difficult, it is a challenge we must handle properly. Today we start several e-mails with basic and fresh information of predictive indexes, that must be used to assess each patient's airway. We hope you find them useful. راه هوایی یک سوال که هر پزشک با فرکانس های مختلف مواجه است همیشه. عادی یا دشوار است، آن را یک چالش ما باید به درستی رسیدگی است. امروز تعدادی از ابتدایی و تازه با اطلاعات جدید از شاخص های پیش بینی شده است که باید به ارزیابی راه هوایی شروع می شود هر بیمار استفاده می شود. ما امیدواریم که شما پیدا کردن آنها مفید است. Validez de los predictores de vía aérea en pacientes externos Validity of airway predictors in outpatient medicine. Mateos Rodríguez A, Navalpotro Pascual J, Pardillos Ferrer L, Fernández Domínguez J, Barragán Chávez J, Martínez González E. An Sist Sanit Navar. 2014 Jan-Apr;37(1):91-8. Abstract Isolation of the airway sometimes determines the survival or death of the patient. To anticipate the presence of a difficult airway (DA) there are a number of indicators that are validated for hospitals: Mallampati, sternum and thyromental distance, interdental distance and Cormack grade. The aim of this study is to evaluate the use of these indicators in the ambulatory setting and to know the incidence of DA. This data was collected from 324 intubations. Most patients were males (65.2%). The average age of the population was 63 years and no significant difference in age between DA and DA was found. A DA presence of 20.7% was objectified and an alternative device utilization of 21.4%. The thyromental distance was abnormal in 59% of patients and sternomentonal distance in 56.4% but neither showed an association with the presence of DA (p = 0.681 and p = 0.415 respectively). Interdental distance was less than 3 cm if presence is associated with DA (p = 0.005). The sensitivity and specificity of all measures are low. According to our series the sternum and thyromental distance are not useful in the ambulatory setting, but interdental distance is useful for predicting a DA. http://recyt.fecyt.es/index.php/ASSN/article/view/23289/15545 Predicción de laringoscopía difícil. Puntuación de Mallampati extendida versus MMT, ULBT y RHTDM Mallampati Extended puntuación frente al MMT, ULBT y RHTMD. Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD. Safavi M, Honarmand A, Amoushahi M. Adv Biomed Res. 2014 May 28;3:133. doi: 10.4103/2277-9175.133270. eCollection 2014. Abstract BACKGROUND:Preoperative using of anatomical landmarks detects potentially difficult laryngoscopies. The main object of the present study was to evaluate the predictive power of Extended Mallampati Score (EMS) in comparison with modified Mallampati test (MMT), the ratio of height tothyromental distance (RHTMD) and the Upper-Lip-Bite test (ULBT) in isolation and combination. MATERIALS AND METHODS:Four hundred seventy sixadult patients who candidate for elective surgery under general anesthesia requiring endotracheal intubation were included in this study and evaluated based of all four factors before surgery. This study was randomized prospective double - blind. After that, laryngoscopy was performed by an anesthesiologist who didn't involve in preoperative airway assessment and graded based on Cormack and Lehane's classification. We calculated sensitivity, specificity, and area under receiver-operating characteristic (ROC) (AUC) for each score. RESULTS:The AUCof the ROC was significantly more for the ULBT (AUC = 0.820, P = 0.049) and RHTMD score (AUC = 0.845, P = 0.033) than the EMS (AUC = 0.703). This variable was significantly higher for the EMS compared with MMT (0.703 vs. 0.569, P = 0.046 respectively). There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score (P = 0.685). The optimalcut-off point for the RHTMD for predicting difficult laryngoscopy was 29.3. CONCLUSION:EMS predicted difficult laryngoscopy better than MMT while both ULBT and RHTMD had more power than EMS and MMT in this regard. ULBT and RHTMD had similar predictive value for prediction of difficult laryngoscopy in general population. KEYWORDS: Difficult laryngoscopy; extended mallampati score; modified mallampati; ratio of patient's height to thyromental distance; upper lip bite test http://www.advbiores.net/downloadpdf.asp?issn=2277-9175;year=2014;volume=3;issue=1;spage=133;epage=133;aulast=Safavi;type=2 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063103/ Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

La vía aérea es siempre una incógnita a la que todo médico se enfrenta con frecuencia variable. Normal o difícil, es un reto que debemos de manejar en forma correcta. Hoy se inicia una serie de envios con información elemental y novedosa de los índices predictivos que se deben de utilizar al evaluar la vía aérea de cada paciente. Deseamos le sean de utilidad.

The airway is always a question to which every physician faces with varying frequency. Normal or difficult, it is a challenge we must handle properly. Today we start several e-mails with basic and fresh information of predictive indexes, that must be used to assess each patient's airway. We hope you find them useful.

راه هوایی یک سوال که هر پزشک با فرکانس های مختلف مواجه است همیشه. عادی یا دشوار است، آن را یک چالش ما باید به درستی رسیدگی است. امروز تعدادی از ابتدایی و تازه با اطلاعات جدید از شاخص های پیش بینی شده است که باید به ارزیابی راه هوایی شروع می شود هر بیمار استفاده می شود. ما امیدواریم که شما پیدا کردن آنها مفید است.


Validez de los predictores de vía aérea en pacientes externos


Validity of airway predictors in outpatient medicine.
Mateos Rodríguez A, Navalpotro Pascual J, Pardillos Ferrer L, Fernández Domínguez J, Barragán Chávez J, Martínez González E.
An Sist Sanit Navar. 2014 Jan-Apr;37(1):91-8.
Abstract
Isolation of the airway sometimes determines the survival or death of the patient. To anticipate the presence of a difficult airway (DA) there are a number of indicators that are validated for hospitals: Mallampati, sternum and thyromental distance, interdental distance and Cormack grade. The aim of this study is to evaluate the use of these indicators in the ambulatory setting and to know the incidence of DA. This data was collected from 324 intubations. Most patients were males (65.2%). The average age of the population was 63 years and no significant difference in age between DA and DA was found. A DA presence of 20.7% was objectified and an alternative device utilization of 21.4%. The thyromental distance was abnormal in 59% of patients and sternomentonal distance in 56.4% but neither showed an association with the presence of DA (p = 0.681 and p = 0.415 respectively). Interdental distance was less than 3 cm if presence is associated with DA (p = 0.005). The sensitivity and specificity of all measures are low. According to our series the sternum and thyromental distance are not useful in the ambulatory setting, but interdental distance is useful for predicting a DA.
http://recyt.fecyt.es/index.php/ASSN/article/view/23289/15545






Predicción de laringoscopía difícil. Puntuación de Mallampati extendida versus MMT, ULBT y RHTDM

Mallampati Extended puntuación frente al MMT, ULBT y RHTMD.
Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD.
Safavi M, Honarmand A, Amoushahi M.
Adv Biomed Res. 2014 May 28;3:133. doi: 10.4103/2277-9175.133270. eCollection 2014.
Abstract
BACKGROUND:Preoperative using of anatomical landmarks detects potentially difficult laryngoscopies. The main object of the present study was to evaluate the predictive power of Extended Mallampati Score (EMS) in comparison with modified Mallampati test (MMT), the ratio of height tothyromental distance (RHTMD) and the Upper-Lip-Bite test (ULBT) in isolation and combination. MATERIALS AND METHODS:Four hundred seventy sixadult patients who candidate for elective surgery under general anesthesia requiring endotracheal intubation were included in this study and evaluated based of all four factors before surgery. This study was randomized prospective double - blind. After that, laryngoscopy was performed by an anesthesiologist who didn't involve in preoperative airway assessment and graded based on Cormack and Lehane's classification. We calculated sensitivity, specificity, and area under receiver-operating characteristic (ROC) (AUC) for each score. RESULTS:The AUCof the ROC was significantly more for the ULBT (AUC = 0.820, P = 0.049) and RHTMD score (AUC = 0.845, P = 0.033) than the EMS (AUC = 0.703). This variable was significantly higher for the EMS compared with MMT (0.703 vs. 0.569, P = 0.046 respectively). There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score (P = 0.685). The optimalcut-off point for the RHTMD for predicting difficult laryngoscopy was 29.3. CONCLUSION:EMS predicted difficult laryngoscopy better than MMT while both ULBT and RHTMD had more power than EMS and MMT in this regard. ULBT and RHTMD had similar predictive value for prediction of difficult laryngoscopy in general population.
KEYWORDS: Difficult laryngoscopy; extended mallampati score; modified mallampati; ratio of patient's height to thyromental distance; upper lip bite test

http://www.advbiores.net/downloadpdf.asp?issn=2277-9175;year=2014;volume=3;issue=1;spage=133;epage=133;aulast=Safavi;type=2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063103/



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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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