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Ruano Santiago M, Soto Garrucho E, González Marín Y, Pérez Muñoz AM, Echevarría Moreno M. Anaesthetic implications for Pompe disease. A case description. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:112-115. [PMID: 36813027 DOI: 10.1016/j.redare.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/07/2021] [Indexed: 02/22/2023]
Abstract
Pompe disease, or type II glycogenosis, is a rare metabolic myopathy inherited in an autosomal recessive pattern, characterized by progressive muscle weakness and multisystem involvement. The disease often results in premature death. Patients with Pompe disease are at high risk for anaesthesia-related complications, particularly cardiac and respiratory problems, although difficult airway management is the greatest complication. It is essential to perform a comprehensive preoperative study in order to reduce the risk of perioperative morbidity and mortality, and to obtain as much information as possible for the surgical procedure. In this article, we report the case of a patient with a history of adult Pompe disease who underwent combined anaesthesia for osteosynthesis of the proximal end of the left humerus.
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Affiliation(s)
- M Ruano Santiago
- Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Valme, Sevilla, Spain.
| | - E Soto Garrucho
- Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - Y González Marín
- Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - A M Pérez Muñoz
- Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Valme, Sevilla, Spain
| | - M Echevarría Moreno
- Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Valme, Sevilla, Spain
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2
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:65-70. [PMID: 35181262 DOI: 10.1016/j.redare.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/26/2021] [Indexed: 06/14/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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3
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00109-2. [PMID: 34544597 DOI: 10.1016/j.redar.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 06/13/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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de la Varga O, Galve AI, Romera A. Perioperative anesthetic management of reductive glossoplasty in a patient with Beckwith-Wiedemann syndrome. ACTA ACUST UNITED AC 2020; 68:156-160. [PMID: 32417109 DOI: 10.1016/j.redar.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/06/2020] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postoperative management of patients with the congenital growth disorder Beckwith-Wiedemann syndrome (BWS) can be complicated. The main clinical manifestations of the syndrome are macroglossia - which may hamper airway management -, prematurity, hemihypertrophy, omphalocele, embryonal tumours and episodes of neonatal hypoglycaemia. OBJECTIVE Our main objective is to describe the perioperative management and potential anaesthetic complications in paediatric patients with BWS undergoing glossectomy. METHODS Case report and literature review. RESULTS We describe the case of an 11-month-old patient diagnosed with BWS who underwent reduction glossoplasty. We performed a comprehensive preoperative evaluation, taking into account potential anaesthetic complications derived from both macroglossia and prematurity, and the risk of hypoglycaemia. The procedure was performed under general anaesthesia. Intubation - performed according to difficult airway management algorithms - was uneventful and the patient was successfully extubated in the operating room. The patient remained stable during the postoperative period, with good respiratory dynamics, SatO2>96% and good glycaemic control. Oral intake was started 4hours after surgery, and she was discharged to the ward at 24hours. CONCLUSION BWS patients require a multimodal approach that includes detailed preoperative planning and knowledge of potential airway-related and systemic complications.
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Affiliation(s)
- O de la Varga
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - A I Galve
- Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, España
| | - A Romera
- Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, España
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5
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Pérez Fernández-Escandón Á, Hevia Sánchez V, Llorente Pendás S, Molina Montalva F. Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery. ACTA ACUST UNITED AC 2019; 66:230-234. [PMID: 30661728 DOI: 10.1016/j.redar.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/16/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022]
Abstract
Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq™ was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety.
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Affiliation(s)
- Á Pérez Fernández-Escandón
- Departamento de Anestesiología y Reanimación, Centro médico de Asturias, Universidad de Oviedo, Oviedo, Asturias, España.
| | - V Hevia Sánchez
- Departamento de Anestesiología y Reanimación, Centro médico de Asturias, Universidad de Oviedo, Oviedo, Asturias, España
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Iglesias González JL, Gómez-Ríos MA, Poveda Marina JL, Calvo-Vecino JM. Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:552-557. [PMID: 30177221 DOI: 10.1016/j.redar.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. METHODS 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. RESULTS The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. CONCLUSIONS Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.
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Affiliation(s)
- J L Iglesias González
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - M A Gómez-Ríos
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Grupo Español de Vía Aérea Difícil (GEVAD); Grupo de Investigación Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | - J L Poveda Marina
- Departamento de Bioestadística, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J M Calvo-Vecino
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Pacreu S, Martínez S, Vilà E, Moltó L, Fernández-Candil J. Dexmedetomidine in difficult airway management with a fibre-optic bronchoscope in the awake patient with Klippel-Feil Syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:537-540. [PMID: 29887292 DOI: 10.1016/j.redar.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 06/08/2023]
Abstract
Klippel-Feil Syndrome is a disease characterised by congenital fusion of cervical vertebra, which leads to cervical limitation and instability. In these cases, the best option is the orotracheal intubation with the fibre-optic bronchoscope with the patient awake. The advantage is that cervical movements that could lead to neurological damage are minimised. In these patients, adequate sedation, together with instillation of local anaesthetic in the pharynx and hypopharynx, is the key to reducing patient discomfort and achieving successful orotracheal intubation. Dexmedetomidine is a selective α2- adrenergic receptor agonist that produces sedation and analgesia at the locus coeruleus without producing respiratory depression, as well as maintaining patient collaboration. The case is presented of a patient with Klippel-Feil Syndrome and difficult airway management, who was given a dexmedetomidine infusion at 0.6μg/kg/h as sedation for an awake fibre-optic endotracheal intubation.
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Affiliation(s)
- S Pacreu
- Servicio de Anestesiología, Reanimación y Terapia del dolor, Parc de Salut Mar, Barcelona, España.
| | - S Martínez
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Vilà
- Servicio de Anestesiología, Reanimación y Terapia del dolor, Parc de Salut Mar, Barcelona, España
| | - L Moltó
- Servicio de Anestesiología, Reanimación y Terapia del dolor, Parc de Salut Mar, Barcelona, España
| | - J Fernández-Candil
- Servicio de Anestesiología, Reanimación y Terapia del dolor, Parc de Salut Mar, Barcelona, España
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8
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Charco-Mora P, Urtubia R, Reviriego-Agudo L. The Vortex model: A different approach to the difficult airway. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:385-393. [PMID: 30037388 DOI: 10.1016/j.redar.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
Airway management is an essential area in anaesthesia, and anaesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails, due to several factors related to its structure and clinical application. The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce the complications rate.
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Affiliation(s)
- P Charco-Mora
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España; Vicepresidente de la Sección de Vía Aérea de la SEDAR.
| | - R Urtubia
- Servicio de Anestesiología, Clínica Vespucio, Santiago de Chile, Chile
| | - L Reviriego-Agudo
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España
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9
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Mira MD, Valldeperas MI, Socias A, Sarasíbar H, Aguilar Sánchez JL. Large retropharyngeal haematoma. Airway management with Airtraq® laryngoscope. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:229-233. [PMID: 29242030 DOI: 10.1016/j.redar.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq® disposable optical laryngoscope.
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Affiliation(s)
- M D Mira
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España.
| | - M I Valldeperas
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - A Socias
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - H Sarasíbar
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - J L Aguilar Sánchez
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
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Gutiérrez JC, Merino S, de la Calle P, Perrino C, Represa M, Moral P. Correlation of preoperative findings in computed axial tomography with the presence of difficult airway in patients undergoing head and neck otorhinolaryngological surgery. ACTA ACUST UNITED AC 2018; 65:252-257. [PMID: 29502798 DOI: 10.1016/j.redar.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish a correlation between 4 measurements made on preoperative computed axial tomography and the presence of difficult airway, as well as its clinical prediction in patients undergoing otorhinolaryngological surgery. MATERIAL AND METHODS A retrospective, observational study was carried out using the information gathered from the clinical notes of 104 patients undergoing general anaesthesia and endotracheal intubation for oncological otorhinolaryngological surgery over a period of 36 months. Based on the findings in the preoperative imaging tests, a multivariate logistic regression analysis was performed, where the dependent variable was the presence of extreme grades of visualization of the glottis visualisation (Cormack III-IV) or the presence of predictors of difficult intubation (Mallampati III-IV). This resulted in a total of 4 tomographic and clinical factors of difficult airway being introduced in this model. RESULTS In the Cormack III-IV group, the results were not statistically significant in the multivariate model when compared to the tomography predictors, distance from epiglottis to posterior pharyngeal wall (95% CI; 0.030 - 2.31, P<.05), and the distance from the base of the tongue to the posterior pharyngeal wall (95% CI; 0.018-1.37, P<.05). In the Mallampati III-IV group, in the multivariate model only the distance from the vocal cords to the posterior pharyngeal wall showed clinically significant results (95% CI; 0.104 - 8.53, P<.05). CONCLUSIONS In the approach to the airway, reliance on predictors is based on physical examination to anticipate situations that put oxygenation and ventilation of the patients at risk. There are still insufficient data to recommend imaging tests in this area, however it seems that in the future they may be added to the diagnostic performance of physical examination as predictors of difficult airway.
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Affiliation(s)
- J C Gutiérrez
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España.
| | - S Merino
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España
| | - P de la Calle
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - C Perrino
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - M Represa
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - P Moral
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
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Gómez-Prieto MG, Míguez-Crespo MR, Jiménez-Del-Valle JR, González-Caro MD, Marmesat-Ríos I, Garnacho-Montero J. National survey on airway and difficult airway management in intensive care units. Med Intensiva 2018; 42:519-26. [PMID: 29467082 DOI: 10.1016/j.medin.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). DESIGN Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. SETTING ICUs of public, private centers, and consortia. RESULTS In total, 101 units responded (56.4%), corresponding to 1,827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% don't use routinely AW assessment scales, being the most frequently used the Cormack-Mallampati association (35.6%). There's not intubation (IOT) protocol in 77.2%, nor DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; P=.03), DAW (64.4% vs. 44.6%; P=.04), and more AW protocols (73.4% vs. 37.5%; P=.000). Having an specific guideline for DAW management in UCI is considered necessary in 99%. CONCLUSIONS There is room for improvement in AW management. It's necessary to identify an expert in DAW in each Unit, and the development of an specific guideline for DAW management in critical care.
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12
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Gómez-Ríos MA, Gaitini L, Matter I, Somri M. Guidelines and algorithms for managing the difficult airway. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:41-48. [PMID: 29031661 DOI: 10.1016/j.redar.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/03/2017] [Indexed: 06/07/2023]
Abstract
The difficult airway constitutes a continuous challenge for anesthesiologists. Guidelines and algorithms are key to preserving patient safety, by recommending specific plans and strategies that address predicted or unexpected difficult airway. However, there are currently no "gold standard" algorithms or universally accepted standards. The aim of this article is to present a synthesis of the recommendations of the main guidelines and difficult airway algorithms.
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Affiliation(s)
- M A Gómez-Ríos
- Departamento de Anestesiología y Medicina Perioperativa, Complejo Hospitalario Universitario de A Coruña , La Coruña (Galicia), España; Grupo de Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), La Coruña (Galicia), España.
| | - L Gaitini
- Department of Anesthesiology, Bnai Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Institute of Technology, Haifa, Israel
| | - I Matter
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Institute of Technology, Haifa, Israel
| | - M Somri
- Department of Anesthesiology, Bnai Zion Medical Center, Haifa, Israel; Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
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13
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España Fuente L, Mella Pérez G, Laserna Cocina B, González González JL. Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis? ACTA ACUST UNITED AC 2018; 65:160-4. [PMID: 28774673 DOI: 10.1016/j.redar.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/21/2022]
Abstract
Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them. A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision® video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients.
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14
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Izquierdo-González B, Gómez-Ríos MÁ, Freire-Vila E. Use of the TotalTrack VLM for emergent endotracheal intubation in predicted difficult airway with obstruction by expanding space-occupying lesions and reduced interincisor opening. Rev Esp Anestesiol Reanim 2017; 64:415-418. [PMID: 28262247 DOI: 10.1016/j.redar.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus.
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Affiliation(s)
- B Izquierdo-González
- Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Anesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, España
| | - M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Anesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, España.
| | - E Freire-Vila
- Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Anesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, España
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15
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España Fuente L, Méndez Redondo RE, González González JL. Use of Clarus Video System ® in expected difficult airway in a patient with Rett syndrome. ACTA ACUST UNITED AC 2016; 64:50-54. [PMID: 27887736 DOI: 10.1016/j.redar.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
Abstract
Difficult airway management remains one of the key points in our specialty, as the difficulty or impossibility of tracheal intubation is the main cause of morbidity/mortality attributable to anaesthesia. Rett syndrome is a severe and incapacitating neurological disease. We present the case of a 21-year-old girl affected by this syndrome, with significant psychomotor retardation and difficult airway predictors, who was scheduled to have a laparoscopic cholecystectomy under general anaesthesia. We decided on one attempt of Clarus Video System® fiberoptic intubation as primary intervention. Intubation was successfully performed with the help of this optical stylet. The use of optical stylets is gaining prominence and finding a place in the latest algorithms of difficult airway management. We highlight the growing role these devices play in managing difficult airway, therefore we review the current situation of videolaryngoscopes in the management of the predicted difficult airway.
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Affiliation(s)
- L España Fuente
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España.
| | - R E Méndez Redondo
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España
| | - J L González González
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España
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16
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Rey J, Encabo CM, Pizarro NE, San Martín JL, López-Timoneda F. [Management of difficult airway with inhalation induction in a patient with Lennox-Gastaut syndrome and neck injury]. Rev Esp Anestesiol Reanim 2015; 62:536-539. [PMID: 25687944 DOI: 10.1016/j.redar.2015.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/30/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
Lennox-Gastaut syndrome is a childhood epileptic encephalopathy, and is characterized by frequent and difficult to treat seizures associated with mental retardation. The case is presented of a 21 year-old male with Lennox-Gastaut syndrome, with bilateral cervical facet joint dislocation fracture at C6-C7 and spinal canal compression as a result of a fall during a seizure. In this case the management of the difficult airway expected in an awake and uncooperative patient, with cervical spinal cord injury is described. An airway management strategy was proposed, that allowed a rapid and safe airway control with the best possible tolerance and maintaining the neck immobilised, so as not to increase neurological injury. Within this strategy, plan A was defined as inhalation induction with sevoflurane to maintain spontaneous breathing and tracheal intubation with Airtraq®. We believe that the Airtraq® video laryngoscope with inhalational induction with sevoflurane is a valid and effective alternative in the management of expected difficult airway.
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Affiliation(s)
- J Rey
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España.
| | - C M Encabo
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - N E Pizarro
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - J L San Martín
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - F López-Timoneda
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
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17
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Cruz P, Alarcón L, Del Castillo T, Cabrerizo P, Díaz S. [Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy]. ACTA ACUST UNITED AC 2014; 62:289-92. [PMID: 25487764 DOI: 10.1016/j.redar.2014.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/15/2014] [Accepted: 09/25/2014] [Indexed: 12/17/2022]
Abstract
Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope.
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Affiliation(s)
- P Cruz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - L Alarcón
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - T Del Castillo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cabrerizo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - S Díaz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
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18
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Sánchez-Morillo J, Gómez-Diago L, Rodríguez-Gimillo P, Herrera-Collado R, Puchol-Castillo J, Mompó-Romero L. Airway evaluation by indirect laryngoscopy in patients with lingual tonsillar hypertrophy. Acta Otorrinolaringol Esp 2013; 64:345-51. [PMID: 23896488 DOI: 10.1016/j.otorri.2013.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/14/2013] [Accepted: 04/28/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Prevalence of the lingual tonsillar hypertrophy is unknown but it is believed that its presence is associated with the difficult airway. To investigate this, indirect laryngoscopy was performed on patients in the preoperative evaluation and this pathology was diagnosed. The relationship with difficulty of viewing the larynx, intubation and ventilation, under general anaesthesia and using direct laryngoscopy, was then studied. METHODS We performed the demographic variable checks and tests for predicting difficult intubation (mouth opening, thyromental distance, cervical flexion-extension, neck thickness and Mallampati test), in the preoperative step on 300 patients who were going to be submitted to general anaesthesia. We then performed indirect laryngoscopy on them using a 70° rigid laryngoscope to ascertain the frequency of appearance of lingual tonsillar hypertrophy. Next, under general anaesthesia, we carried out direct laryngoscopy to verify whether there was difficulty in viewing the larynx and intubation and ventilation. We then investigated the association of demographic predictors of difficult intubation, including indirect laryngoscopy, with the presence of this condition. RESULTS Prevalence of lingual tonsillar hypertrophy was 2%. No relationship between the appearance of this entity and the difficulty of viewing the larynx, intubation and ventilation was found. Only indirect laryngoscopy was linked to the appearance of this pathology. CONCLUSIONS Lingual tonsillar hypertrophy is a relatively frequent disorder, whose presence is not usually associated with difficult airway.
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Onrubia X, Lluch-Oltra A, Armero R, Baldó J. Use of GlideScope for double lumen endotracheal tube insertion in an awake patient with difficult airway. ACTA ACUST UNITED AC 2013; 61:346-8. [PMID: 23849718 DOI: 10.1016/j.redar.2013.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/30/2013] [Accepted: 05/06/2013] [Indexed: 11/17/2022]
Abstract
There is scientific evidence that an anticipated difficult airway must be managed with the patient being awake. The GlideScope has been proven to be a useful device to intubate the trachea in some instances when difficult airway is present, and particularly in the awake patient. It has also been used for double lumen tube (DLT) in the anaesthetized patient, but its use with DLT in both circumstances, awake patients with difficult airway has not been described. GlideScope enabled us to achieve accurate local anesthetic spraying and a successful endotracheal intubation with a double lumen tube (DLT) in an awake patient with predicted difficult airway and bronchoaspiration risk. Different ways to resolve cases like this can be found in the anesthetic literature, but we think this could be another option to bear in mind. We also describe a new variation in the maneuver of introducing a DLT into the trachea under GlideScope view as DLT presents with some difficulties when introduced under normal circumstances. This option could add some risk for the patients when used in inexperienced hands and there is not sufficient scientific evidence in the literature to recommend it for all cases.
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Affiliation(s)
- X Onrubia
- Servicio de Anestesiología-Reanimación, Hospital Universitari Dr. Peset, Valencia, Spain.
| | - A Lluch-Oltra
- Servicio de Anestesiología-Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - R Armero
- Servicio de Anestesiología-Reanimación, Hospital Universitari Dr. Peset, Valencia, Spain
| | - J Baldó
- Servicio de Anestesiología-Reanimación, Hospital de Manises, Valencia, Spain
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