viernes, 11 de julio de 2014

VAD en embarazadas/Difficult airway in pregnancy

La parturienta con obesidad mórbida. Retos para el anestesiólogo, incluyendo la vía aérea dificl. ¿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.
Indian J Anaesth. 2010 Nov;54(6):508-21. doi: 10.4103/0019-5049.72639.

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.
KEYWORDS:Adipocyte; complications; difficult airway; morbidly obese; parturient; regional; team work

Muerte fetal debido a compromiso de la vía aérea complicada por crisis tiroidea en una madre con enfermedad de Graves. Informe de un caso

Fetal death due to upper airway compromise complicated by thyroid storm in a mother with uncontrolled Graves' disease: a case report.
Yildizhan R, Kurdoglu M, Adali E, Kolusari A.
J Med Case Rep. 2009 May 28;3:7297. doi: 10.1186/1752-1947-3-7297.
We report an unusual case of upper airway compromise complicated by thyroid storm in a pregnant woman with Graves' disease, ending with the in utero death of the fetus. This complication might have developed due to upper airway edema as a result of poorly controlled hyperthyroidism. CASE PRESENTATION:A 41-year-old Turkish woman at 27 weeks' gestation suffering from Graves' disease was referred to our emergency department with a diagnosis of respiratory arrest. She was unconscious and had been intubated. Her laboratory results were compatible with thyrotoxicosis. The patient had suffered from respiratory difficulty for a long time and had stopped using her antithyroid medications after the first trimester of pregnancy. One day before, she had visited an obstetrician because her respiratory distress had increased. At that time, her fetus was still alive. She was given oxygen therapy and then sent home. With a presumptive diagnosis of thyroid storm, she was admitted to the intensive care unit and treated with aggressive medical therapy. The baby was found to be no longer alive and was delivered vaginally after labor induction. The mother was discharged 10 days later with maintenance therapy. CONCLUSION:Hyperthyroidism during pregnancy warrants very close attention and should almost always be treated with appropriate antithyroid medications. Maternal respiratory distress in such patients can be an early sign of impending upper airway compromise and thyroid storm, which can endanger the mother and fetus unless prompt and aggressive therapy is initiated.

Intubación difícil y fallada en 3430 anestesias generales obstétricas

Difficult and failed intubation in 3430 obstetric general anaesthetics.
Djabatey EA, Barclay PM.
Anaesthesia. 2009 Nov;64(11):1168-71.
A retrospective audit was performed of all obstetric general anaesthetics in our hospital over an 8 year period to determine the incidence of difficult and failed intubation. Data was collected from a number of sources to ensure accuracy. A total of 3430 rapid sequence anaesthetics were given. None of the patients had a failed or oesophageal intubation (95% CI, 0-1:1143). There were 23 difficult intubations (95% CI, 1:238-1:100). This was anticipated in nine cases, requiring awake fibreoptic intubation in three cases. Consultants or specialist registrars were involved in the management of all cases. We attribute the low incidence of airway complications to the above average rate of general anaesthesia in our hospital, senior cover and specialised anaesthetic operating department assistants.

Anestesiología y Medicina del Dolor
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