miércoles, 16 de mayo de 2018

Laringoespasmo / Laryngospasm

Mayo 16, 2018. No. 3082
Actualización en el manejo del laringoespasmo
Update on the management of laryngospasm.
Hernández-Cortez E.
J Anesth Crit Care Open Access. 2018;8(2):1-6. DOI: 10.15406/jaccoa.2018.08.00327
Introduction
Laryngospasm is defined as the sustained closure of the vocal cords. It is a primitive protective airway reflex, which happens to safeguard the integrity of the airway by protecting it from tracheobronchial aspiration.1 Laryngospasm is also defined as an exaggerated response of the closure reflex or glottic muscle spasm. Essentially is a protective reflex, which acts to prevent the entry of any foreign material into the tracheobronchial tree. The presence of this reflex results in an impediment to adequate breathing, under these conditions it becomes a sudden obstruction of upper airway. A feature of laryngospasm is that the airway closure is maintained even after the initial causal stimulus disappears. In any of the situations mentioned above, we face a partial or total loss of the airway, and therefore an anesthetic urgency. Forty % of the airway obstructions are secondary to laryngospasm, and this may result in a life-threatening complication, and is a major cause of cardiac arrest in the pediatric patient.
Eficacia de lidocaína para prevenir laringoespasmo en niños: Revisión sistemática y meta-análisis
The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis.
Anaesthesia. 2014 Dec;69(12):1388-96. doi: 10.1111/anae.12788. Epub 2014 Jul 3.
Abstract
The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. We included randomised controlled trials reporting the effects of intravenous and/or topical lidocaine on the incidence of laryngospasm during general anaesthesia. Nine studies including 787 patients were analysed. The combined results demonstrated that lidocaine is effective in preventing laryngospasm (risk ratio (RR) 0.39, 95% CI 0.24-0.66; I(2)  = 0). Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.
Espasmo en la vía aérea pediátrica: ¿Qué hacer?
Dra. Liliana Ramírez-Aldana, Dr. David Ángel Pablo García-Arreola, Dra. Deoselina Hernández-Gutiérrez
Rev Mex Anestesiol Vol. 35. Supl. 1 Abril-Junio 2012 pp S159-S163
RESUMEN
Los niños poseen características anatómicas y funcionales de la vía aérea que los difi eren de los adultos. Estas diferencias son sufi cientes para provocar que al presentarse un espasmo de la vía aérea superior o inferior, si no se resuelve adecuadamente, el acto anestésico puede terminar en una catástrofe. Por lo que en el presente artículo revisaremos en forma breve las diferencias anatómicas y funcionales de la vía aérea pediátrica en relación con el adulto y dos entidades: el laringoespasmo y el broncoespasmo haciendo énfasis en la defi nición, fi siopatología, etiología, formas de prevención y sugerencias de tratamiento. Palabras clave: Vía aérea pediátrica, espasmo, extubación, laringoespasmo, broncoespasmo.
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