RESUMEN
Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.
Asunto(s)
Anestesiología , Laringoscopios , Adulto , Humanos , Anestesiología/métodos , Brasil , Manejo de la Vía Aérea/métodos , Intubación Intratraqueal/métodos , Laringoscopía/métodosAsunto(s)
Anestesia Obstétrica , Anestesiología , Cesárea , Parto Obstétrico , Femenino , Humanos , EmbarazoRESUMEN
JUSTIFICATIVA E OBJETIVOS: A técnica da dose preparatória é uma alternativa para encurtar o tempo de latência dos bloqueadores neuromusculares adespolarizantes. O objetivo deste estudo foi avaliar o tempo para instalaçäo do bloqueio neuromuscular máximo, as condições de intubaçäo traqueal e as alterações cardiocirculatórias ocasionadas por diferentes doses de cisatracúrio em injeçäo única e em doses fracionadas. MÉTODO: Foram estudados 80 pacientes, estado físico ASA I e II, distribuídos em dois grupos de acordo com a dose de cisatracúrio: Grupo I (0,1 mg.kg-1) e Grupo II (0,2 mg.kg-1). Formaram-se subgrupos de acordo com a técnica de curarizaçäo usada: Subgrupos P1 e P2 (dose preparatória) - 0,02 mg.kg-1ou 0,04 mg.kg-1 de cisatracúrio, respectivamente, seguido após um minuto de 0,08 mg.kg-1 ou 0,16 mg.kg-1 do mesmo bloqueador neuromuscular, respectivamente; Subgrupos U1 e U2 - injeçäo única de dose total de 0,1 mg.kg-1 ou 0,2 mg.kg-1 de cisatracúrio, respectivamente. A Induçäo anestésica foi feita com etomidato precedido de alfentanil. A funçäo neuromuscular foi monitorizada empregando-se a SQE a cada 12 segundos. Foram avaliados: o tempo para instalaçäo do bloqueio neuromuscular máximo; as alterações de pressäo arterial média e de freqüência cardíaca, e as condições de intubaçäo traqueal. RESULTADOS: Os tempos para instalaçäo do bloqueio neuromuscular máximo foram: Grupo I (3,90 ± 0,60 min e 3,88 ± 0,74 min, nos subgrupos P1 e U1, respectivamente) e Grupo II (1,40 ± 0,40 min e 2 ± 0,30 min, nos subgrupos P2 e U2, respectivamente) sem diferença significativa. A comparaçäo entre os subgrupos P1 e P2 e os subgrupos U1 e U2, mostrou diferença significativa. As condições de intubaçäo traqueal foram aceitáveis em todos os pacientes sem alterações cardiocirculatórias. CONCLUSÕES: As doses empregadas de cisatracúrio näo encurtou o tempo para a instalaçäo do bloqueio neuromuscular máximo, em relaçäo ao seu emprego em injeçäo única, porém proporcionaram condições aceitáveis de intubaçäo traqueal, sem alterações cardiocirculatórias
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes/administración & dosificación , Fármacos Neuromusculares no Despolarizantes/farmacología , Atracurio , Bloqueantes Neuromusculares , Tiempo de Reacción , Frecuencia Cardíaca , Intubación Intratraqueal , Presión ArterialRESUMEN
BACKGROUND AND OBJECTIVES: The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses. METHODS: Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated. RESULTS: Mean times for maximum neuromuscular block onset were: Group I (3.90 +/- 0.60 min and 3.88 +/- 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 +/- 0.40 min and 2 +/- 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes. CONCLUSIONS: Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes.
