Ultrasonido y vía aérea / Ultrasound and airway

Febrero 13,  2020 No. 3338

Video Información del Valle de Guadalupe Convocatoria para Capítulos sobre Anestésicos Locales Call for Book Chapters on Local Anesthetics Información / Information Acceso de la vía aérea guiado con ultrasonido Ultrasound guided airway access Lages N1, Vieira D2, Dias J2, Antunes C2, Jesus T2, Santos T3, Correia C3. Author information Rev Bras Anestesiol. 2018 Nov - Dec;68(6):624-632. doi: 10.1016/j.bjan.2018.06.014. Epub 2018 Sep 20. Abstract Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation. KEYWORDS: Airway management; Manejo de vias aéreas; Ultrasound; Ultrassom PDF Utilidad de la medición guiada por ultrasonido del diámetro transversal mínimo de la vía aérea subglótica para determinar el tamaño del tubo endotraqueal en niños con cardiopatía congénita: un estudio observacional prospectivo. Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study. Pillai R1, Kumaran S1, Jeyaseelan L1, George SP1, Sahajanandan R1. Ann Card Anaesth. 2018 Oct-Dec;21(4):382-387. doi: 10.4103/aca.ACA_220_17. Abstract INTRODUCTION: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. METHODS: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. RESULTS: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland-Altman plot. CONCLUSION: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population. KEYWORDS: Endotracheal tube; minimal transverse diameter of subglottic airway; ultrasound PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

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