ML en pediatría / LMA in pediatrics

Marzo 4, 2017. No. 2618

Estudio piloto en maniquí mostró que un dispositivo de vía aérea supraglótica mejoró la ventilación neonatal simulada en un entorno de bajos recursos. Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low-resource setting. Pejovic NJ1,2, Trevisanuto D3, Nankunda J4,5, Tylleskär T2. Acta Paediatr. 2016 Dec;105(12):1440-1443. doi: 10.1111/apa.13565. Abstract AIM: We compared the performance of personnel in a low-resource setting when they used the I-gel cuffless neonatal laryngeal mask or a face mask on a neonatal airway management manikin. METHODS: At Mulago Hospital, Uganda, 25 doctors, nurses and midwives involved in neonatal resuscitation were given brief training with the I-gel and face mask. Then, every participant was observed positioning both devices on three consecutive occasions. The success rate and insertion times leading to effective positive pressure ventilation (PPV) were recorded. Participants rated the perceived efficiency of the devices using a five-point Likert scale. RESULTS: The I-gel achieved a 100% success rate on all three occasions, but the face mask was significantly less effective in achieving effective PPV and the failure rates at the first, second and third attempts were 28%, 8% and 20%, respectively. The perceived efficiency of the devices was significantly superior for the I-gel (4.7 ± 0.4) than the face mask (3.3 ± 0.8). CONCLUSION: The I-gel was more effective than the face mask in establishing PPV in the manikin, and user satisfaction was higher. These encouraging manikin data could be a stepping stone for clinical research on the use of the I-gel for neonatal resuscitation in low-resource settings. KEYWORDS: Face mask; I-gel; Laryngeal mask; Low-resource country; Neonatal resuscitation PDF Uso de ML durante ecocardiografía transesofágica en pacientes pediátricos The use of laryngeal mask airway during transesophageal echocardiography in pediatric patients. Shafi Ahmed MA1, Al-Ghamdi AA1, Mowafi HA1, Al-Metwalli RR1, Mousa WF1, Lardhi AA2. Saudi J Anaesth. 2014 Oct;8(4):489-92. doi: 10.4103/1658-354X.140858. Abstract BACKGROUND: Transesophageal echocardiography (TEE) in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation (ET). This study was performed to investigate the safety and efficacy of using the laryngeal mask airway (LMA) as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. MATERIALS AND METHODS: A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA (LMA group) or ET (ET group). Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. RESULTS: There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group (P < 0.01). The mean recovery time was also significantly shorter in the LMA than in the ET group (44 ± 8 min and 59 ± 11 min, respectively; P < 0.001). CONCLUSION: The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE. KEYWORDS: Laryngeal mask airway; randomized clinical trial; transesophageal echocardiography PDF  ML para resucitación neonatal en un país en desarrollo Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC. Zanardo V1, Simbi A, Micaglio M, Cavallin F, Tshilolo L, Trevisanuto D. BMC Health Serv Res. 2010 Aug 31;10:254. doi: 10.1186/1472-6963-10-254. Abstract BACKGROUND: Studies carried out in developing countries have indicated that training courses in newborn resuscitation are efficacious in teaching local birth attendants how to properly utilize simple resuscitation devices. The aim of this study was to assess the knowledge and expertise gained by physicians and midwifes who participated in a Neonatal Resuscitation Course and workshop organized in a Third World Country on the use of Laryngeal Mask Airway (LMA). METHODS: A 28-item questionnaire, derived from the standard test contained in the American Heart Association and the American Academy of Pediatrics Neonatal Resuscitation Manual, was administered to 21 physicians and 7 midwifes before and after a course, which included a practical, hands-on workshop focusing on LMA positioning and bag-ventilation in a neonatal manikin. RESULTS: The knowledge gained by the physicians was superior to that demonstrated by the midwifes. The physicians, in fact, demonstrated a significant improvement with respect to their pre-course knowledge. Both the physicians and the midwives showed a good level of expertise in manipulating the manipulating the manikin during the practical trial session. The midwifes and physicians almost unanimously manifested a high degree of approval of neonatal resuscitation by LMA, as they defined it a sustainable and cost-effective method requiring minimal expertise. CONCLUSIONS: Further studies are warranted to test the advantages and limits of the neonatal LMA training courses in developing countries. PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com 4° Congreso Internacional de Control Total de la Vía Aérea Asociación Mexicana de Vía  Aérea Difícil, AC Ciudad de México 21, 22 y 23 de Abril 2017 Informes: amvadmexico@gmail.com Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Conceptos de traumatismo de columna cervical

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Cervical Spine Trauma Concepts

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Dr. Ebraheim animated video illustrates spine concepts associated the cervical spine – trauma.

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Vía aérea en pediatría / Pediatric airway

Marzo 5, 2017. No. 2619

VÍA AÉREA DIFÍCIL EN PEDIATRÍA HAYDEE OSSES C. Rev Chil Anest, 2010; 39: 125-132 INTRODUCCIÓN Las complicaciones relacionadas con el manejo de la vía aérea pediátrica son frecuentes y en ocasiones generan morbi-mortalidad, afectando principalmente a recién nacidos y lactantes menores. Éstos, por lo general, son niños sanos ASA I o II. Como causa directa de morbilidad se encuentra la intubación difícil, ventilación inadecuada, apnea y obstrucción bronquial. La mayor parte de estas complicaciones son evitables y al auditarse se encuentran los siguientes problemas: falla en reconocer o anticiparse a los problemas, revisión inadecuada de máquina y monitores, escasa vigilancia, preparación insufi ciente frente a situaciones adversas encontradas y, falta de habilidades técnicas especialmente en situaciones de tensión1 . Los pacientes pediátricos presentan un amplio espectro de enfermedades, tanto congénitas como adquiridas, que pueden repercutir en la vía aérea, difi cultando la intubación y/o ventilación2 . Para optimizar el manejo de una vía aérea difícil es importante comprender las diferencias anatómicas de la vía aérea pediátrica y familiarizarse con las enfermedades y síndromes comunes que la afectan PDF Controversias en la vía aérea pediátrica en el perioperatorio Controversies in Pediatric Perioperative Airways. Kluka J1, Stourac et al Biomed Res Int. 2015;2015:368761. doi: 10.1155/2015/368761. Epub 2015 Nov 22. Abstract Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PDF Eventos de seguridad del paciente en el manejo de las vías respiratorias pediátricas fuera del hospital: una revisión del expediente médico por el CSI-EMS. Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS. Hansen M1, Meckler G2, Lambert W3, Dickinson C4, Dickinson K4, Van Otterloo J4, Guise JM1,3,4,5. BMJ Open. 2016 Nov 11;6(11):e012259. doi: 10.1136/bmjopen-2016-012259. Abstract OBJECTIVE: To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management.  CONCLUSIONS: Errors in paediatric out-of-hospital airway management are common, especially in the context of intubations and during cardiac arrest. KEYWORDS: ACCIDENT & EMERGENCY MEDICINE PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com 4° Congreso Internacional de Control Total de la Vía Aérea Asociación Mexicana de Vía  Aérea Difícil, AC Ciudad de México 21, 22 y 23 de Abril 2017 Informes: amvadmexico@gmail.com Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Fusión Occipitocervical : demo

http://www.cirugiavertebral.com.mx/academia/fusion-occipitocervical-demo/

Occipitocervical Fusion Demo

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https://youtu.be/JhwG1u55iAw

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Courtesy: Seattle Science Foundation

www.seattlesciencefoundation.org

Dr. Daryl Fourney University of Saskatchewan in our lab performing an occipital-cervical fusion.

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