2020, Number 2
Utilidad de un protocolo de manejo de la vía aérea en el paciente obeso
Language: Spanish
References: 30
Page: 210-221
PDF size: 347.90 Kb.
ABSTRACT
Introduction: there are several difficult airway algorithms; However, some authors consider that the extrapolation of recommendations created for the general population has served as a guide in the management of the obese patient without considering their weight. Objective: to determine the usefulness of an airway management protocol in the obese patient. Method: a descriptive and developmental study was carried out in the Surgical Unit of the “Manuel Fajardo Rivero” Hospital of the City of Santa Clara in the period from September 2014 to April 2018. The population was made up of the total obese patients programmed for elective surgery with general anesthesia. An intentional non-probabilistic sampling was performed, the sample was made up of patients who met the defined inclusion and exclusion criteria. An airway management protocol designed by the authors was applied, which included various plans for intubation and ventilation of the obese patient and the usefulness of the protocol was related to variables of interest. Results: the airway could be established by conventional laryngoscopy in the largest number of cases (81.3%), a small number of patients (16.2%) presented adverse incidents, the protocol was mostly useful (70%) and in all obese groups, according to the body mass index, the protocol had a high percentage of utility (95.1%). Conclusions: the application of the protocol allowed the establishment of the airway and was useful in the majority of patients.REFERENCES
Chaparro-Mendoza K, Luna-Montúfar CA, Gómez JM. Videolaringoscopios: ¿la solución para el manejo de la vía aérea difícil o una estrategia más? Revisión no sistemática. Rev Colomb Anestesiol [Internet]. 2015 Jul-Sep [citado 30 Mar 2019];43(3):225-233. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0120334715000453. https://doi.org/10.1016/j.rca.2015.03.012
Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev [Internet]. 2016 Nov [citado 30 Mar 2019];15;11:CD011136. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472630/. https://doi.org/10.1002/14651858.CD011136.pub2
Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: A cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia [Internet]. 2015 Mar [citado 30 Mar 2019];70(3):272-81. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25511370. https://doi.org/10.1111/anae.12955
Gómez Ríos MA, Gaitini L, Matter I, Somri M. Guías y algoritmos para el manejo de la vía aérea difícil. Rev Esp Anestesiol Reanim [Internet]. 2018 Ene [citado 30 Mar 2019];65(1):41-48. Disponible en: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0034935617301998.pdf. https://doi.org/10.1016/j.redar.2017.07.009
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth [Internet]. 2015 Dec [citado 30 Mar 2019];115(6):827-48. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650961/. https://doi.org/10.1093/bja/aev371
Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia [Internet]. 2015 Nov [citado 30 Mar 2019];70(11):1286-1306. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606761/. https://dx.doi.org/10.1111/anae.13260
Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth [Internet]. 2015 [citado 30 Mar 2019];25(4):346-362. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25684039. https://doi.org/10.1111/pan.12615
Gómez García J, Fernández Vaquero MA. Manejo de vía aérea en pacientes con obesidad mórbida. Rev Elec AnestesiaR. [Internet]. 2014 Jun [citado 30 Mar 2019];6(6):[aprox. 4 p.]. Disponible en: http://revistaanestesiar.org/index.php/rear/article/view/231. https://doi.org/https://doi.org/10.30445/rear.v6i6.231
Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology [Internet]. 1997 Dec [citado 30 Mar 2019];87(6):1290-97. Disponible en: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1948562
Consuegra Carvajal AN, Rodríguez Rueda JM, Pérez Socorro D, Benítez Pérez MO, Quintero Sarduy N, Mora Guane I. Manejo de la ventilación durante la fibrobroncoscopia con máscara laríngea. Acta Méd Centro [Internet]. 2016 [citado 30 Mar 2019];10(2):31-38. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/440/636
Consuegra Carvajal AN, Rodríguez Rueda JM, Quintero Sarduy N, Mora Guane IC, Pérez Socorro D. Manejo de la máscara laríngea Proseal por diplomantes de la Especialidad de Anestesia. Acta Méd Centro [Internet]. 2016 [citado 30 Mar 2019];10(4):18-26. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/759/1002
Akulian JA, Yarmus L, Feller-Kopman D. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management. Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):357-67. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25999008. https://doi.org/10.1016/j.anclin.2015.02.009
Wong DT, Yee AJ, Leong SM, Chung F. The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: A narrative review. Can J Anaesth [Internet]. 2017 Apr [citado 30 Mar 2019];64(4):416-427. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28050802. https://doi.org/10.1007/s12630-016-0802-z