RESUMO
BACKGROUND AND OBJECTIVE: Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital's awake fiberoptic intubation protocol. MATERIAL AND METHODS: For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol's key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients' diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. RESULTS: In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. CONCLUSION: Our hospital's protocol was followed in all cases and no post-implementation complications were detected.
Assuntos
Protocolos Clínicos , Intubação Intratraqueal/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Tecnologia de Fibra Óptica , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Procedimentos Cirúrgicos Cardíacos , Solução Hipertônica de Glucose , Glucose , Rim/fisiologia , Metilprednisolona/farmacologia , Solução Salina Hipertônica , Cloreto de Sódio , Injúria Renal Aguda/tratamento farmacológico , Adolescente , Adulto , Diurese/efeitos dos fármacos , Circulação Extracorpórea/métodos , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológicoAssuntos
Analgesia/métodos , Anestesia/métodos , Buprenorfina/farmacologia , Fentanila/análogos & derivados , Hormônios/sangue , Morfinanos/farmacologia , Adulto , Anestesia Intravenosa , Glicemia/análise , Buprenorfina/administração & dosagem , Creatina/sangue , Eletrólitos/sangue , Fentanila/administração & dosagem , Fentanila/farmacologia , Humanos , Pessoa de Meia-IdadeRESUMO
Introducción y objetivo: El fibroscopio flexible para la intubación endotraqueal ocupa un puesto importante en las guías de manejo de la vía aérea difícil. El objetivo del presente estudio fue describir la eficacia y seguridad de un protocolo de intubación con fibroscopio en el paciente despierto en un hospital terciario. Material y métodos: Se diseñó un estudio retrospectivo observacional. Recogimos los datos de todas las intubaciones con fibroscopio en pacientes despiertos realizadas durante un periodo de 3 años tras la instauración del protocolo en nuestro centro. Los puntos más importantes del protocolo hacen referencia a la disposición del quirófano, el personal requerido y la sedación para la realización del procedimiento. Se recogieron las variables demográficas, la comorbilidad de los pacientes, la predicción de la posible dificultad de la vía aérea realizada en la consulta preanestésica, el cumplimiento del protocolo, los fármacos utilizados y las complicaciones registradas. Resultados: Durante el periodo de estudio se realizaron 634 intubaciones con fibroscopio, 473 pacientes (74,6%) tenían al menos un factor de riesgo de aspiración y 232 (36,5%) al menos alguna comorbilidad cardiovascular. En el 67% de los casos se preveía intubación difícil. En el 99% de los casos se usó remifentanilo mediante sistema Target Controlled Infusion (TCI) con una media de concentración efecto alcanzada de 2,9 ng/ml. En todos los casos se siguió el protocolo respecto al personal implicado y la disposición del quirófano. En ningún caso se registraron complicaciones respiratorias ni hemodinámicas durante la intubación con fibroscopio ni en el postoperatorio inmediato. Conclusión: El protocolo establecido en nuestro centro se siguió en el 100% de los casos y no hubo complicaciones tras la instauración del protocolo (AU)
Background and objective: Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospitals awake fiberoptic intubation protocol. Material and methods: For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocols key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. Results: In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. Conclusion: Our hospitals protocol was followed in all cases and no post-implementation complications were detected (AU)