miércoles, 30 de noviembre de 2016

Intubación nasal / Nasal intubation

Noviembre 28, 2016. No. 2522


Intubación nasal. Una revisión completa
Nasal intubation: A comprehensive review
Chauhan V, Acharya G.
Indian J Crit Care Med 2016;20:662-7
Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure.
Intubación nasal con fibroscopio con paciente sentado en cirugía electiva de mandíbula bajo anestesia general
Sitting Nasal Intubation With Fiberoptic in an Elective Mandible Surgery Under General Anesthesia.
Anesth Pain Med. 2015 Nov 28;5(6):e29299. doi: 10.5812/aapm.29299. eCollection 2015.
INTRODUCTION: Patients with mandible deformity may die, as a result of airway management failures. The awake nasal fiberoptic intubation is known as the optimum intubation method, in the mentioned patients, although, in several cases, fiberoptic intubation fails. CASE PRESENTATION: The present case discusses a patient with severe deformity of mandible that was admitted for correction with free-flap. The following intubation techniques were used for her airway management, respectively: blind awake nasal intubation, awake oral fiberoptic and awake nasal fiberoptic, which failed all. We therefore decided to perform awake nasal intubation, with fiberoptic, in sitting position. CONCLUSIONS: In this case, after failure of awake fiberoptic intubation, awake direct laryngoscopy and blind nasal intubation, finally awake nasal intubation in sitting position, using fiberoptic led to success.
KEYWORDS: Airway Management; Endotracheal Intubation; Fiber Optic Technology; Free Flaps; Intubation
Uso de sonda nasogástrica para facilitar intubación nasotraqueal. Estudio randomizado controlado
The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial.
Anaesthesia. 2014 Jun;69(6):591-7. doi: 10.1111/anae.12627. Epub 2014 Apr 18.
During nasotracheal intubation, the tracheal tube passes through either the upper or lower pathway in the nasal cavity, and it has been reported to be safer that the tracheal tube passes though the lower pathway, just below the inferior turbinate. We evaluated the use of a nasogastric tube as a guide to facilitate tracheal tube passage through the lower pathway, compared with the 'conventional' technique (blind insertion of the tracheal tube into the nasal cavity). A total of 60 adult patients undergoing oral and maxillofacial surgery were included in the study. In 20 out of 30 patients (66.7%) with the nasogastric tube-guided technique, the tracheal tube passed through the lower pathway, compared with 8 out of 30 patients (26.7%) with the 'conventional' technique (p = 0.004). Use of the nasogastric tube-guided technique reduced the incidence and severity of epistaxis (p = 0.027), improved navigability (p = 0.034) and required fewer manipulations (p = 0.001) than the 'conventional' technique.
Calentamiento del tubo endotraqueal en intubación nasotraqueal a ciegas en cirugía maxilofacial
Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries.
J Cardiovasc Thorac Res. 2013;5(4):147-51. doi: 10.5681/jcvtr.2013.032. Epub 2013 Dec 5.
INTRODUCTION: Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 deg;C and to compare the patients in terms of success rate and complications. METHODS: 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. RESULTS:success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. CONCLUSION:In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.
KEYWORDS: Anesthesia; Blind Intubation; Endotracheal Tube; Oral and Maxillofacial Surgery; Warming
Segundo Curso-Taller de Anestesia y Dolor
Zapopan Jalisco, México
Dic 1-2, 2016
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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