Revisiones_bibliográficas TyO_Web: Más de videolaringoscopios / More on videolaryngoscopes

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miércoles, 1 de marzo de 2017

Más de videolaringoscopios / More on videolaryngoscopes

Febrero 25, 2017. No. 2611

Videolaringoscopios difieren sustancialmente en la iluminación de la cavidad oral: Un estudio de maniquí.

Videolaryngoscopes differ substantially in illumination of the oral cavity: A manikin study.

Pieters BM1, van Zundert AA2.

Indian J Anaesth. 2016 May;60(5):325-9. doi: 10.4103/0019-5049.181593.

Abstract

BACKGROUND AND AIMS: Insufficient illumination of the oral cavity during endotracheal intubation may result in suboptimal conditions. Consequently, suboptimal illumination and laryngoscopy may lead to potential unwanted trauma to soft tissues of the pharyngeal mucosa. We investigated illumination of the oral cavity by different videolaryngoscopes (VLS) in a manikin model. METHODS: We measured light intensity from the mouth opening of a Laerdal intubation trainer comparing different direct and indirect VLS at three occasions, resembling optimal to less-than-optimal intubation conditions; at the photographer's dark room, in an operating theatre and outdoors in bright sunlight. RESULTS: Substantial differences in luminance were detected between VLS. The use of LED light significantly improved light production. All VLS produced substantial higher luminance values in a well-luminated environment compared to the dark photographer's room. The experiments outside-in bright sunlight-were interfered with by direct sunlight penetration through the synthetic material of the manikin, making correct measurement of luminance in the oropharynx invalid. CONCLUSION: Illumination of the oral cavity differs widely among direct and indirect VLS. The clinician should be aware of the possibility of suboptimal illumination of the oral cavity and the potential risk this poses for the patient.

KEYWORDS: Airway; anaesthetic techniques-laryngoscopy; equipment-laryngoscopes; intubation

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Comparación de los videolaringoscopios C-MAC (®) y GlideScope (®) en pacientes con trastornos de la columna cervical e inmovilización.

Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.

Brück S1, Trautner H, Wolff A, Hain J, Mols G, Pakos P, Roewer N, Lange M.

Anaesthesia. 2015 Feb;70(2):160-5. doi: 10.1111/anae.12858. Epub 2014 Sep 29.

Abstract

In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. The first-attempt failure rate for the C-MAC was 42% (95% CI 23-63%) compared with 7% (95% CI 1-22%) for the GlideScope, p = 0.002. The laryngeal view was excellent and comparable with both devices, with the C-MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope.

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Limitaciones de la vídeolaringoscopía. Una realidad del manejo anestésico

Limitations of the Videolaryngoscope: An Anesthetic Management Reality

Ahmed A. Treki, Tracey Straker.

INTERNATIONAL ANESTHESIOLOGY CLINICS 2017;Volume 55, Number 1, 97-104

Securing the airway has always been a challenging task. It requires the development of the nesthesiologist's psychomotor skills and continuous assessment of existing equipment due to technologic advances. Endotracheal intubation has evolved since the introduction of the Macintosh and Miller blades in the 1940s. The technique has changed from the classic concept of obtaining a line of sight by aligning oral, laryngeal, and pharyngeal axes using conventional direct laryngoscopy (DL) to development of alternative indirect tools that capture the glottic view through a small camera at the tip of the blade, transmitting it to a video screen independent of the line of sight. Because of a large array of videolaryngoscope (VL) designs available in practice, one cannot generalize regarding the similarities of these videoscopes. Each VL has its own design features, specifications, and indications.

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