RESUMEN
Abstract Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.
Asunto(s)
Humanos , Femenino , Máscaras Laríngeas/efectos adversos , Traumatismos del Nervio Craneal/complicaciones , Traumatismos del Nervio Hipogloso/etiología , Nervio LingualRESUMEN
Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.
Asunto(s)
Traumatismos del Nervio Craneal , Traumatismos del Nervio Hipogloso , Máscaras Laríngeas , Traumatismos del Nervio Craneal/complicaciones , Femenino , Humanos , Traumatismos del Nervio Hipogloso/etiología , Máscaras Laríngeas/efectos adversos , Nervio LingualRESUMEN
Managing a pediatric patient is a challenge for the anesthesiologist. Optimizing the use of airway devices through solving common questions among general anesthesiologists turns out to be a way of improving and maximizing de safety we offer our patients, reducing de occurrence of the most common complications the pediatric patient has, which are respiratory complications.
El enfrentamiento del paciente pediátrico supone un desafío para el anestesiólogo. En este contexto el optimizar el uso de los dispositivos de vía aérea, resolviendo dudas muy frecuentes entre los anestesiólogos generales, supone una practica que aumenta la seguridad de nuestros pacientes, reduciendo las complicaciones mas frecuentes en ellos que son las complicaciones respiratorias.
Asunto(s)
Humanos , Niño , Pediatría , Manejo de la Vía Aérea , Complicaciones Intraoperatorias/prevención & control , Máscaras Laríngeas , Intubación IntratraquealRESUMEN
BACKGROUND AND OBJECTIVES: Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging. METHODS: A prospective observational study was conducted on 82 patients aged 3-15 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope. RESULTS: The average age of the patients was 6.27⯱â¯4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (pâ¯<â¯0.001; râ¯=â¯0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (ORâ¯=â¯2.961; pâ¯=â¯0.046; 95% Cl 2.850-30.745). CONCLUSION: The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective.
Asunto(s)
Máscaras Laríngeas , Laringoscopios , Anestesia General , Niño , Preescolar , Humanos , Lactante , Estudios Prospectivos , UltrasonografíaRESUMEN
Abstract Background and objectives: The conscious patient cooperation during neurological procedures has become necessary for the delimitation of areas to be managed by a neurosurgeon, with better results in the treatment of tumor lesions, vascular or epileptic foci, and lesser sequelae. The need for perioperative awareness (responsiveness to commands) challenges anesthesiologists to further ensure patient safety during the procedure. Several techniques have been described for this purpose. Case report: In this case, interaction with the patient during brain tumor resection enabled a broad approach of the tumor lesion, limited by deficits in speech and naming observed during surgical manipulation, avoiding major consequences. The chosen technique was deepening of general anesthesia during surgical times of most painful stimulus with intraoperative awakening of the patient. Conclusions: Patient selection, an exhaustive explanation of the procedure to him, and the selection of drugs are crucial for a successful procedure. Laryngeal mask is useful in times requiring greater depth and anesthetic ventilation control, primarily in situations where endotracheal intubation may be hindered by the position. The continuous infusion of remifentanil and adjuncts in the awake period associated adequate analgesia and full consciousness.
Resumo Justificativa e objetivos: A colaboração consciente do paciente durante procedimentos neurológicos tem se tornado necessária para delimitar áreas a serem abordadas pelo neurocirurgião, com melhores resultados no tratamento de lesões tumorais, vasculares ou focos epiléticos e minimização de sequelas. A necessidade de consciência perioperatória e responsividade a comandos desafia o anestesiologista a garantir ainda a segurança do paciente durante o procedimento. Várias técnicas têm sido descritas para esse fim. Relato de caso: No presente caso, a interação com paciente durante ressecção de tumor cerebral possibilitou abordagem ampla de lesão tumoral, limitada por déficits de fala e de identificação notados à manipulação cirúrgica, e evitou sequelas maiores. A indução de anestesia geral em tempos cirúrgicos de maior estímulo doloroso com despertar intraoperatório do paciente foi a técnica escolhida. Conclusões: A seleção do paciente, seu exaustivo esclarecimento e a seleção das drogas são de fundamental importância para o sucesso do procedimento. A máscara laríngea é instrumento útil em tempos que exigem maior profundidade anestésica e controle da ventilação, primariamente em situações em que a intubação endotraqueal pode estar dificultada pelo posicionamento. A infusão contínua de remifentanil e coadjuvantes no período desperto associou analgesia adequada e consciência plena.
Asunto(s)
Humanos , Craneotomía/métodos , Neurocirugia , Máscaras Laríngeas , Remifentanilo/administración & dosificaciónRESUMEN
Abstract Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. Case report: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5 mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15 mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15 mm adapter was reattached to the tracheal tube. Conclusion: The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.
Resumo Os recém-nascidos e crianças pequenas com malformação craniofacial podem ser muito difíceis ou impossíveis de ventilar por máscara ou de intubar. Gostaríamos de relatar a intubação com fibra óptica de um bebê com síndrome de Treacher Collins usando a técnica descrita por Ellis et al. Relato de caso: Uma criança de um mês de idade com síndrome de Treacher Collins foi programada para cirurgia mandibular sob anestesia geral endotraqueal. A laringoscopia direta para intubação oral não revelou a glote. A intubação com fibra óptica usando as abordagens nasal e oral por meio de máscara laríngea de tamanho 1,5 foi tentada, mas ambas as abordagens falharam porque o fibroscópio portando um tubo sem balonete de 3,5 mm ficou preso no interior da cavidade nasal ou dentro da máscara laríngea, respectivamente. Portanto, a máscara laríngea foi mantida no lugar e a técnica de intubação com fibra óptica descrito por Ellis et al. foi planejada: o tubo traqueal com o adaptador de 15 mm removido foi colocado proximalmente sobre o fibroscópio; o fibroscópio foi avançado na traquéia sob visualização em tela devídeo; a máscara laríngea foi removida, deixando o fibroscópio no lugar; o tubo traqueal foi passado completamente através da máscara laríngea e avançado para baixo sobre o fibroscópiona traquéia; o fibroscópio foi removido e o adaptador de 15 mm foi recolocado no tubo traqueal. Conclusão: O método de intubação com fibra óptica através de uma máscara laríngea descrito por Ellis et al. pode ser usado com sucesso em bebês com síndrome de Treacher Collins.
Asunto(s)
Humanos , Masculino , Lactante , Máscaras Laríngeas , Manejo de la Vía Aérea , Disostosis Mandibulofacial/cirugía , Tecnología de Fibra ÓpticaRESUMEN
BACKGROUND AND OBJECTIVES: The conscious patient cooperation during neurological procedures has become necessary for the delimitation of areas to be managed by a neurosurgeon, with better results in the treatment of tumor lesions, vascular or epileptic foci, and lesser sequelae. The need for perioperative awareness (responsiveness to commands) challenges anesthesiologists to further ensure patient safety during the procedure. Several techniques have been described for this purpose. CASE REPORT: In this case, interaction with the patient during brain tumor resection enabled a broad approach of the tumor lesion, limited by deficits in speech and naming observed during surgical manipulation, avoiding major consequences. The chosen technique was deepening of general anesthesia during surgical times of most painful stimulus with intraoperative awakening of the patient. CONCLUSIONS: Patient selection, an exhaustive explanation of the procedure to him, and the selection of drugs are crucial for a successful procedure. Laryngeal mask is useful in times requiring greater depth and anesthetic ventilation control, primarily in situations where endotracheal intubation may be hindered by the position. The continuous infusion of remifentanil and adjuncts in the awake period associated adequate analgesia and full consciousness.
RESUMEN
Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. CASE REPORT: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15mm adapter was reattached to the tracheal tube. CONCLUSION: The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.
Asunto(s)
Manejo de la Vía Aérea , Máscaras Laríngeas , Disostosis Mandibulofacial , Tecnología de Fibra Óptica , Humanos , Lactante , Masculino , Disostosis Mandibulofacial/cirugíaRESUMEN
This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Obesidad Mórbida/cirugía , Máscaras Laríngeas/normas , Procedimientos Quirúrgicos Torácicos/instrumentación , Ventilación Unipulmonar/instrumentación , Intubación Intratraqueal/instrumentación , Dolor Postoperatorio/etiología , Atelectasia Pulmonar , Factores de Tiempo , Faringitis/etiología , Ventiladores Mecánicos/normas , Método Doble Ciego , Estudios Prospectivos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Procedimientos Quirúrgicos Torácicos/métodos , Diseño de Equipo , Ventilación Unipulmonar/métodos , Tempo Operativo , Intubación Intratraqueal/métodosRESUMEN
This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Obesidad Mórbida/cirugía , Máscaras Laríngeas/normas , Ventilación Unipulmonar/instrumentación , Intubación Intratraqueal/instrumentación , Atelectasia Pulmonar , Factores de Tiempo , Método Doble Ciego , Estudios Prospectivos , Resultado del Tratamiento , Diseño de Equipo , Ventilación Unipulmonar/métodos , Tempo Operativo , Intubación Intratraqueal/métodosRESUMEN
Abstract Objective: To compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. Methods: Preterm infants (28-35 weeks of gestational age), weighing 1 kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2) ≥ 0.40 to maintain oxygen saturation 91-95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2 ≤ 0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24 h, MV requirement, and presence of surfactant in gastric content. Results: Forty-eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p = 0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. Conclusions: Surfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.
Resumo Objetivo: Comparar a eficácia de curto prazo da administração de surfactante por máscara laríngea em comparação com o tubo endotraqueal. Métodos: Neonatos prematuros (28-35 semanas de idade gestacional), com 1 kg ou mais, com síndrome do desconforto respiratório, que necessitavam de pressão positiva nasal contínua nas vias aéreas, com aumento do esforço respiratório e/ou fração de oxigênio inspirado (FiO2) ≥ 0,40 para manter a saturação de oxigênio 91-95%, foram randomizados para receber surfactante por ML seguido por nCPAP ou por TE seguido por ventilação mecânica (VM). O resultado clínico primário foi definido como FiO2 ≤ 0,30 três horas após o surfactante. Os resultados secundários do grupo de ML foram: necessidade de segunda dose de surfactante nas primeiras 24 horas, necessidade de VM e presença de surfactante no conteúdo gástrico. Resultados: Foram randomizados 48 pacientes; 26 no grupo de ML e 22 no grupo de TE. Seis dentre os 26 pacientes (23%) do grupo de ML e cinco dentre 22 pacientes (22,7%) do grupo de TE não apresentaram o resultado primário (p = 0,977); 14 (53,8%) dos pacientes do grupo de ML não foram intubados nem ventilados; 12 (46,1%) foram submetidos a VM: por falha do surfactante (23%), por falha da nCPAP (11,5%) e por complicações tardias (11,5%). Os grupos foram semelhantes em relação às condições pré-natais e de nascimento e a ocorrência de eventos adversos. Não foi encontrado conteúdo gástrico significativo em 61,5% dos pacientes do grupo de ML. As necessidades de oxigênio e da segunda dose de surfactante, o índice arterial/alveolar e as morbidades foram semelhantes entre os grupos. Conclusões: A administração de surfactante por ML mostrou eficácia de curto prazo com necessidade complementar de oxigênio semelhante ao surfactante por TE e menor necessidade de VM. Serão necessários estudos adicionais com tamanho da amostra maior para confirmar esses resultados.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Surfactantes Pulmonares/administración & dosificación , Máscaras Laríngeas , Intubación Intratraqueal , Recien Nacido Prematuro , Resultado del TratamientoRESUMEN
Abstract Background and objectives: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. Methods: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. Results: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. Conclusions: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations.
Resumo Justificativa e objetivos: O tamanho da máscara laríngea ProSeal (MLPS) em crianças é determinado com base no peso do paciente. No entanto, em alguns casos, pode ser necessário um método opcional. Este estudo teve como objetivo comparar o tamanho da MLPS convencional pela orelha e pelo peso em crianças. Métodos: Após aprovação do Comitê de Ética institucional e receber o consentimento informado assinado pelos pais, 197 crianças com estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), programadas para uma operação geniturinária de rotina, foram incluídas no estudo. O tamanho correto da MLPS foi determinado de acordo com o tamanho da orelha em crianças. Os resultados foram comparados com os do método padrão, baseado no peso, recomendado pelas diretrizes do fabricante. Os pacientes foram classificados em diferentes grupos, a depender dos tamanhos das MLPS, conforme determinado por ambos os métodos. A concordância entre as duas técnicas foi avaliada com as estatísticas do coeficiente kappa (k). Resultados: Inserção e ventilação adequada foram obtidas em 185 pacientes na primeira tentativa e 12 pacientes precisaram de uma segunda tentativa. Três pacientes precisaram ser intubados. A concordância entre os dois métodos de seleção do tamanho da MLPS foi moderada com a estatística κ. Conclusões: A escolha do tamanho da MLPS em crianças de acordo com a orelha da criança é válida e prática. Em particular, é um método opcional em situações nas quais o peso do paciente é desconhecido, como em situações de emergência.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Máscaras Laríngeas , Diseño de Equipo , Antropometría , Estudios Prospectivos , Oído Externo/anatomía & histología , Intubación Intratraqueal/instrumentaciónRESUMEN
OBJECTIVE: To compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. METHODS: Preterm infants (28-35 weeks of gestational age), weighing 1kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2)≥0.40 to maintain oxygen saturation 91-95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2≤0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24h, MV requirement, and presence of surfactant in gastric content. RESULTS: Forty-eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p=0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. CONCLUSIONS: Surfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.
Asunto(s)
Intubación Intratraqueal , Máscaras Laríngeas , Surfactantes Pulmonares/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. METHODS: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. RESULTS: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. CONCLUSIONS: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations.
RESUMEN
BACKGROUND AND OBJECTIVES: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. METHODS: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. RESULTS: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. CONCLUSIONS: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations.
Asunto(s)
Diseño de Equipo , Máscaras Laríngeas , Antropometría , Niño , Preescolar , Oído Externo/anatomía & histología , Femenino , Humanos , Lactante , Recién Nacido , Intubación Intratraqueal/instrumentación , Masculino , Estudios ProspectivosRESUMEN
Abstract Background and objectives The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. Case report A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. Conclusion We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.
Resumo Justificativa e objetivo A decisão quanto ao manejo de paciente ambulatorial com via aérea difícil previamente diagnosticada com o uso de dispositivo supraglótico permanece controversa. Relatamos o caso de inserção de máscara laríngea ProSeal™ em paciente acordado, com via aérea difícil prevista, agendado para cirurgia ambulatorial. Relato de caso Paciente do sexo feminino, 46 anos, programada para cirurgia de ressecção de nódulo de mama com alta hospitalar no mesmo dia. A história anestésica incluía uma intubação impossível, com o cancelamento da cirurgia e posterior intubação com o uso de fibroscópio, com a paciente acordada. A paciente relatou que ficou emocionalmente abalada com a experiência anterior e recusou essa abordagem. Considerando essa experiência anterior, uma abordagem das vias aéreas com a paciente acordada e o uso de uma máscara laríngea ProSeal™ foi planejada, após se explicar o procedimento para a paciente e tranquilizá-la. Após topicalização adequada, uma máscara laríngea (LMA ProSeal™) de tamanho 4 foi inserida com sucesso depois de duas tentativas e a permeabilidade foi confirmada por capnografia. A anestesia foi induzida por via intravenosa e a cirurgia foi feita sem intercorrências. Conclusão Descrevemos uma estratégia opcional viável para a intubação em uma paciente acordada com via aérea difícil previamente diagnosticada submetida a cirurgia ambulatorial. Nessa situação clínica específica, quando a intubação traqueal é considerada desnecessária, a via aérea supraglótica em paciente acordado pode permitir uma ventilação adequada e seu uso deve ser considerado.
Asunto(s)
Humanos , Femenino , Máscaras Laríngeas , Manejo de la Vía Aérea/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Intubación Intratraqueal , Neoplasias de la Mama/cirugía , Tecnología de Fibra Óptica , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVES: The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. CASE REPORT: A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. CONCLUSION: We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.
Asunto(s)
Manejo de la Vía Aérea/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Intubación Intratraqueal , Máscaras Laríngeas , Neoplasias de la Mama/cirugía , Femenino , Tecnología de Fibra Óptica , Humanos , Persona de Mediana EdadRESUMEN
ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.
RESUMO O manejo anestésico de pacientes com grandes massas situadas no mediastino pode ser complicado por causa dos efeitos da pressão da massa sobre as vias aéreas ou grandes vasos. Relatamos o manejo anestésico bem-sucedido de uma paciente de 64 anos com uma grande massa mediastinal que invadiu os grandes vasos e comprimiu a traqueia. Um stent traqueal foi colocado para aliviar a compressão da traqueia, sob anestesia geral. A ventilação espontânea foi mantida durante o período perioperatório com o uso de uma máscara laríngea clássica. Discutimos a utilidade da máscara laríngea para o manejo da colocação de stent traqueal em pacientes com massas situadas no mediastino.
Asunto(s)
Humanos , Femenino , Estenosis Traqueal/cirugía , Stents , Anestesia General/métodos , Neoplasias del Mediastino/complicaciones , Estenosis Traqueal/etiología , Máscaras Laríngeas , Neoplasias del Mediastino/patología , Persona de Mediana EdadRESUMEN
The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.
Asunto(s)
Anestesia General/métodos , Neoplasias del Mediastino/complicaciones , Stents , Estenosis Traqueal/cirugía , Femenino , Humanos , Máscaras Laríngeas , Neoplasias del Mediastino/patología , Persona de Mediana Edad , Estenosis Traqueal/etiologíaRESUMEN
BACKGROUND: Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AIMS: To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. METHOD: The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. RESULTS: Difference between ETLMI (2.49 ± 0.44) and ETTI (2.81 ± 0.65) as well as MACLMI (1.67 ± 0.13) and MACTI (1.77 ± 0.43) was statistically very significant, while BISLMI (49.05 ± 10.76) and BISTI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups. CONCLUSION: We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.
JUSTIFICATIVA: Sevoflurano é um agente inalatório de escolha em anestesia pediátrica. Para o manejo de vias aéreas em crianças, uma opção adequada para o TET é uma MLP pediátrica (referência de segunda geração SAD). Vários estudos mostraram que uma menor concentração do sevoflurano é necessária para a inserção da ML em comparação com a IT. O BIS é um monitor útil da profundidade da anestesia. OBJETIVOS: Comparar a concentração de sevoflurano (valores no fim da expiração e da CAM) necessária para a inserção de MLP e intubação traqueal em correlação com o BIS. MÉTODO: Estudo prospectivo, randômico e cego conduzido com crianças entre 2-9 anos, estado físico ASA I-II, randomicamente alocados nos grupos P (inserção de MLP) e IT (intubação traqueal). Pré-medicação sedativa não foi administrada. A indução foi feita com sevoflurano a 8% e, em seguida, a concentração predeterminada foi mantida durante 10 minutos. A via aérea foi garantida por MLP ou tubo endotraqueal, sem o uso de relaxante muscular. A concentração de sevoflurano no fim da expiração, CAM, BIS e outros parâmetros vitais foram monitorados a cada minuto até a inserção do dispositivo respiratório. As condições de inserção foram observadas. A análise estatística foi feita com o teste t de Student e Anova. RESULTADOS: As diferenças entre TEIML (2,49 ± 0,44) e TEIT (2,81 ± 0,65), bem como CAMIML (1,67 ± 0,13) e CAMIT (1,77 ± 0,43), foram estatisticamente muito significativas; enquanto BISIML (49,05 ± 10,76) e BISIT (41,25 ± 3,25) foram significativos. As condições de inserção foram comparáveis em ambos os grupos. CONCLUSÃO: Podermos concluir que a MLP em comparação com a intubação traqueal pode ser segura para a via aérea de crianças com o uso de menos concentração de sevoflurano, o que foi confirmado pelo BIS.