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2005, Número 1

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Rev Mex Anest 2005; 28 (1)


Profilaxis de la broncoaspiración perioperatoria

Carmona-García P, Villazala R, Iluminada-Canal M, Cabrerizo P, Peleteiro A

Idioma: Español
Referencias bibliográficas: 51
Paginas: 43-52
Archivo PDF: 83.88 Kb.


RESUMEN

La broncoaspiración pulmonar de contenido gástrico es una temida complicación de los procedimientos anestésicos favorecida por la depresión de los reflejos protectores de la vía aérea inherente a la disminución del nivel de conciencia. El riesgo general de una aspiración pulmonar es bajo, con una mínima morbimortalidad aunque ésta aumenta notablemente en determinados pacientes que asocian ciertos factores de riesgo que implican incrementos del contenido gástrico, o disminución del vaciado gástrico. Sin embargo es imprescindible para el anestesiólogo el conocimiento de los factores de riesgo, medidas preventivas y tratamiento de esta complicación. En esta revisión hacemos una valoración de las pautas de ayuno propuestas, el uso de fármacos para incrementar el pH gástrico, la aplicación de la presión cricoidea y los recientes artilugios para el manejo de la vía aérea en este tipo de pacientes.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Mendelson SL. The aspiration of stomach contents into lungs during obstetric anaesthesia. Am J Obstet Gynecol 1946; 52: 191-205.

  2. Mellin-Olsen J, Fasting S, Gisvold E. Routine preoperative gastric emptying is seldom indicated. A study of 85594 anaesthetics with special focus on aspiration pneumonia. Acta Anaesthesiol Scand 1996; 40: 1184-1188.

  3. Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 1993; 78: 56-62.

  4. Alexander NG, Smith Graham. Gastroesophageal reflux and aspiration of gastric contents in anaesthetic practice. Anesth Analg 2001; 93: 494-513.

  5. Soredei E, Bjornestad E, Steen PA. An audit of perioperative aspiration pneumonitis in gynecological and obstetric patients. Acta Anaesthesiol Scand 1996; 40: 14-9.

  6. Kluger MT, Short TG. Aspiration during anaesthesia: a review of 133 cases from the australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 1999; 54: 19-26.

  7. Roewer N. Can pulmonary Aspiration of gastric contents be prevented by balloon occlusion of the cardia? A study with a new nasogastric tube. Anesth Analg 1995; 80: 378-83.

  8. Department of health and social security. Deaths due to complications of anaesthesia. In: Report on confidential enquiries into maternal deaths in England and Wales. London: Her Majerty´s Stationary Office; 1957-98.

  9. López MAC, Tomás BJ, Montero BR. Pautas de ayuno preoperatorio y premedicación para reducir el riesgo de aspiración pulmonar. Rev Esp Anestesiolo Reanim 2002; 49; 314-323.

  10. Hardy JF, Lepage Y, Bonneville-Chouinard N. Ocurrence of gastroduodenal reflux on induction of anaesthesia does not correlate with the volume of gastric contents. Can J Anaesth 1990; 37(5): 502-8.

  11. Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth 1999; 80: 453-60.

  12. Coté CJ. Preoperative preparation and premedication. Br J Anaesth 1999; 83: 16-28.

  13. Bateman DN. Effects of meal temperature and volume on the emptying of liquid from the human stomach. J Physiol 1982; 331: 461-467.

  14. Maltby JR, Lewis P Martin A, Sutherland LR. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Can J Anaesth 1991; 38: 425-9.

  15. Maekawa N, Mikawa K, Yaku H, Nishina K, Obara H. Effects of 2, 4 and 12 hours fasting intervals on preoperative gastric fluid pH and volume, and plasma glucosa and lipid homeostasis in children. Acta Anaesthesiol Scand 1993; 37(8): 783-7.

  16. Green SM, Krauss B. Pulmonary aspiration risk during emergency department procedural sedation; an examination of the role of fasting and sedation depth. Acad Emerg Med 2002; 9: 35-42.

  17. Schreiner MS, Triebwasser A, Keon TP. Ingestion of liquids compared with preoperative fasting in pediatric patients. Anesthesiology 1990; 74: 593-597.

  18. Van Thiel DH, Stremple JF. Lower esophageal sphincter pressure in cirrhotic men with ascites: before and after diuresis. Gastroenterology 1977; 72: 842-4.

  19. Vanner RG, Pryle BJ, O´Dwyer JP, Reynolds F. Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia. Anaesthesia 1992; 47: 371-5.

  20. Vanner RG, Pryle BJ, O´Dwyer JP, Reynolds F. Upper oesophageal sphincter pressure during inhalational anaesthesia. Anaesthesia 1992; 47: 950-4.

  21. Moulton C, Pennycook AG. Relation between Glasgow coma score and cough reflex. Lancet 1994; 343: 1261-2.

  22. Merio R, Festa A, Bergmann H, Eder T, Eibl N, Stacher-Janotta G, Weber U, Budka C, Heckerberg A, Bauer P, Fracesconi M, Schemthaner G, Satacher G. Slow gastric emptying in Type I diabetes: relation to autonomic and peripheral neuropathy, blood glucose and glycaemic control. Diabetes Care 1997; 20: 419-23.

  23. Porter JS, Bonello E, Reynolds F. The influence of epidural administration of fentanyl infusion on gastric emptying in labour. Anaesthesia 1997; 52: 1151-6.

  24. American Society of Anaesthesiologist Task Force on preoperative fasting. Practice Guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. Anesthesiology 1999; 90: 896-905.

  25. Fasting S, Soreide E, Raeder JC. Changing preoperative fasting policies. Acta Anaesthesiol Scand 1998; 42: 1188-1191.

  26. Soreider E, Stromskag KE, Steen PA. Statistical aspects in studies of preoperative fluid intake and gastric content. Acta Anaesthesiol Scand 1995; 39: 738-743.

  27. Morgan GE, Mikhail MS. Coadyuvantes de la anestesia. En: Anestesiología clínica. México DF. Ed: El manual moderno. 1999: 237-246.

  28. Kullkarni PN, Batra YN, Wig J. Effects of different combinations of H2 receptor antagonist with gastrokinetic drugs on gastric fluid pH and volumen in children, a comparative study. Int J Pharmacol Ther 1997; 35: 561-4.

  29. Lin CJ, Huang CL, Hsu HW, Chen TL. Prophylaxis against acid aspiration in regional anaesthesia for elective caesarean section: a comparison between oral single-dose ranitidine, famotidine and omeprazol assessed with fiberoptic gastric aspiration. Acta Anaesthesiol 1996; 34: 179-84.

  30. Kristesen MS, Gellet S, Bach AB, Jensen TK. Haemodynamics and arterial oxygen saturation during preoperative emptying of the stomach. Acta Anaesthesiol Scand 1991; 35: 342-344.

  31. Vaner RG, Pryle BJ. Regurgitation and oesophageal rupture with cricoid pressure: a cadaver study. Anaesthesia 1992; 47: 732-5.

  32. Manning B, Winter DC, McGreal G, Kirwan WO, Redmon HP. Nasogastric intubation causes gastro-oesophageal reflux in patients undergoing elective laparotomy. Surgery 2001; 130: 788-91.

  33. Ferrer M, Bauer TT, Torres A, Piera C. Effect of nasogastric tube size on gastroesophageal reflux and microaspiration in intubated patients. Ann Intern Med 1999; 130: 991-4.

  34. Thwaites AJ, Rice CP, Smith I. Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation. Anaesthesia 1999; 54: 372-381.

  35. Llorens J. Inducción de secuencia rápida. Rev Esp Anestesiol Reanim 2003; 50: 87-96.

  36. Sellick BA. Rupture of the oesophagus following cricoid pressure? (letter). Anaesthesia 1982; 37: 213-4.

  37. Shorten GD, Alfille PH, Gliklich RE. Airway obstruction following application of cricoid pressure. Journal of Clinical Anesthesia 1991; 3: 403-5.

  38. Meek T, Vincent A, Duggan JE. Cricoid pressures: can positive force be sustained? Br J Anaesth 1998; 80: 672-4.

  39. Campbell AE, Turley A, Wilkes AR, May JE. Cricoid yoke: The effect of surface area and applied force on discomfort experienced by conscious volunteers. Eur J Anaesthesiology 2003; 20: 52-55.

  40. Aoyama K, Takenaka I, Sata T, Shigematsu A. Cricoid pressure impedes positioning and ventilation through the laryngeal mask airway. Can J Anaesth 1996; 43: 1035-40.

  41. Brimacombe JR, Berry AM. Cricoid pressure. Can J Anaesth 1997; 44: 414-425.

  42. Rabey PG, Murphy PJ, Langton JA, Barker P, Rowbotham DJ. Effect of the laryngeal mask airway on lower oesophageal sphincter pressure in patients during general anaesthesia. Br J Anaesth 1992; 69: 346-8.

  43. Roux M, Drolet P, Girard M, Grenier Y, Petit B. Effect of the laryngeal mask airway on oesophageal PH: influence of the volume and pressure inside the cuff. Br J Anaesth 1999; 82: 566-9.

  44. Bapat PR, Verghese C. Laryngeal mask airway and the incidence of regurgitation during gynecological laparoscopies. Anesth Analg 1997; 85: 139-43.

  45. Akhar TM, Street MK. Risk of aspiration with the laryngeal masks. Br J Anaesth 1994; 72: 447-50.

  46. Kapila A, Addy EV, Verghese C, Brain AIJ. The intubating laryngeal mask airway: An initial assessment of performance. Br J Anaesth 1997; 79: 710-3.

  47. Baskett PJF, Parr MJA, Nolan JP. The intubating laryngeal mask. Anaesthesia 1998; 53: 1174-9.

  48. Nygren J, Thorell A, Jacobsson H, Larsson S, Schenell PO, Hylen L, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg 1995; 222: 728-734.

  49. Hausel J, Nygren J, Lagerkranser M, Hellstrom PM, Hammaarquist F, Almstrom C, Lindh A, Thorell A, Ljungqvist O. A carbohydrate-Rich Drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93: 1344-50.

  50. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109-17.

  51. Longareda AM, Olarra J, Suárez L, García A. Modificar el ayuno preoperatorio puede modular la respuesta al estrés postquirúrgico. Rev Esp Anestesiol Reanim 2002; 49: 314-323.




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