López-Maya L, Lina-Manjarrez F

Language: Spanish
References: 22
Page: 322-327
PDF size: 57.35 Kb.

ABSTRACT

Objective: To present a case of management of difficult non predictable airway in elective surgery under general anesthesia. In this case, the author, reflects on the surgery evaluation, since it is very frequent to count on a little time to assess it at urgency surgeries. Therefore, when it is present, its management and conservation must be evaluated according to its knowledge and the existing tools. Clinical case: Male patient of 34 years old programmed for open cholecystectomy. Obese through Mallampati II evaluation, short neck, Patil Aldreti lower than 6 centimeters. Rest: normal. The patient is monitored and begins with the medication for intubation with direct laringoscopy, being observed a Cormack-Lehane IV. Two failed attempts of intubation are made, after that there are two attempts more with failed McCoy No. 4 sheet. Finally, there is an airway management through a disposable laryngeal mask, beginning a surgical procedure which lasted for 2:30 hours, without complications. Conclusions: The present case shows us the importance of knowing predictive factors of a difficult airway. We must be constantly updated about this medical problem, as well as about the available guides and strategies in order to obtain the best possible results. This is not so easy, but it is actually possible if we count on knowledge, ability or skills, techniques and technological resources.

REFERENCES

1. Corde BE. Planteamientos para el tratamiento de las vías respiratorias superiores. Clin Anest Nort Am 2002;4:775-793.

2. Mallampati SR. Valoración clínica de las vías respiratorias. Clin Anest Nort Am 1995;2: 279-286.

3. Practice Guidelines for Management of Difficult Airway: a report. American Society of Anaesthesiologists task force on management of the difficult airway. Anesthesiology 1991;75:1087-1110.

4. Tripathy M. Short thyromental distance: A predictor of difficult intubation or an indicator for small blade selection? Anesthesiology 2006;104:1131-1136.

5. Shiga T. Difficult intubation in apparently normal patients: A meta-analysis of bedside screening test performance. Anesthesiology 2005;103:429-437.

6. Khan ZH. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: A prospective blinded study. Anesth Analg 2003;96:595-599.

7. Osornio PJC. Estudio comparativo entre diferentes pruebas de valoración de la vía aérea para predecir la dificultad de la intubación en pacientes adultos. Rev Mex Anest 2003;86:75-79.

8. Jonathan LB. Practice guidelines for management of the difficult airway: An updated report by. The American Society of Anesthesiologist task force on management of the difficult airway. Anesthesiology 2003;98:1269-1277.

9. Covarrubias GA. Actualidades en la vía aérea difícil. Rev Mex Anest 2004;27:210-218.

10. Adnet F. The intubation difficult scale (IDS): Proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997;87:1290-1297.

11. Cormack RS. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105.

12. Mateos CME. Vía aérea difícil. Aplicaciones prácticas para su evaluación y manejo. Rev Mex Anest 2001;1:145-149.

13. Mesa MA. Evaluación histórica del manejo de la vía aérea. Manual Clínico de la Vía Aérea. 2º Ed. Manual Moderno. 2001:1-11.

14. Combes J. Unanticipated difficult airway in anesthetized patients: Prospective validation of a management algorithm. Anesthesiology 2004;100:1146-1150.

15. Brimacombe JB. The laryngeal mask airway: The first ten years. Anaest Intensive Care 1993;21:225-226.

16. Braian ALJ. The development of the laryngeal mask- a brief history of the invention, early clinical studies and experimental work from which the laryngeal mask envolved. Eur J Anesth 1991;4:5-17.

17. Álvarez RJJ. Mascarilla laríngea (LMA). Rev Mex Anest 2002;25:56-62.

18. Wong DT. Management choices for the difficult airway by anesthesiologist in Canada. Can J Anest 2002;49:850-856.

19. Vanner RG. Mechanisms of regurgitations and its prevention with cricoid pressure. Int J Obstet Anesth 1993;3:207-215.

20. Vanner RG. The role of the laryngeal in the failed intubation drill. Int J Obstet Anesth 1995;4:191-192.

21. Jenkens J. The laryngoscope and the laryngeal mask airway. Anaesthesia 1993;48:735.

22. Benumot JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996;84:686-699.