Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
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
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.
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.
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Courtesy : Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery Department of Surgery Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu
Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision
Standard Edition (140312.140314)
Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries and when other common donors are unavailable due to injury like the extensor carpi radialis brevis. In this case, the patient presented three months following a partial C7 and C8,T1 brachial plexus injury from a fall with no recovery on electrodiagnostic studies. The brachialis to anterior interosseous nerve transfer was elected with the supinator to flexor digitorum superficialis nerve transfer and lateral antebrachial cutaneous to ulnar sensory nerve transfer. This video details the specifics for the brachialis transfer with an extended incision into the forearm to confirm the proximal topography of the anterior interosseous fascicle in the median nerve. Additionally, this patient has an anomalous sensory nerve anastomosis from a brachialis nerve branch to the sensory component of the median nerve.
Tables of Contents (Standard) 00:57 Proximal Arm Exposure 01:51 Exposure and Identification of Median Nerve in the Arm 03:18 Exposure and Identification of Musculocutaneous Nerve and Brachialis Branch 04:41 Neurolysis of Median Nerve to Identify the Pronator Teres and AIN Fascicles 07:38 Distal Forearm Exposure 08:34 Step-lengthening the Pronator Teres for Proximal Median Nerve Exposure 10:36 Exposure of Median Nerve in the Forearm 11:05 Identifying the Distal Pronator Teres Branch 12:20 Identifying the Proximal Pronator Teres Branch and Proximal Neurolysis 12:52 Exposure of Anterior Interosseous Nerve Branch 14:16 Extension of Proximal Arm Exposure 14:58 Fascicular Course of the Anterior Interosseous Nerve from Distal to Proximal 16:42 Dissection and Distal Division of Donor Brachialis Nerve Branch 17:27 Anomalous Sensory Anastomosis from Brachialis Nerve Branch to Median Nerve 18:25 Neurolysis and Proximal Division of Recipient Anterior Interosseous Fascicle 19:42 Brachialis to Anterior Interosseous Nerve Transfer
Narration: Susan E. Mackinnon Videography: Andrew Yee
