Vía aérea de paciente de cirugía cardiaca / Airway of the cardiac surgical patients

Septiembre 14, 2017. No. 2811

Manejo de la vía aérea de los pacientes para cirugía cardiaca. Perspectivas actuales Airway management of the cardiac surgical patients: Current perspective. Choudhury A1, Gupta N2, Magoon R1, Kapoor PM1. Author information Ann Card Anaesth. 2017 Jan;20(Supplement):S26-S35. doi: 10.4103/0971-9784.197794. Abstract The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Vía aérea en el obeso / Airway in the obese

Junio 27, 2017. No. 2732

El desempeño de la Escala de Dificultad de la Intubación en parturientas obesas sometidas a Cesárea The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section. Eiamcharoenwit J1, Itthisompaiboon N2, Limpawattana P3, Siriussawakul A4. Biomed Res Int. 2017;2017:3075756. doi: 10.1155/2017/3075756. Epub 2017 Jan 26. Abstract Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively. PDF El grado de dificultad de intubación y la frecuencia de complicaciones en pacientes obesos en el Servicio de Urgencias del Hospital y la Unidad de Cuidados Intensivos: Estudio de casos y controles. The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study. Cierniak M1, Sobczak R, Timler D, Wieczorek A, Borkowski B, Gaszyński T. Medicine (Baltimore). 2016 Dec;95(52):e5777. doi: 10.1097/MD.0000000000005777. Abstract The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score. Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to explain those correlations would be needed. PDF Manejo de la vía aérea perioperatoria y periprocedimientos y seguridad respiratoria para el paciente obeso: Consenso SIAARTI 2016. Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus. Petrini F1, Di Giacinto I2, Cataldo R3, Esposito C4, Pavoni V5, Donato P6, Trolio A7, Merli G8, Sorbello M9, Pelosi P10; Obesity Task Force for the SIAARTI Airway Management Study Group. Collaborators (34) Minerva Anestesiol. 2016 Dec;82(12):1314-1335. Epub 2016 Oct 19. Abstract Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as "globesity". Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Obesidad y vía aérea / Obesity and airway

Junio 28, 2017. No. 2733

Índices predictores de vía aérea en pacientes obesos Dr. Javier A Ramírez-Acosta, Dra. Gabriela Griselda Torrico-Lara, Dra. Carla Mónica Encinas-Pórcel Rev Mex Anestesiología Vol. 36. No. 3 Julio-Septiembre 2013 pp 193-201 RESUMEN La tráquea de los pacientes obesos puede ser más difícil de intubar que la de aquellos pacientes con un peso normal. La incidencia de intubación difícil en personas obesas (índice de masa corporal >30 kg/m2) se incrementa hasta tres veces en comparación con pacientes no obesos. Sin embargo, la obesidad por sí sola no predice una intubación traqueal difícil, por lo que se considera un factor de riesgo independiente de la intubación difícil. En la actualidad, las pruebas de detección disponibles para intubación difícil tienen sólo poder de discriminación de pobre a moderado cuando se usan solas. La combinación de tests o maniobras predictivas podría ser más efi ciente al determinar anticipadamente una vía aérea difícil. Incluir el índice de masa corporal en índices de riesgo multifactoriales puede mejorar la predicción de intubación difícil. La gran cantidad de parámetros que predicen intubación difícil como Mallampati, Cormack y Lehane, índice de masa corporal, etc., no son específi cos en la predicción de la intubación traqueal difícil. Previamente, el paradigma de la intubación segura se ha basado en: 1) una valoración preoperatoria adecuada de la vía aérea de los pacientes, 2) habilidades adecuadas para la intubación y 3) herramientas adecuadas para la intubación. Palabras clave: Obesidad, vía aérea difícil. PDF Manejo de la vía aérea en pacientes llevados a cirugía bariátrica en el Hospital Universitario de San Ignacio, Bogotá, Colombia Fritz E. Gempelera,, Lorena Díazb y Lina Sarmient Rev Colomb Anestesiol. 2012;40(2):119-123 Resumen Introducción. La obesidad ha aumentado en los últimos años y aún más los obesos mórbidos, en quienes se han reconocido comorbilidades que dificultan el manejo perioperatorio anestésico, incluido el manejo de la vía aérea. En la valoración preanestésica existen parámetros del examen físico y de la historia clínica que son predictores de intubaciones difíciles o fallidas, y es en estos casos cuando el fibroscopio retromolar de Bonfils ha sido una herramienta útil. Objetivo: Observar los predictores de vía aérea difícil a partir del examen físico, la incidencia de intubación difícil y las herramientas utilizadas para el manejo de la vía aérea en pacientes obesos. Material y métodos: Estudio observacional descriptivo de 352 pacientes obesos llevados a cirugía bariátrica en el Hospital Universitario de San Ignacio, Bogotá, en quienes se evaluó índice de masa corporal, apertura oral, Mallampati, distancia tiromentoniana, circunferencia del cuello y uso de laringoscopio o fibroscopio retromolar de Bonfils y su dificultad en la utilización. Conclusiones: La intubación con fibroscopio retromolar de Bonfils es exitosa en el 100% de los casos observados en pacientes obesos y la dificultad de la intubación con dicho dispositivo no se correlaciona con los parámetros evaluados. PDF Rapidez y eficacia del signo ultrasonográfico de ¨pulmón deslizante¨ y auscultación en la confirmación de la intubación endotraqueal en pacientes con sobrepeso y obesidad. Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients. Rajan S1, Surendran J1, Paul J1, Kumar L1. Indian J Anaesth. 2017 Mar;61(3):230-234. doi: 10.4103/0019-5049.202164. Abstract BACKGROUND AND AIMS: Obese individuals are predisposed to difficult airway and intubation. They usually yield confusing or misleading auscultatory findings. We aimed to assess the rapidity and efficacy of ultrasonographic (USG) sliding lung sign for confirming endotracheal intubation in normal as well as overweight and obese surgical patients. METHODS: This prospective, observational study was performed in forty surgical patients. Twenty patients with body mass index (BMI) <25 were recruited to Group A, whereas twenty patients with BMI ≥25 constituted Group B. Following induction and intubation, appearance of end-tidal carbon dioxide waveform was used to confirm endotracheal intubation. Presence of breath sounds bilaterally was sought by auscultation, and time taken for auscultatory confirmation was noted. The USG confirmation of air entry to the lung field as indicated by lung sliding was sought, and the time taken was noted. Chi-square test, independent t-test and paired t-test were used as applicable. RESULTS: Auscultatory confirmation was more rapid in Group A as compared to Group B (9.34 ± 2.43 s vs. 14.35 ± 5.53 s, P = 0.001). However, there was no significant difference in USG confirmation time in both the groups (8.57 ± 2.05 s vs. 8.61 ± 1.66 s). Four patients in Group B had doubtful breath sounds against none in Group A. There was no doubtful lung slide with USG in both groups. One case of endobronchial intubation in Group B was diagnosed with USG which was doubtful by auscultation. CONCLUSION: Ultrasound directed confirmation of endotracheal tube placement in overweight and obese patients is superior in speed and accuracy in comparison to the standard auscultatory method. KEYWORDS: Auscultation; endotracheal intubation; obesity; sliding lung sign; ultrasonography PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org