Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 622
Filtrar
1.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 28-34, ene. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186463

RESUMO

Background: The objective of this study was to evaluate the effects of three single-limb heated wired circuits (SLHWC) for NIV, on ventilatory parameters and humidification performance in a simulation lung model. Methods: Three SLHWC compatible with the MR-850 Heated Humidifier (HH) (Fisher & Paykel, Auckland, New Zealand) were tested: RT-319 (FP) (Fisher & Paykel, Auckland, New Zealand), Respironics 1045770 (RP) (DEAS, Castel Bolognese, Italy) and Intersurgical B/SYS 5809001 (IT) (Intersurgical, Wokingham, UK). A Bipap Vision ventilator (Philips Respironics, Murrysville, PA, USA) in pressure control ventilation (PCV) connected to a test lung was used for simulation. Each SHWC performance was evaluated in four ventilatory conditions: IPAP of 15 cm H2O with FiO2 0.3 and 1, respectively; and, IPAP of 25 cm H2O with FiO2 0.3 and 1, respectively. EPAP was set at 5 cm H2O. Hygrometric and ventilatory measurements including: relative humidity (RH), temperature (T), Pplat, PIP, PEEP, peak inspiratory flow (PIF), and tidal volume (Vt) were measured. Results: In each FiO2 group absolute humidity (AH) was similar with FP regardless of the IPAP level employed compared to IT and RP (P<.001). Except for RP at FiO2 0.3, AH increased significantly in IT and RP groups as IPAP increased (P < .001). PIP, Pplat, PEEP, PIF, and Vt values were significantly higher with FP and RP in each FiO2 group compared to IT (P < .001). Conclusions: Humidification performance varied significantly among the three circuits, being FP the only one able to maintain stable AH values during the study with no influence on ventilatory parameters


Introducción: El objetivo de este estudio fue evaluar los efectos de 3 circuitos de ramal único (SLHWC) para la ventilación mecánica no invasiva (VNI) en los parámetros de ventilación y la humidificación en un modelo de simulación pulmonar. Métodos: Se evaluaron 3 SLHWC compatibles con el humidificador calefactado MR-850 (HH) (Fisher & Paykel, Auckland, Nueva Zelanda): RT-319 (FP) (Fisher & Paykel, Auckland, Nueva Zelanda), Respironics 1045770 (RP) (DEAS, Castel Bolognese, Italia) y Intersurgical B/SYS 5809001 (IT) (Intersurgical, Wokingham, Reino Unido). Para la simulación se empleó un ventilador Bipap Vision (Philips Respironics, Murrysville, PA, EE. UU.) con ventilación controlada por presión (PCV) conectado a un simulador pulmonar. El rendimiento de cada SHWC se evaluó en 4 condiciones ventilatorias: IPAP de 15 cm H2O con FiO2 igual a 0,3 o igual a 1; IPAP de 25 cm H2O con FiO2 igual a 0,3 o igual a 1. La EPAP se estableció en 5 cm H2O. Las medidas ventilatorias e higrométricas incluyeron: humedad relativa (HR) humedad absoluta (AH), temperature (T), Pplat, PIP, PEEP, pico de flujo inspiratorio (PIF) y volumen tidal (Vt). Resultados: Para cada grupo de FiO2 FP detectó valores similares de humedad absoluta (HA) en comparación con IT y RP (p<0,001), independientemente del nivel IPAP utilizado. Se registró un incremento significativo de la HA en todos los grupos medidos con IT y RP conforme aumentaron los valores de IPAP (p<0,001), excepto en el grupo de FiO2, igual a 0,3 medido con RP. Los valores de PIP, Pplat, PEEP, PIF y Vt resultaron significativamente más elevados con FP y RP en cada grupo FiO2 en comparación con IT (p < 0 ,001). Conclusiones: La evaluación de la humidificación varió significativamente entre los 3 circuitos, siendo FP el único capaz de mantener estables los valores de HA durante el estudio sin influencia alguna de los parámetros ventilatorios


Assuntos
Humanos , Umidificadores/normas , Mecânica Respiratória , Ventilação não Invasiva/instrumentação , Manuseio das Vias Aéreas/instrumentação , Pico do Fluxo Expiratório , Análise de Variância , Ventilação não Invasiva/métodos , Ventilação não Invasiva/tendências
2.
Thorac Surg Clin ; 30(1): 91-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761288

RESUMO

The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.


Assuntos
Manuseio das Vias Aéreas , Anestesia/métodos , Estenose Traqueal/cirurgia , Traqueotomia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Humanos , Stents , Traqueotomia/instrumentação , Traqueotomia/métodos
3.
Medicine (Baltimore) ; 98(51): e18287, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860976

RESUMO

RATIONALE: Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. PATIENT CONCERNS: A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. DIAGNOSES: Laryngoscopy-guided endotracheal intubation was expected to be difficult in LDP. INTERVENTIONS: After the induction of anesthesia, a non-inflatable LMA was introduced into the laryngopharynx with the patient in LDP. He was then maneuvered into a supine position and removal of the LMA was followed by endotracheal intubation. OUTCOMES: The surgery for the removal of the hematoma was performed in a prone position. The airway intubated with an endotracheal tube was well maintained during the entire surgery. LESSONS: LMA is a useful device for airway management in patients in LDP who cannot lie supine.


Assuntos
Manuseio das Vias Aéreas/métodos , Máscaras Laríngeas , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/instrumentação , Dorso/cirurgia , Hematoma/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Masculino , Neurofibromatose 1/terapia , Decúbito Dorsal
4.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 417-418, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185141

RESUMO

En la actualidad, el uso de los dispositivos supraglóticos (DSG) para el manejo de la vía aérea está ampliamente extendido en urgencias y emergencias por su fácil manejo. El objetivo de la presente revisión es comparar los dispositivos supraglóticos para el manejo de la vía aérea, tubo laríngeo (TL) y máscara laríngea (ML), en sus diferentes versiones, para determinar cuál de ellos reúne las mejores condiciones para un uso eficiente en la atención a urgencias y emergencias. Se realiza una revisión sistemática de la literatura a través de la consulta en 9 bases de datos bibliográficas: Biblioteca Cochrane Plus, Medline, CINAHL, Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, Web of Science y ScienceDirect. Fueron seleccionados registros que estaban comprendidos entre los años 2014 y 2019, en español, inglés, francés y portugués, donde se realizara una comparación entre los DSG, TL y ML, en sus diferentes versiones. Se identificaron un total de 18 estudios válidos tras la lectura crítica. En la mayoría de aspectos evaluados, no se apreciaron diferencias significativas entre ambos dispositivos. Destancaba una presión de sellado orofaríngeo y velocidad de inserción superior en determinados contextos en la utilización del TL, y existía además una visión menor de la glotis mediante la utilización del broncoscopio. Los diferentes contextos en que se puede presentar la utilización de los DSG y la escasez de registros que comparan el TL con las ML en sus diferentes versiones no permite una clara diferenciación en cuanto a eficacia. No obstante, sí parece evidenciarse una visión menor de la glotis en la utilización del TL tras ser valorado con el fibroscopio, factor a tener en cuenta si se tiene presente que en la atención secundaria la intubación selectiva mediante la intubación traqueal, considerada el "patrón oro", puede llegar a ser una necesidad


Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a systematic review of the literature comparing laryngeal tubes and various laryngeal mask airway devices (LMAs) to determine which ones can be used most efficiently in emergencies. Nine databases were searched, as follows: Cochrane Library Plus, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, the Web of Science, and ScienceDirect. We collected studies published between 2014 and 2019 in Spanish, English, French, and Portuguese that compared laryngeal tubes to LMAs of different types for supraglottic airway management. Eighteen studies were selected for analysis after critical reading. Significant differences were not seen between tubes and LMAs with respect to most variables, but in certain contexts the oropharyngeal seal and speed of insertion were superior with laryngeal tubes; however, when fiberoptic bronchoscopes were then inserted the view of the glottis was poor. The different contexts in which these devices are used and the scarcity of studies comparing laryngeal tubes to LMAs does not allow us to identify clear differences among them with respect to efficiency. However, tubes seem to offer poorer visibility of the glottis according to evaluation with fiberoptic scopes, a factor to bear in mind if tracheal intubation, which is considered the gold standard, might become necessary


Assuntos
Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Manuseio das Vias Aéreas/instrumentação , Máscaras Laríngeas , Intubação Intratraqueal/instrumentação , Manuseio das Vias Aéreas/métodos , Intubação Intratraqueal/métodos , Desenho de Equipamento
5.
Ann Saudi Med ; 39(5): 302-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580693

RESUMO

BACKGROUND: Laryngeal masks are increasingly used in place of endotracheal intubation or face masks for maintaining the airway during surgery. OBJECTIVES: Compare the insertion time and other features of the Baska and I-gel masks in patients undergoing general anesthesia for urological surgery. DESIGN: Randomized-controlled, single-blind study. SETTINGS: Urology surgical operating rooms of a tertiary care hospital. SUBJECTS AND METHODS: We enrolled concomitant patients whose surgery was expected to last less than two hours. Following premedication and adequate relaxation, subjects were randomly allocated to the I-gel mask or the Baska mask. Computer-generated random numbers were used for randomization with sealed opaque envelopes for allocation concealment. MAIN OUTCOME MEASURES: The primary outcome measure of the study was the time required for laryngeal mask airway (LMA) insertion. Also, the number of device placement attempts, the number of postoperative signs and symptoms (cough, breath holding, laryngeal spasm, lip trauma, blood on the mask), and laryngopharyngeal morbidity scores at 1 and 24 hours postoperatively. SAMPLE SIZE: 211 met inclusion criteria, 200 participants completed the study. RESULTS: Compared to I-gel, the Baska mask required a longer time for insertion, and its airway pressure was higher. The median (minimum-maximum) duration of LMA insertion in the Baska and I-gel groups was 14 (6-25) and 7 (5-12) seconds, respectively (z=-10.934; P<.001). The mean (SD) airway pressures were significantly different between the two groups (15.8 [1.9] and 14.9 [1.7] cm/H2O for Baska and I-gel, respectively; t=3.668; P<.001). Seal pressure was not significantly different between the groups (0.08 [0.2] vs. 0.07 [0.2] cm/H2O in the Baska and I-gel groups, respectively, (t=1.35; P=.194). CONCLUSIONS: The Baska and I-gel masks are similar in most respects. Both have reasonably acceptable insertion times and can be used for selected surgical procedures. LIMITATIONS: The requirement for more vigorous training is a limitation of the Baska mask. Results could differ with patients younger than 18 years of age or obese patients. CONFLICT OF INTEREST: None. CLINICAL TRIAL REGISTRY: Not registered.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Adulto , Manuseio das Vias Aéreas/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos/métodos
6.
Medicine (Baltimore) ; 98(40): e17473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577780

RESUMO

Awake craniotomy is a unique technique utilized for mapping neuro and motor function during neurosurgical procedures close to eloquent brain tissue. Since active communication is required only during surgical manipulation of eloquent brain tissue and the patient is "sedated" during other parts of the procedure, different methods for anesthesia management have been explored. Furthermore, airway management ranges from spontaneous breathing to oro or nasotracheal intubation. Case reports have described the use of laryngeal masks (LMs) previously; however, its safety compared to tracheal intubation has not been assessed.We conducted a retrospective analysis of 30 patients that underwent awake craniotomy for tumor surgery to compare the feasibility and safety of different airway management strategies. Nasal fiberoptic intubation (FOI) was performed in 21 patients while 9 patients received LM for airway management. Ventilation, critical events, and perioperative complications were evaluated.Cannot intubate situation occurred in 4 cases reinserting the tube after awake phase, while no difficulties were described reinserting the LM (P < .0001). Furthermore, duration of mechanical ventilation after tumor removal was significantly lower in the LM group compared to FOI group (62 ±â€Š24 vs. 339 ±â€Š82 [min] mean ±â€Šsem, P < .0001). Postoperatively, 2 patients in each group were diagnosed with and treated for respiratory complications including pneumonia, without statistical significance between groups.In summary, LM is a feasible airway management method for patients undergoing awake craniotomy, resulting in reduced ventilation duration compared to FOI procedure.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Neoplasias Encefálicas/cirurgia , Craniotomia , Tecnologia de Fibra Óptica , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vigília , Adulto Jovem
7.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
8.
Medicine (Baltimore) ; 98(31): e16678, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374047

RESUMO

RATIONALE: The benefits of prolonged endotracheal intubation (ETI) in comparison to early tracheotomy is still over the controversy. Little information is available in concern to prolonged ETI more than years. We report the consequence of oral ETI in a 95-year old man for 839 days. PATIENT CONCERNS: This patient was transferred to the intensive care unit due to sputum asphyxia and respiratory arrest. Timely ETI was performed. However, as a neurological insult, extubation had a high risk of failure due to the insufficient ability of sputum clearance. In addition, his family members refused further surgical interventions including tracheotomy. DIAGNOSES: Prolonged ETI occurred in this patient. On day 240 and 329 after ETI, 3D airway image did not reveal laryngeal stenosis or laryngeal lesions. On day 459 and 662, ET tube (ETT) exchanged was performed and the balloon became stiff and inelasticity. INTERVENTIONS: Although a possible tracheoesophageal fistula was suspected by imaging findings on day 547, the gastroscopy did not reveal the fistula on the esophagus. Enteral nutrition was delivered through the gastric tube, while the mediastinal infection was not observed during subsequent follow-up of computed tomography. OUTCOMES: He received tracheostomy due to acute sputum obstruction within ETT and abrupt oxygen desaturation on day 839. LESSONS: During prolonged ETI, more attention should focus on airway humidification, proper cuff pressure and optimal time for tube exchange in order to avoid severe complications.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Intubação Intratraqueal/métodos , Insuficiência Respiratória/terapia , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Esôfago/diagnóstico por imagem , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Qualidade de Vida , Tomografia Computadorizada por Raios X
9.
Indian Pediatr ; 56(7): 587-593, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333214

RESUMO

Flexible fiberoptic bronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indications and utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airway anomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of skilled personnel when used judiciously.


Assuntos
Manuseio das Vias Aéreas , Broncoscópios , Broncoscopia , Pediatria/instrumentação , Sistema Respiratório , Doenças Respiratórias , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Criança , Humanos , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/cirurgia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Ultrassonografia de Intervenção/métodos
10.
J Spec Oper Med ; 19(2): 91-94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201758

RESUMO

BACKGROUND: Airway compromise is the second leading cause of preventable death on the battlefield. Unlike a cricothyrotomy, supraglottic airway (SGA) placement does not require an incision and is less technically challenging. We compare the survival of causalities undergoing cricothyrotomy versus SGA placement. METHODS: We used a series of emergency department (ED) procedure codes to search within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016. This is a subanalysis of that data set. RESULTS: During the study period, 194 casualties had a documented cricothyrotomy and 22 had a documented SGA as the sole airway intervention. The two groups had similar proportions of explosive injuries (57.7% versus 63.6%, p = .328), similar composite injury severity scores (25 versus 27.5, p = .168), and similar AIS for the head, face, extremities, and external body regions. The cricothyrotomy group had lower AIS for the thorax (0 versus 3, p = .019), a trend toward lower AIS for the abdomen (0 versus 0, p = .077), more serious injuries to the head (67.5% versus 45.5%, p = .039), and similar rates of serious injuries to the face (4.6% versus 4.6%, p = .984). Glasgow Coma Scale (GCS) scores were similar on arrival to the ED (3 versus 3, p = .467) as were the proportion of patients surviving to discharge (45.4% versus 40.9%, p = .691). On repeated multivariable analyses, the odds ratios for survival were not significantly different between the two groups. CONCLUSIONS: We found no difference in short-term outcomes between combat casualties who received an SGA vs those who received a cricothyrotomy. Military prehospital personnel rarely used either advanced airway intervention during the recent conflicts in Afghanistan and Iraq.


Assuntos
Manuseio das Vias Aéreas/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Intubação Intratraqueal/métodos , Traqueostomia/estatística & dados numéricos , Lesões Relacionadas à Guerra/terapia , Afeganistão/epidemiologia , Manuseio das Vias Aéreas/instrumentação , Humanos , Intubação Intratraqueal/instrumentação , Iraque/epidemiologia , Análise de Sobrevida , Resultado do Tratamento , Lesões Relacionadas à Guerra/mortalidade
11.
Dtsch Med Wochenschr ; 144(10): 690-694, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31083739

RESUMO

Laryngeal masks are supraglottic airway devices developed in the early 1980s. Today, they are frequently used in clinical routine to provide airway access for mechanical ventilation in patients undergoing surgery with a short duration. Moreover, the they have also become integral part of difficult airway management in patients who cannot be intubated by the use of conventional laryngoscopy.Relevant advances have been made to simplify their positioning and improve tightness with the aim to allow for the use of higher airway pressures during mechanical ventilation thereby reducing the risk of gastric insufflation and pulmonary aspiration. Focusing on this goal, several different prototypes have been developed and introduced in clinical practice until today. However, even these new developed laryngeal masks still do not provide reliable protection against pulmonary aspiration until today. Consequently, their use In critical care medicine is still limited to rescue situations with intubation failure.In this review some of the most popular lanryngeal masks are presented, indications for their use are outlined and their handling is described.


Assuntos
Máscaras Laríngeas , Manuseio das Vias Aéreas/efeitos adversos , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/estatística & dados numéricos , Medicina de Emergência/instrumentação , Humanos , Complicações Pós-Operatórias/prevenção & controle
12.
A A Pract ; 12(10): 378-381, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31091201

RESUMO

Although rare, cannot intubate and cannot oxygenate situations are challenging acute events. The development of management algorithms, standardized equipment provisions, and appropriate clinical training in the application of front-of-neck access techniques are necessary to optimize procedural success to ensure adequate oxygenation. The OxyTain algorithm is an institutionally developed protocol to manage cannot intubate and cannot oxygenate events. With proper implementation, this unique process aligning the cannula cricothyroidotomy and scalpel bougie as primary and secondary techniques, respectively, can potentially optimize procedural success. This algorithmic approach is trained routinely among our anesthesia providers, while the equipment is standardized throughout our anesthetizing locations.


Assuntos
Manuseio das Vias Aéreas/métodos , Educação Médica Continuada/métodos , Manuseio das Vias Aéreas/instrumentação , Algoritmos , Cânula , Competência Clínica , Humanos , Intubação Intratraqueal/efeitos adversos
13.
PLoS One ; 14(5): e0216673, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071171

RESUMO

BACKGROUND: Changes in head and neck position may significantly affect the performance of supraglottic airway devices (SADs) by altering the pharyngeal structure. PURPOSE: This systematic review and meta-analysis aimed to elucidate the effect of changes in head and neck position on performance of SADs. DATA SOURCE: Bibliographic databases, including PubMed, EMBASE, the Cochrane library, and the Web of Science. STUDY ELIGIBILITY CRITERIA: Prospective studies investigating the effects of head and neck positions on the performance of SADs. METHODS: A random effect model was applied in the all analyses. Subgroup analysis was performed according to the type of device and the age of patient. The oropharyngeal leak pressure was the primary outcome measure. Secondary outcome measures included peak inspiratory pressure, fibreoptic view, and ventilation score (PROSPERO, CRD42017076971). RESULTS: Seventeen studies met the eligibility criteria. Overall, the oropharyngeal leak pressure significantly increased (mean difference 4.07 cmH2O; 95% confidence interval 3.30 to 4.84) during neck flexion with adverse effects on ventilation and fibreoptic view. Conversely, the oropharyngeal leak pressure decreased (mean difference -4.05; 95% confidence interval -4.90 to -3.20) during neck extension with no significant effect on ventilation or fibreoptic view. Rotation of the head and neck did not significantly affect SAD performance. CONCLUSIONS: The reduced oropharyngeal leak pressure in the extended neck position was not associated with impaired ventilation except with the air-Q self-pressurizing airway. The flexed neck position significantly worsens ventilation and the alignment between the SAD and glottis despite improving the seal except with the air-Q self-pressurizing airway and LMA Proseal.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/efeitos adversos , Cabeça , Humanos , Intubação Intratraqueal , Máscaras Laríngeas , Pescoço , Postura/fisiologia , Estudos Prospectivos
14.
BMC Anesthesiol ; 19(1): 82, 2019 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109293

RESUMO

BACKGROUND: Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special airway management strategy. CASE PRESENTATION: A 48-year-old woman who had left pneumonectomy 2 years ago was scheduled to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS). A 32-French (Fr) left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff's inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. CONCLUSION: Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the implementation of the operation mentioned above could be solved.


Assuntos
Manuseio das Vias Aéreas/métodos , Intubação Intratraqueal/métodos , Neoplasias Pulmonares/cirurgia , Mastectomia Segmentar/métodos , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Manuseio das Vias Aéreas/instrumentação , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Neoplasias Pulmonares/diagnóstico por imagem , Mastectomia Segmentar/instrumentação , Pessoa de Meia-Idade , Pneumonectomia/instrumentação , Cirurgia Torácica Vídeoassistida/instrumentação
15.
Anaesthesia ; 74(6): 751-757, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30933322

RESUMO

The TotaltrackTM is a new video laryngeal mask, which combines a supraglottic airway with a videolaryngoscope. We evaluated the performance of this device in an observational study in 300 adult patients. The Totaltrack was inserted at the first attempt and the glottis seen in all cases. In 249 patients (83%; 95%CI 78.7-87.3%) the glottis was seen at the first attempt. Adequate ventilation and tracheal intubation were achieved in all patients. The median time to visualisation of vocal cords, to confirmation of ventilation and to successful tracheal intubation was 5 s, 13 s and 24 s, respectively. Nineteen patients (6.3%; 95%CI 3.55-9.05%) suffered minor complications, such as mucosal lesion or blood staining. The Totaltrack appears effective for airway management.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Máscaras Laríngeas , Gravação de Videoteipe/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
18.
Medicine (Baltimore) ; 98(10): e14746, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855468

RESUMO

BACKGROUND: Supraglottic airway (SGA) device with non-inflatable cuff reduce the airway complications associated with cuff hyperinflation. The aim of the study is to determine whether the default setting of Supreme is as effective as the non-inflatable cuff devices. The oropharyngeal leak pressure was measured and compared between the Supreme and Air-Q, a typical non-inflatable cuff device. We hypothesized that the default setting of Supreme is non-inferior to the the Air-Q self-pressurized (SP) in respect to the oropharyngeal leak pressure. METHODS: Eighty-four patients aged 1 to 7 years who were scheduled for general anesthesia, participated in the study. The patients were randomly assigned to Supreme group (n = 41) or Air-Q SP group (n = 43). We considered that the primary outcome, oropharyngeal leak pressure of Supreme group would be non-inferior to the Air-Q SP group, within 3 cmH2O. Other outcomes included tidal volume loss, difficulty of insertion, insertion time, and complications. RESULTS: The oropharyngeal leak pressure of the Supreme and Air-Q SP was 19.9 ±â€Š4.1 cm H2O and 17.4 ±â€Š2.9 cm H2O, respectively. The mean differences of 2 devices (Air-Q SP-Supreme) were -2.5 cm H2O, (95% confidence interval [-4.0 to -0.9], P = .002). The upper CI was smaller than the non-inferiorty margin (3 cm H2O). This result suggested that the default setting of Supreme was superior to the Air-Q SP with respect to the oropharyngeal leak pressure. However, there were no significant differences in tidal volume loss over time, ease of device insertion score, insertion time, and complications. CONCLUSIONS: The Supreme can be used in the default setting in pediatric patients accordingly in terms of tolerable leak pressure and the stability for mechanical ventilation compared with Air-Q SP.


Assuntos
Manuseio das Vias Aéreas , Anestesia Geral , Complicações Intraoperatórias , Máscaras Laríngeas , Respiração Artificial/métodos , Manuseio das Vias Aéreas/efeitos adversos , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Criança , Pré-Escolar , Desenho de Equipamento/métodos , Falha de Equipamento , Feminino , Humanos , Lactente , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Máscaras Laríngeas/efeitos adversos , Máscaras Laríngeas/normas , Masculino , Volume de Ventilação Pulmonar , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(10): e14832, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855511

RESUMO

The nasopharyngeal airway is an important equipment in airway management, a correct placement is crucial for its effectiveness. We measured the nares-to-epiglottis distance (NED) and examined the correlations of the optimal insertion length (NED-1) with patient characteristics and various external facial measurements. We aimed to develop a simple method for estimating the optimal insertion length and to help select an appropriate nasopharyngeal airway.Two hundred patients of ASA grade I & II aged >20 years undergoing elective surgery under general anesthesia were enrolled. We measured nares-to-ear tragus distance (NTD), nares-to-mandibular angle distance (NMD), philtrum-to-ear tragus distance (PTD), and philtrum-to-mandibular angle distance (PMD). The NED was measured by fiber-optic bronchoscope. All measurements were obtained in centimeters. NED-1 (cm) was defined as the optimal insertion length. The patient's sex, age, body weight, body height, and body mass index were recorded.The NED-1 significantly correlated with body weight, body height, NTD, NMD, PTD, and PMD. Backward stepwise multiple linear regression analysis yielded the formula for predicting NED-1: 0.331 - 0.018 × BW + 0.061 × BH + 1.080 × NMD - 1.256 × PMD + 0.697 × PTD (r = 0.640, P < .001). The regression lines of the optimal insertion length versus PTD showed the best fit to the equality line. The measurements of PTD showed the minimal differences from NED-1 and with the most patients showing <1 cm differences from NED-1.The optimal insertion depth of nasopharyngeal airway can easily be predicted by the distance from philtrum-to-ear tragus, and a nasopharyngeal airway of an appropriate size can be selected accordingly.


Assuntos
Manuseio das Vias Aéreas/métodos , Epiglote/anatomia & histologia , Modelos Biológicos , Nariz/anatomia & histologia , Adulto , Idoso , Manuseio das Vias Aéreas/instrumentação , Anestesia , Estatura , Peso Corporal , Broncoscopia , Procedimentos Cirúrgicos Eletivos , Epiglote/diagnóstico por imagem , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Mandíbula/anatomia & histologia , Pessoa de Meia-Idade , Nariz/diagnóstico por imagem , Tamanho do Órgão , Adulto Jovem
20.
Laryngoscope ; 129(10): 2354-2360, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30786030

RESUMO

OBJECTIVES: The aim of this study was to compare the relative compliance and the dermatological and pulmonary outcomes when the Provox Luna system (Atos Medical, Malmö, Sweden) is added during the night to the usual tracheastoma care of laryngectomized subjects. METHODS: This was a multicenter randomized crossover trial conducted in the Netherlands Cancer Institute, Erasmus Medical Center, and Maastricht University Medical Center in The Netherlands. The study included 46 laryngectomized subjects with prior heat and moisture exchanger (HME) and adhesive experience. RESULTS: A significant improvement in the number of compliant individuals was found: Luna: n = 43 of 45 (96%); usual care: n = 35 of 46 (76%), P = 0.02. The Luna period was associated with longer intervals of daily HME use (Luna 23.2 hours [range: 15.6-24.0 hours], usual care [UC]: 21.5 hours [range: 6.0-24.0 hours], P = 0.003) and an increased frequency of skin improvement overnight (Luna 3.9 days [standard deviation (SD)]: 7.0 days), Usual Care: 8.1 days ([SD: 10.8 days], P = 0.008). Fifty-six percent (n = 26) of participants wanted to continue using the Provox Luna system at the conclusion of the study. CONCLUSION: An improvement in compliance and skin recovery overnight was observed when the Provox Luna was added to the usual adhesive and HME use. Therefore, there is utility in supplementing the usual post-total laryngectomy care with the Provox Luna system at night, particularly in the setting of compliance concerns and in subjects who desire dermatological relief overnight. LEVEL OF EVIDENCE: 1b Laryngoscope, 129:2354-2360, 2019.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Laringectomia/instrumentação , Laringe Artificial/psicologia , Cooperação do Paciente/estatística & dados numéricos , Traqueostomia/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Países Baixos , Desenho de Prótese , Traqueostomia/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA