RESUMO
Introducción: La intubación de secuencia de rápida es un procedimiento que minimiza el tiempo necesario para asegurar la vía respiratoria en pacientes con alto riesgo de broncoaspiración. Objetivo: Comparar la eficacia de tres dosis de succinilcolina en la inducción de secuencia rápida en pacientes con estómago y la calidad de la intubación, así como los efectos secundarios de dichos fármacos. Métodos: Se realizó un estudio observacional, de corte transversal para evaluar la calidad de la intubación con inducción de secuencia rápida en pacientes de urgencia, con estómago lleno. Se administraron 0,4 mg/kg de succinilcolina al grupo I, 0,6 mg/kg al grupo II y 1 mg/kg al grupo III. En todos los pacientes se evaluó la vía respiratoria. El estudio se realizó en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre agosto de 2013 y 2016. Resultados: El tiempo de visualización de las cuerdas vocales fue rápido en los tres grupos. Los mejores resultados se obtuvieron en el grupo III, seguido del grupo II. Las condiciones de intubación fueron excelentes en el grupo III (90 %), buenas en grupo II (80 %) y regulares en el grupo I (70 %). Las variables hemodinámicas mostraron diferencias significativas entre grupos (p=0,008). Conclusiones: Se determinó la eficacia del empleo de tres dosis de succinilcolina en la inducción de secuencia rápida, con intubación óptima y segura cuando se empleó la succinilcolina a dosis de 1 mg/kg; pero con mayor porcentaje de alteraciones hemodinámicas como efectos adversos(AU)
Introduction: Rapid sequence intubation is a procedure that minimizes the time required to guarantee the respiratory airway in patients with high risk of bronchoaspiration. Objectives: To compare the quality of intubation with three doses of succinylcholine in rapid sequence induction in patients with full stomach, as well as the side effects of such drugs. Methods: An observational, cross-sectional study was carried out to assess the quality of intubation with rapid sequence intubation in emergency patients and with full stomach. The group I was administered 0.4 mg/kg of succinylcholine; the group II, 0.6 mg/kg; and the group III 1 mg/kg. The respiratory airway was assessed in all patients. The study was carried out in Hermanos Ameijeiras Clinical Surgical Hospital, between August 2013 and 2016. Results: The time of visualization of the vocal folds was fast in the three groups. The best results were obtained in the group III, followed by the group II. The intubation conditions were excellent in the group III (90%), good in the group II (80%), and fair in the group I (70%). The hemodynamic variables showed significant differences among the three groups (p=0.008). Conclusions: The effectiveness was determined of using three doses of succinylcholine in rapid sequence intubation, with optimal and safe intubation when succinylcholine was used at doses of 1 mg/kg, but it had a higher percentage of hemodynamic alterations as adverse effects(AU)
Assuntos
Humanos , Masculino , Feminino , Succinilcolina/efeitos adversos , Succinilcolina/uso terapêutico , Indução e Intubação de Sequência Rápida/métodos , Estudos TransversaisRESUMO
La succinilcolina es un fármaco neuromuscular despolarizante generalmente utilizado en el contexto de protocolo de intubación de secuencia rápida indicada en pacientes en los cuales es necesario asegurar la vía aérea en menos de sesenta segundos. Se realizó un estudio descriptivo transversal con el objetivo de determinar la duración del bloqueo neuromuscular con succinilcolina y los niveles de colinesterasa plasmática en pacientes sépticos intervenidos en el Hospital Central Universitario Dr. Antonio María Pineda. Se incluyeron 30 pacientes con sepsis con un promedio de edad de 49,6 ± 17,4 años y predominio del sexo masculino (70%); la principal indicación de cirugía abdominal fue obstrucción intestinal (36,6%) y peritonitis secundaria (23,3%). Los valores de colinesterasa plasmática se registraron disminuidos en 42,8% de los hombres y 33,3% de las mujeres encontrándose valores promedios de 5554,1 ± 1220,5 U/L y 4770,1 ± 1627,4 U/L, respectivamente. La duración del bloqueo neuromuscular fue mayor de 14 minutos en 66,6% de las mujeres; el promedio de duración fue de 14,4 ± 5,1 min (mujeres) y 9,4 ± 4,3 min en hombres. Hubo una pobre correlación entre los niveles de colinesterasa plasmática y la duración así como el tiempo de recuperación del bloqueo neuromuscular. En conclusión, el bloqueo neuromuscular prolongado debido a la baja actividad de la colinesterasa después de la administración de succinilcolina se presenta en menos de la mitad de los pacientes sépticos estudiados(AU)
Succinylcholine is a depolarizing neuromuscular drug generally used in the context of rapid sequence intubation indicated in patients in whom it is necessary to secure the airway in less than sixty seconds. A descriptive cross-sectional study was conducted in order to determine the duration of neuromuscular blockade with succinylcholine and plasma cholinesterase levels in septic patients admitted at Hospital Central Universitario Dr. Antonio Maria Pineda. A sample of 30 patients with sepsis were studied, with a mean age of 49.6 ± 17.4 years, predominantly male (70%). The main indication for abdominal surgery was intestinal obstruction (36.6%) and secondary peritonitis (23.3%). Diminished values of plasma cholinesterase were recorded in 42.8% of men and 33.3% of women; mean plasma levels were 5554.1 ± 1220.5 U/L and 4770.1 ± 1627.4 U/L, respectively. Duration of neuromuscular blockade was longer in women (66.6%) with an average duration of 14.4 ± 5.1 min and 9.4 ± 4.3 min for men. A poor correlation between cholinesterase plasmatic levels and duration as well as time of recovery of neuromuscular blockage was found. Prolonged neuromuscular blockade is due to low cholinesterase activity after administration of succinylcholine and occurs in less than half of septic patients studied(AU)
Assuntos
Humanos , Masculino , Feminino , Succinilcolina/farmacologia , Indução e Intubação de Sequência Rápida , Anestesia Endotraqueal , Colinesterases , Sepse , Assistência ao PacienteRESUMO
JUSTIFICATIVA E OBJETIVOS: O médico clínico frequentemente se depara com a necessidade do acesso a via aérea em situações de urgência e emergência. O objetivo deste estudo foi rever as principais publicações sobre acesso às vias aéreas nessas situações descrevendo as melhores evidências para a execução deste procedimento.CONTEÚDO: Foram selecionados artigos na base de dados Medline (1950-2010), por meio das palavras-chave: intubação orotraqueal, sequência rápida, laringoscopia. Adicionalmente,referências desses artigos, capítulos de livros e artigos históricos foram avaliados. Foram identificados e revisados 68 artigos. Foram considerados ensaios clínicos da língua inglesa, estudos retrospectivose de revisão. Os artigos foram avaliados por análisede método e determinação de limitações de desenho. Por se tratar de uma revisão narrativa, foram apresentadas as conclusões mais relevantes dos principais estudos e metanálises, sem a interferência direta da análise pessoal dos autores deste estudo.CONCLUSÃO: A técnica de acesso a via aérea é indispensável para o clínico. Os conhecimentos sobre sua anatomia, condição ideal para a laringoscopia envolvendo o melhor posicionamento e técnicas que podem ser utilizadas deve ser rotineiro ao clínico. O clinico pode se deparar muitas vezes com o paciente com risco de aspiração pulmonar e deve conhecer também a técnica de sequência rápida envolvendo todas as suas particularidades e aspectos de segurança.(AU)
BACKGROUND AND OBJECTIVES: The internist frequently comes across with the necessity for emergency airway access.The objective of this study was to review the major publications about airway access in these conditions describing the best evidencesto execute this procedure.CONTENTS: We selected articles in Medline (1950-2010), by means of keywords: orotracheal, rapid sequence intubation and laryngoscopy. Additionally, references to these articles, chapters of books and historical articles were evaluated. We identified and reviewed 68 articles. We considered clinical trials, retrospective studies and clinical reviews in English. Articles were analyzing basedin methods and determination of design limitations. As a narrative review, we presented the most relevant findings of major studiesand meta-analyses without involving our personal point of view.CONCLUSION: The technique of airway access is a vital procedureto the internist. Knowledge of the airways anatomy and ideal scenario for laryngoscopy involving the best positioning and techniques,that can should be used as a routine for the clinical practice. The internist many times may get with the patient at risk for pulmonary aspiration and should know the technique of rapid sequence intubation,involving all its particularities and safety aspects.(AU)