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Introduction: Over the past few months, ChatGPT has raised a lot of interest given its ability to perform complex tasks through natural language and conversation. However, its use in clinical decision-making is limited and its application in the field of anesthesiology is unknown. Objective: To assess ChatGPT's basic and clinical reasoning and its learning ability in a performance test on general and specific anesthesia topics. Methods: A three-phase assessment was conducted. Basic knowledge of anesthesia was assessed in the first phase, followed by a review of difficult airway management and, finally, measurement of decision-making ability in ten clinical cases. The second and the third phases were conducted before and after feeding ChatGPT with the 2022 guidelines of the American Society of Anesthesiologists on difficult airway management. Results: On average, ChatGPT succeded 65% of the time in the first phase and 48% of the time in the second phase. Agreement in clinical cases was 20%, with 90% relevance and 10% error rate. After learning, ChatGPT improved in the second phase, and was correct 59% of the time, with agreement in clinical cases also increasing to 40%. Conclusions: ChatGPT showed acceptable accuracy in the basic knowledge test, high relevance in the management of specific difficult airway clinical cases, and the ability to improve after learning.

Introducción: En los últimos meses, ChatGPT ha suscitado un gran interés debido a su capacidad para realizar tareas complejas a través del lenguaje natural y la conversación. Sin embargo, su uso en la toma de decisiones clínicas es limitado y su aplicación en el campo de anestesiología es desconocido. Objetivo: Evaluar el razonamiento básico, clínico y la capacidad de aprendizaje de ChatGPT en una prueba de rendimiento sobre temas generales y específicos de anestesiología. Métodos: Se llevó a cabo una evaluación dividida en tres fases. Se valoraron conocimientos básicos de anestesiología en la primera fase, seguida de una revisión del manejo de vía aérea difícil y, finalmente, se midió la toma de decisiones en diez casos clínicos. La segunda y tercera fases se realizaron antes y después de alimentar a ChatGPT con las guías de la Sociedad Americana de Anestesiólogos del manejo de la vía aérea difícil del 2022. Resultados: ChatGPT obtuvo una tasa de acierto promedio del 65 % en la primera fase y del 48 % en la segunda fase. En los casos clínicos, obtuvo una concordancia del 20 %, una relevancia del 90 % y una tasa de error del 10 %. Posterior al aprendizaje, ChatGPT mejoró su tasa de acierto al 59 % en la segunda fase y aumentó la concordancia al 40 % en los casos clínicos. Conclusiones: ChatGPT demostró una precisión aceptable en la prueba de conocimientos básicos, una alta relevancia en el manejo de los casos clínicos específicos de vía aérea difícil y la capacidad de mejoría secundaria a un aprendizaje.

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Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.

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Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

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Abstract Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

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Abstract Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.

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Abstract Escobar syndrome is a rare, autosomal recessive disease of unknown incidence. It is characterized by multiple skeletal, genitourinary and orofacial abnormalities. The multiple malformations (mainly orofacial) and restricted mobility of these patients pose a challenge to the anesthesia team, especially as regards airway management. We describe the clinical case of a pediatric patient diagnosed with Escobar syndrome who underwent two consecutive anesthesia interventions, with evidence of progressive airway anomalies that characterize this syndrome. The case required adaptation, according to the clinical stage of the disease, of the current algorithms used to approach an anticipated difficult airway in pediatrics, and the incorporation of new devices, not described so far in patients with this pathology, as part of the planning and execution phases.

Resumen El síndrome de Escobar es una enfermedad rara, autosómica recesiva, de incidencia desconocida. Se caracteriza por múltiples anomalías esqueléticas, genitourinarias y orofaciales. Las múltiples malformaciones (principalmente orofaciales) y la restricción de la movilidad de estos pacientes determinan un desafío para el equipo anestésico, especialmente en el manejo de la vía aérea. Se describe el caso clínico de una paciente pediátrica con diagnóstico de síndrome de Escobar que fue sometida a dos anestesias consecutivas, en el que se evidencia una progresión de las anomalías de la vía aérea propias del síndrome, por lo que se requiere adecuar, según el estadío clínico de la enfermedad, los algoritmos actuales de abordaje de vía aérea difícil pediátrica anticipada y la incorporación de nuevos dispositivos en la planificación y ejecución para su manejo que no han sido descritos en pacientes con esta patología.

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Airway management can be difficult in surgeries of patients with mucopolysaccharidosis. We performed a retrospective review of 31 surgeries performed between 2015 and 2019. The mean age of the patients was 127.6 months. MPS-IV and MPS-VI were the most frequent subtypes. Orthopedic surgeries were the most common surgery type. Difficult intubation was seen in 10 procedures. All patients with difficult intubation were aged over 36 months. Video laryngoscopy was the most common intubation method. Seventeen patients were followed up in the intensive care unit. Although video laryngoscopy seems to be a safe method in these patients, one should always be prepared for alternative methods.

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Abstract Airway management can be difficult in surgeries of patients with mucopolysaccharidosis. We performed a retrospective review of 31 surgeries performed between 2015 and 2019. The mean age of the patients was 127.6 months. MPS-IV and MPS-VI were the most frequent subtypes. Orthopedic surgeries were the most common surgery type. Difficult intubation was seen in 10 procedures. All patients with difficult intubation were aged over 36 months. Video laryngoscopy was the most common intubation method. Seventeen patients were followed up in the intensive care unit. Although video laryngoscopy seems to be a safe method in these patients, one should always be prepared for alternative methods.

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Los quistes epidermoides son patologías benignas que se originan cuando células germinativas quedan atrapadas dentro de los arcos branquiales durante su cierre. Su prevalencia es baja, siendo aún menos prevalente su par, el quiste dermoide. Se presenta el caso clínico de una paciente de 17 años, de sexo femenino que debuta con aumento de volumen en piso de la cavidad, bilateral (de larga data), con obstrucción parcial de vía aérea, dificultad a la fonación y deglución. La tomografía computarizada entrega una imagen hipodensa, autolimitada, en los espacios submandibular y sublingual. Como hipótesis diagnóstica se sugiere un quiste dermoide o epidermoide. La paciente es intervenida y la muestra entregada a anatomopatología. El diagnóstico definitivo corrobora la hipótesis presuntiva de quiste epidermoide.

Epidermoid cysts are benign pathologies that originate when germinative cells become trapped within the branchial arches during their closure. Its prevalence is low, and its peer, the dermoid cyst, is even less prevalent. The clinical case is presented of a 17-year-old female patient who presents a bilateral increase in the oral cavity (long- standing), with partial obstruction of the airway, difficulty in phonation and swallowing. The computed tomography provides a hypodense, self-limited image in the submandibular and sublingual spaces. A dermoid or epidermoid cyst is suggested as a diagnostic hypothesis. The patient undergoes surgery, and the sample is delivered to pathology. The definitive diagnosis corroborates the presumptive hypothesis of an epidermoid cyst.

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Introducción: la vía aérea difícil es aquella situación clínica en la cual un anestesiólogo entrenado convencionalmente experimenta dificultad en la aplicación de ventilación con mascarilla facial, en la intubación endotraqueal o ambas, es de vital importancia su identificación, puesto que su manejo adecuado marcará la diferencia en el desenlace de los pacientes que requieren intubación, en especial los recibidos en urgencias. Objetivo: revisar de manera sistemática el estado actual del conocimiento y evidencia clínica relacionada al manejo de la vía aérea difícil en in- tubación de emergencia. Material y métodos: se realizó una revisión sistemática en PubMed, Cochrane, EBSCO y OVID; se emplearon los términos manejo de vía aérea difícil e intubación de emergencia. Resul- tados: la búsqueda arrojó 356 resultados, se excluyeron los estudios de revisión sistemática, metaanálisis, artículos basados en opiniones, infor- mes de casos, cartas al editor; 128 artículos fueron analizados; además, se buscó analizar artículos de distinta área de la investigación médica; se seleccionaron 21 artículos para ser analizados en esta revisión sistemática. Conclusiones: inesperadamente los artículos revisados concluyen, en su gran mayoría, que independientemente del protocolo de intubación, el aspecto que juega un rol determinante en el manejo de la vía aérea difícil es la experiencia y preparación previa del médico anestesiólogo (AU)

Introduction: difficult airway is that clinical situation in which a conventionally trained anesthesiologist experiences difficulty in ventilation with a face mask, in endotracheal intubation or both. In this review article we will focus on emergency intubation. Objective: to systematically review the current state of knowledge and clinical evidence related to the management of difficult airways in emergency intubation. Material and methods: a systematic review was carried out in PubMed, Cochrane data base, EBSCO and OVID; the terms: difficult airway management and emergency intubation; only clinical trials and scientific research reports were analyzed. Results: the search yielded 356 results, of which systematic review studies, meta-analysis, opinion-based articles, case reports, letters to the editor were excluded; which gave us 128 articles, after they were analyzed; it was also sought to analyze articles from different areas of medical research; 21 articles were selected to be analyzed in this systematic review. Conclusions: unexpectedly, the majority of the reviewed articles conclude that regardless of the intubation protocol or the tools used, the aspect that plays a decisive role in the management of the difficult airway is the experience and previous preparation of the anesthesiologist (AU))

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El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se presenta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.

Specialized airway management is essential in emergency units where endotracheal intubation has been the technique of choice. The difficult airway is defined as a clinical situation in which a trained medical team experiences difficulties in ventilation and, or intubation. Acute airway obstruction is one of the most extreme medical emergencies, requiring immediate intervention. We present the case of a patient with inspiratory stridor with quick criteria for intubation where a tumour in the vocal cords with airway obstruction is found.

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Introducción: El manejo de la vía aérea, conceptualizado como el conjunto de maniobras y empleo de dispositivos que permiten una ventilación adecuada y segura en pacientes que por diversas condiciones clínicas lo requieren, llega a ser uno de los desafíos más importantes que enfrenta un anestesiólogo en su práctica. Se considera que el resultado final dependerá de las características del paciente, la disponibilidad de equipos, así como de su destreza y habilidades. Cuando no se tienen en cuenta estos aspectos, aumenta la incidencia de morbilidad y mortalidad perioperatoria. Objetivo: Describir la conducta anestesiológica ante una paciente con diagnóstico de vía aérea difícil no prevista durante el perioperatorio. Presentación de caso: Se presenta el caso de una paciente anunciada para cirugía de urgencia, sin antecedentes patológicos personales, con antecedente de anestesia para amigdalotomía en la niñez. A pesar de un interrogatorio y examen físico minucioso, con utilización de herramientas como los test predictivos de vía aérea difícil y el empleo de dispositivos para su abordaje, no fue posible la intubación y se hizo necesario un abordaje quirúrgico de urgencia. Conclusiones: La vía aérea es parte integral del manejo anestésico. En la actualidad no se cuenta con un método clínico capaz de incluir la valoración de todos los parámetros que sugieran la presencia de vía aérea difícil. Una historia preoperatoria detallada y minuciosa evaluación de esta puede identificar factores de riesgos potenciales, pero casos como estos demuestran que a pesar de las medidas que se puedan tomar, no se está exento de fracasar en la permeabilización de la vía aérea(AU)

Introduction: The management of the airway, conceptualized as the set of maneuvers and use of devices that allow adequate and safe ventilation in patients who require it due to various clinical conditions, becomes one of the most important challenges faced by an anesthesiologist in the practice. It is considered that the final result will depend on the characteristics of the patient, the availability of equipment, as well as their dexterity and skills. When these aspects are not taken into account, the incidence of perioperative morbidity and mortality increases. Objective: Describe the anesthesiological behavior in a patient with a difficult airway diagnosis not foreseen during the perioperative period. Case presentation: The case of a patient announced for emergency surgery, without a personal pathological history, with a history of anesthesia for tonsillectomy in childhood is presented. Despite a thorough interrogation and physical examination, with the use of tools such as predictive tests of difficult airway and the use of devices for their approach, intubation was not possible and an emergency surgical approach was necessary. Conclusions: The airway is an comprehensive part of anesthetic management. At present there is no clinical methods capable of including the assessment of all the parameters that suggest the presence of a difficult airway. A detailed preoperative history and thorough evaluation of this can identify potential risk factors, but cases like these show that despite the measures that can be taken, it is not exempt from failing to permeate the airway(AU)

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RESUMEN Se presentó un paciente masculino de 8 años de edad, de la raza negra, a la consulta del servicio de Cirugía Maxilofacial del Hospital Américo Boavida de Luanda, en la República de Angola, en el mes de marzo de 2018. Los familiares refirieron una gran deformidad facial de crecimiento lento y progresivo, que se acompañaba de dificultad para respirar por las fosas nasales. Se le realizó un diagnóstico presuntivo de displasia fibrosa facial monostótica del maxilar derecho. Fue intervenido quirúrgicamente bajo anestesia endotraqueal, previa realización de las pruebas para la valoración de la apertura de la boca, donde se tomaron los incisivos superiores e inferiores como referencia: obtuvo una clasificación en clase II (2,6-3 cm) y la escala de Mallampati en grado IV. Se logró superar las dificultades para la intubación. Se le realizó exéresis tridimensional con abordaje de Weber-Ferguson y reconstrucción estética facial.

ABSTRACT An eight-years-old black male patient was attended in the Maxillofacial Surgery Service consultation at the Americo Boavida Hospital in Luanda, Angola, in march 2018. Relatives reported a huge facial deformity with characteristic variable (slow growth) and evolve with time. Also they referred presence of difficulty in breathing through the nostrils, associated with this anomaly. A presumptive diagnosis of monostotic facial fibrous dysplasia of the right maxillary segment was made. He underwent surgery under endotracheal anesthesia, after undergoing tests for the evaluation of the range of mouth opening, where the upper and lower incisors were taken as references: classification obtained in test was Class II (2.6-3 cm) and the Mallampati scale was Grade IV. The intubation procedures difficulties were overcome. Three-dimensional excision with Weber-Ferguson approach and reconstructive plastic surgery was performed.

RESUMO Paciente do sexo masculino, 8 anos, de raça negra, apresentou-se ao serviço de Cirurgia Buco Maxilo Facial do Hospital Américo Boavida, em Luanda, na República de Angola, em março de 2018. Os familiares relataram grande deformidade facial lenta e progressiva, que foi acompanhada de dificuldade em respirar pelas narinas. Foi feito diagnóstico presuntivo de displasia fibrosa facial monostótica da maxila direita. Foi operado sob anestesia endotraqueal, após a realização dos testes de avaliação da abertura da boca, onde foram tomados como referência os incisivos superiores e inferiores: obteve a classificação de classe II (2,6-3 cm) e a escala de Mallampati no grau IV. As dificuldades na intubação foram superadas. A exérese tridimensional foi realizada com a abordagem de Weber-Ferguson e cirurgia plástica reconstrutiva.

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Abstract: Eleven years old children, proposed for resection of pylocitic astrocytoma of cerebellum, presented with lingual tonsil hypertrophy causing a unpredictable difficult airway approach. The presence of a lingual tonsil hypertrophied isn't diagnosed most of the times, with their occurrence being associated with previous tonsillectomy in more than half of the cases. Its occurrence, and non-identification, can originate scenarios of difficult airway approach, with a higher morbility association.

Resumen: Niño con 11 años, propuesto para exéresis de recidiva de astrocitoma pilocítico del cerebelo con hipertrofia de las amígdalas linguales a condicionar vía aérea difícil no previsible. La hipertrofia de las amígdalas linguales es subdiagnosticada y se suele asociar a amigdalectomía previa en más de la mitad de los casos. Su ocurrencia y no reconocimiento, puede originar situaciones de vía aérea difícil, con alta morbilidad asociada.

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Subglottic stenosis is a congenital and/or acquired pathology, which can be secondary to prolonged endotracheal intubation and tracheotomy. It is associated with hypoperfusion of the epithelium related to the cuff pressure of the endotracheal tube and/ or the tracheostomy cannula. Grade III-IV stenosis represents urgent and/or emergent airways, which must be managed by expert anesthesiologists who are extensively trained in techniques and algorithms. We report a case of a woman with multiple pre- dictors of difficult airway, obesity and mechanical ventilation due to tracheotomy; with subsequent grade III subglottic stenosis managed with tracheal dilation; who presented a new symptomatic episode, a non-dilatable stenosis of 2 mm and an indication for emergency tracheal reconstruction.

Las estenosis subglótica es una patología congénita y/o adquirida, que puede ser secundaria a intubación endotraqueal prolongada y necesidad de traqueostomía. Está asociada a una hipoperfusión del epitelio relacionado con la presión de cuff del tubo endotraqueal y/o de la cánula de traqueostomía. Las estenosis grado III-IV, representan vías aéreas urgentes y/o emergentes, que deben manejarse por anestesiólogos expertos y ampliamente entrenados en las técnicas y los algoritmos. Reportamos el caso de una mujer con múltiples predictores de vía aérea difícil, antecedente obesidad y de ventilación mecánica por traqueotomía; con posterior estenosis subglótica grado III manejada con dilatación traqueal; que presenta nuevo episodio sintomático, una estenosis no dilatable de 2 mm e indicación de reconstrucción traqueal de emergencia.

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OBJETIVO. Determinar la asociación que existe entre las valoraciones de la articulación atlantooccipital durante la valoración preanestésica y la valoración del Cormack Lehane durante la intubación para predecir una vía aérea difícil en el paciente pediátrico de 0 a 12 años de edad que ingresaron a quirófano del Hospital Municipal Boliviano Holandés en los meses de agosto a octubre de la Gestión 2017. MATERIAL Y METODOS. Es un diseño observacional descriptivo de corte transversal, en 70 pacientes de 0 a 12 años de edad que siguiendo criterios estrictos de inclusión se evaluó la clasificación de vía aérea difícil pediátrica analizando la concordancia entre la asociación de la valoración de la articulación atlantooccipital con la escala de Cormack-Lehane. RESULTADOS. Se evaluaron pacientes entre 0 a 12 años, la Escala de Bellhouse Dore encontrada fue Grado I 39%, Grado III 29%, Grado II 24% y Grado IV 8% y el Cormack Lehane encontrado es grado I 39%, grado III 29%, grado II 24% y el grado IV 8%. La asociación de ambas escalas determinó como predictor de vía aérea normal al 63%, potencialmente difícil 29% y vía aérea difícil 8%. CONCLUSIÓN. Existe asociación entre las valoraciones de la articulación atlantooccipital durante la valoración preanestesica y la valoración del Cormack Lehane durante la intubación como predictor de una vía aérea difícil en el paciente pediátrico de 0 a 12 años de edad.

OBJECTIVE. To determine the association that exists between the assessments of the atlanto-occipital joint during the preanesthetic assessment and the assessment of the Cormack Lehane during intubation to predict a difficult airway in pediatric patients aged 0 to 12 who were admitted to the Municipal Boliviano Holandés Hospital in the months of August to October of the Management 2017. MATERIAL AND METHODS. It is an observational descriptive crosssectional design, in 70 patients from 0 to 12 years of age who, following strict inclusion criteria, evaluated the classification of pediatric difficult airway, analyzing the concordance between the association of the atlanto-occipital joint assessment with the Cormack-Lehane scale. RESULTS. Patients between 0 to 12 years old were evaluated, the Bellhouse Dore Scale found was Grade I 39%, Grade III 29%, Grade II 24% and Grade IV 8% and the Cormack Lehane found is grade I 39%, grade III 29 %, grade II 24% and grade IV 8%. The association of both scales determined a 63% normal airway as a predictor, 29% potentially difficult and 8% difficult airway. CONCLUSION. There is an association between the assessments of the atlanto-occipital joint during the pre-anesthetic assessment and the assessment of the Cormack Lehane during intubation as a predictor of a difficult airway in pediatric patients 0 to 12 years of age.

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Acquired subglottic cysts are an unusual cause of stridor. They are usually developed following a tracheal intubation episode in a premature patient. We report the clinical case of an ex-premature patient who was diagnosed as having an acquired subglottic cyst after causing a difficult intubation situation. This situation can potentially uncover the obstruction and initiate the complete diagnostic and therapeutic process.

Una causa poco frecuente de estridor laríngeo corresponde a quistes subglóticos. En general se desarrollan luego de una intubación en un paciente prematuro. Se presenta el caso clínico de un ex prematuro que presenta una intubación difícil dada por la presencia de un quiste subglótico. Gracias a esta situación, se inició el estudio y tratamiento del quiste.

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Difficulties in airway management turn out to be the leading cause of cardiac arrest in anesthesia and they represent 50% of severe non-fatal anesthesiological complications. The main obstacle lies in the difficulties to predict it. Difficult intubation occurs in 1.5 to 8% of general anesthesia procedures and it can be defined as one requiring more than three attempts at laryngoscopy or more than 10 minutes of laryngoscopy. In order to identify and prevent an adverse event in patients at risk of presenting a difficult intubation, several parameters have been investigated. Anatomical factors that can predict difficult direct laryngoscopy require a complete pre-anesthetic evaluation and physical examination by the anesthesiologist. These include: the Mallampati scale, the thyromental distance (of Patil), the sternomental distance, the mandibular protrusion test and the atlanto- occipital extension; which combined have a high positive predictive value to anticipate difficult airway management.

Las dificultades en el abordaje de la vía aérea resultan ser la primera causa de paro cardíaco en anestesia y, a su vez, representan al 50% de las complicaciones severas no fatales de causa anestesiológica. El principal obstáculo a superar radica en las dificultades para predecirla[]. La intubación dificultosa se define como la necesidad de tres o más intentos o el empleo de más de 10 minutos para lograr la intubación traqueal, situación que ocurre en 1,5 a 8% de los procedimientos de anestesia gene- ral[]. Con el fin de identificar pacientes con riesgo de presentar una intubación dificultosa, se han investigado diversos parámetros capaces de anticipar un evento adverso. La caracterización de factores anatómicos que puedan dificultar la laringoscopia directa y la consecuente intubación orotraqueal, requieren de un examen e interrogatorio completo y minucioso por parte del anestesiólogo. Entre estos factores anatómicos encontramos la escala de Mallampati, la distancia tiromentoniana (de Patil)[],[], la distancia esternomentoniana, el test de protrusión mandibular y la extensión atlantooccipital; que combinados tienen un alto valor predictivo positivo para anticipar una vía aérea dificultosa

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RESUMEN El manejo de la vía respiratoria es uno de los aspectos más importantes en Anestesia. Entre el 50 y 70 % de los paros cardiacos durante la anestesia general obedecen a dificultades en la intubación. Los pacientes obesos tienen un 30 % más de probabilidades de presentar intubación difícil con respecto a pacientes normopesos. También desarrollan desaturación de oxígeno más rápido, lo que aumenta el riesgo de complicaciones. Teniendo en cuenta lo anterior, se decidió realizar este trabajo, con el objetivo de actualizar sobre el uso de los métodos para el abordaje de la vía respiratoria en dichos pacientes. Se mostraron los criterios y resultados de investigaciones de autores sobre el tema. Se concluye que, a pesar de que el método más utilizado para abordar la vía aérea en obesos es la intubación orotraqueal con visión directa, se debe considerar el uso de máscara laríngea de intubación, fibroscopio flexible y videolaringoscopios, sobre todo en personas superobesas (AU).

ABSTRACT The respiratory tract management is one of the most important topics in anesthesia. Between 50 and 70 % of the heart arrests occurring during general anesthesia are due to intubation difficulties. Obese patients are 30 % more likely of presenting difficult intubation with respect to normal weight patients. They also develop oxygen desaturation faster, increasing the complication risk. Taking into consideration the above reasons, the authors decided to write this article, with the aim of updating on the methods to approach the respiratory tract in those patients. The authors' criteria and research outcomes on the theme are showed. It was concluded that even though the most used method to approach the airway in obese patients is the orotracheal intubation with direct vision, the use of a laryngeal intubation mask, flexible fiberscope and video laryngoscopes should be considered, especially in superobese patients (AU).

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