RESUMO
La lesión de vía aérea causada por tubos de doble luz es una complicación infrecuente pero potencialmente muy grave. Describimos el caso de una paciente que presentó una rotura bronquial durante la ventilación unipulmonar con un tubo de doble luz izquierdo, complicándose con una parada cardíaca secundaria de la que se recuperó sin secuelas. Causas intrínsecas de la paciente, como el antecedente de radioterapia externa, y un posible sobreinflado del neumotaponamiento pudieron contribuir al desarrollo de esta complicación. La posible lesión de vía aérea debe ser considerada por todos los profesionales que empleen tubos de doble luz durante el cuidado de sus pacientes (AU)
Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients (AU)
Assuntos
Humanos , Feminino , Idoso , Brônquios/lesões , Intubação/efeitos adversos , Respiração Artificial , Parada Cardíaca/complicações , Ruptura/etiologia , Fatores de Risco , Doença IatrogênicaRESUMO
No disponible
Assuntos
Humanos , Brônquios/lesões , Traumatismos Torácicos/cirurgia , Manuseio das Vias Aéreas/métodos , Anestesia/métodos , StentsRESUMO
Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients.
Assuntos
Adenocarcinoma/cirurgia , Brônquios/lesões , Intubação/efeitos adversos , Neoplasias Pulmonares/cirurgia , Segunda Neoplasia Primária/cirurgia , Ventilação Monopulmonar/instrumentação , Radioterapia Adjuvante/efeitos adversos , Ruptura/etiologia , Idoso , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Brônquios/patologia , Brônquios/efeitos da radiação , Feminino , Fibrose , Parada Cardíaca , Humanos , Mastectomia Segmentar , Pneumonectomia , Pressão/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/complicações , Lesões por Radiação/complicações , Lesões por Radiação/patologiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anestesia por Inalação/métodos , Anestesia por Inalação , Dióxido de Carbono/uso terapêutico , Anestesia com Circuito Fechado/instrumentação , Anestesia com Circuito Fechado/métodos , Anestesia com Circuito Fechado , Anestesia Geral/métodos , Anestesia GeralAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anestesia Epidural/instrumentação , Anestesia Epidural/métodos , Anestesia Epidural , Anestesia Local/tendências , Infiltração-Percolação/métodos , Cateteres/normas , Cateteres/tendências , Cateteres , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgiaAssuntos
Dióxido de Carbono , Inalação , Respiração Artificial/efeitos adversos , Ventiladores Mecânicos , Idoso , Humanos , Masculino , Erros MédicosAssuntos
Tomografia Computadorizada por Raios X , Traqueia/lesões , Estenose Traqueal/diagnóstico por imagem , Traqueostomia/efeitos adversos , Adulto , Manuseio das Vias Aéreas , Granulomatose com Poliangiite/complicações , Humanos , Ileostomia , Masculino , Estenose Traqueal/etiologia , TraqueotomiaRESUMO
Objetivos. En la intubación fibroscópica, el hecho de gozar de una visión directa y en tiempo real, no nos asegura el correcto avance del tubo endotraqueal (TET) hasta su posición intratraqueal. El empleo de cánulas orales ayuda a la consecución de una vía aérea libre para el paso del fibroscopio y el TET. Comparamos la cánula VAMA(R) y la cánula Berman(R) en cuanto a tiempo necesario para la intubación, visión fibroscópica y facilidad de paso del TET. Pacientes y método. Noventa pacientes sin criterios de vía aérea difícil fueron randomizados en dos grupos, B y V, según el tipo de cánula empleada. Tras inducir anestesia general, se procedió a la intubación con fibroscopio flexible, midiendo tiempos de fibroscopia e intubación, intentos de fibroscopia, calidad de visión fibroscópica y grado de dificultad en el paso del TET. Resultados. No se obtuvieron diferencias estadísticamente significativas entre ambas cánulas, si bien, la tendencia apuntaba a menores tiempo de intubación (p=0,292) y menor dificultad al paso del TET (p=0,447). Con ambos dispositivos, la calidad de visión fue buena, encontrando únicamente algún grado de obstrucción en la vía aérea en el 22% de los pacientes. En ningún caso esta obstrucción fue total, por lo que todos los pacientes pudieron ser intubados correctamente. Conclusiones. La cánula VAMA® representa una alternativa eficaz a las clásicas cánulas de intubación fibroasistida. Además, su novedoso diseño ofrece ciertas ventajas para la correcta orientación del fibroscopio y la retirada de la cánula tras la intubación (AU)
Objectives. In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA® (V) and Berman® (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. Patients and methods. 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(R) (B) and VAMA(R) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. Results. No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA® group compared to the Berman® group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. Conclusions. The VAMA® cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation(AU)
Assuntos
Humanos , Masculino , Feminino , Intubação/instrumentação , Intubação/métodos , Intubação Intratraqueal , Anestesia Geral/instrumentação , Anestesia Geral/métodos , Anestesia Geral , Anestesia Geral/tendências , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/tratamento farmacológico , Intubação Intratraqueal/economiaRESUMO
OBJECTIVES: In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS: 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS: No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS: The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.
Assuntos
Anestesia , Intubação Intratraqueal/instrumentação , Adulto , Idoso , Cateteres , Desenho de Equipamento , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Ecocardiografia/instrumentação , Ecocardiografia/métodos , Ecocardiografia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Radiografia Torácica/métodos , Radiografia Torácica , Comorbidade , Cardiopatias Congênitas/fisiopatologia , Cardiopatias CongênitasAssuntos
Migração de Corpo Estranho/etiologia , Átrios do Coração , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Bloqueio de Ramo/etiologia , Complexos Cardíacos Prematuros/etiologia , Contraindicações , Emergências , Circulação Extracorpórea , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Aneurisma Cardíaco/complicações , Septos Cardíacos/patologia , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Taquicardia Ventricular/etiologia , UltrassonografiaRESUMO
Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación (AU)
An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route (AU)
Assuntos
Humanos , Masculino , Feminino , Valor Preditivo dos Testes , Acromegalia/tratamento farmacológico , Sensibilidade e Especificidade , Laringoscopia/métodos , Hipófise , Hipófise , Prega Vocal , Prega Vocal , Intubação/instrumentação , Intubação/métodos , Laringoscopia/tendências , Laringoscopia , Hipófise/cirurgiaRESUMO
An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.
Assuntos
Acromegalia , Intubação Intratraqueal/métodos , Laringoscópios , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación(AU)
An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route(AU)
Assuntos
Humanos , Masculino , Feminino , Acromegalia/tratamento farmacológico , Hipertrofia/tratamento farmacológico , Técnicas e Procedimentos Diagnósticos/instrumentação , Laringoscopia/métodos , Sistema Hipófise-Suprarrenal , Sistema Hipófise-Suprarrenal/cirurgia , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/cirurgia , Hipófise , Hipófise/cirurgia , Sensibilidade e Especificidade , Hipertrofia/complicações , Laringoscopia/instrumentação , Laringoscopia , Hipertrofia/diagnóstico , Prega Vocal , Prega Vocal/cirurgiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Laringoscopia/métodos , Laringoscopia , Gravação em Vídeo/instrumentação , Cirurgia Vídeoassistida , Laringoscopia/tendências , Laringoscópios/tendências , LaringoscópiosRESUMO
OBJETIVO: Evaluar la utilidad del laringoscopio ópticoAirtraq®, evaluando sus indicaciones y beneficios, asícomo las posibles limitaciones de su empleo en una serieretrospectiva de pacientes.PACIENTES Y MÉTODOS: Revisión retrospectiva de losprimeros 124 pacientes de nuestro centro cuya intubaciónendotraqueal fue realizada con Airtraq®. Se tuvieronen cuenta variables anatómicas y demográficas delos pacientes, así como la exploración preoperatorio dela vía aérea. Tras la realización de la intubación con Airtraq® se recogieron datos en cuanto a su facilidad demanejo y calidad del procedimiento.RESULTADOS: En un 97,6% de los pacientes se consiguióuna intubación correcta y en sólo 3 (2,4%) pacientesfue imposible. La calidad de la laringoscopia fue óptimaen más del 95% de los casos. Las complicaciones eincidencias fueron mínimas.CONCLUSIÓN: El laringoscopio Airtraq® ha demostradoque facilita la intubación en aquellos casos en losque intentos previos de laringoscopia han sido infructuososy en pacientes con predictores evidentes de víaaérea difícil (VAD), incluso cuando fue empleado porpersonal no entrenado en su uso. La facilidad en suempleo y su relativa inocuidad, lo convierten en unpráctico dispositivo en distintos tipos de pacientes ysituaciones clínicas(AU)
OBJECTIVES: To evaluate the utility of the AirTraqoptical laryngoscope in a retrospective case series,assessing indications for use and benefits as well aspossible limitations.PATIENTS AND METHODS: Retrospective study of the first124 patients in whom we used the AirTraq for trachealintubation. Anatomical and demographic variables wererecorded in addition to preoperative findings onexamination of the airway. Ease in accomplishing themaneuver and quality of the procedure were assessedafter intubation with the AirTraq.RESULTS: The trachea was correctly intubated in97.6% of the patients. Intubation failed in only 3 (2.4%)patients. Laryngoscopic quality was optimal in over95% of the cases. There were few complications or otherevents.CONCLUSIONS: The AirTraq laryngoscope has beenshown to facilitate intubation even when nonexpert staffperform the maneuver in cases in which previousattempts at laryngoscopy have failed and in which adifficult airway is anticipated. Ease of use and relativesafety make the AirTraq a practical device for a varietyof patient types and clinical settings(AU)
