lunes, 21 de julio de 2014

Vía aérea en embarazada/Airway in pregnant women

El embarazo se asocia con disminución en la faringe pero no traqueal o laríngea del área de sección transversal: un estudio piloto utilizando el método de la reflexión acústica

Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method.
Leboulanger N, Louvet N, Rigouzzo A, de Mesmay M, Louis B, Farrugia M, Girault L, Ramirez A, Constant I, Jouannic JM, Fauroux B.
Int J Obstet Anesth. 2014 Feb;23(1):35-9. doi: 10.1016/j.ijoa.2013.08.008. Epub 2013 Aug 22.
BACKGROUND: The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. METHODS:We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery.RESULTS:Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P < 0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P< 0.001). CONCLUSION:Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.

¿Es la investigación ultrasónica de la sombra de aire del diámetro transversal traqueal razonable para la evaluación de la vía aérea difícil en mujeres embarazadas? Un estudio comparativo prospectivo.

Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airway in pregnant women: A prospective comparative study.
Turkay Aydogmus M, Erkalp K, Nadir Sinikoglu S, Usta TA, O Ulger G, Alagol A.
Pak J Med Sci. 2014 Jan;30(1):91-5. doi: 10.12669/pjms.301.3972.
Objective: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. Methods: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. Results: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. Conclusion: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.
KEYWORDS: Pregnancy; airway evaluation; body mass index; diameter of transverse tracheal air shadow; obesity; ultrasonography

ML ProSeal en la vía aérea durante cesárea después de intubación traqueal fallida

Use of a ProSeal laryngeal mask airway for airway maintenance during emergency Caesarean section after failed tracheal intubation.
Awan R, Nolan JP, Cook TM.
Br J Anaesth. 2004 Jan;92(1):144-6.
We report the use of the ProSeal laryngeal mask airway to establish and maintain the airway during emergency Caesarean section when tracheal intubation had failed with conventional laryngoscopy and mask ventilation was difficult. The ProSeal laryngeal mask allowed controlled ventilation without gas leak and facilitated drainage of the stomach.

Anestesiología y Medicina del Dolor

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