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Gabriela G. Huerta Tovar
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Justificación
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
Derivado de una intubación difícil: muerte cerebral o muerte
desde 55% hasta 93%.
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
Ventilación difícil
Incapacidad de un anestesiólogo entrenado para
mantener la saturación de oxígeno por arriba de 90%
usando una mascarilla facial, con una fracción inspirada
de oxígeno de 100%.
Intubación difícil
Tres o más intentos para la intubación de la tráquea o más
de 10 minutos para conseguirla
Benumof JL (1997) The ASA difficult airway algorithm: new thoughts considerations. Annual Refresher course lectures. Am Soc Anesthesiologists, Par Ridge, 241:1–7
Vía aérea difícil
Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on
Management of the Difficult Airway. Anesthesiology 2013;118(2):251-270
Una vía aérea difícil ocurre con una incidencia baja
pero constante en la práctica de la anestesiología.
Pahor, Ahmes L. (2007). "Ear, Nose and Throat in Ancient Egypt". The Journal of Laryngology & Otology 106 (8): 677–87
Manejo de vía aérea para ahogamiento
Andrea Vesalio1542
De humanis corporis fabrica
- junco en la tráquea de un cordero
Baker, A. Barrington (1971). "Artificial respiration, the history of an idea". Medical History 15 (4): 336–51
1854 Manuel García
Primera laringoscopía
Bouchut, E (1858). "D'une nouvelle méthode de traitement du croup par le tubage du larynx" [On a new method of
treatment for croup by larynx intubation]. Bulletin de l'Académie Impériale de Médecine (in French) 23: 1160–2.
1885 O’Dwyer presenta la
técnica en Nueva York.
Herramientas modificadas.
Rápidamente aceptado en el
mundo.
Sperati G, Felisati D. Bouchut, O’Dwyer and laryngeal intubation in patients with croup. Acta Otorhinolaryngologica Italica. 2007;27(6):320-323.
Anatomía
FARINGE
- Base del cráneo al
borde inferior del
cartílago cricoides
- Continúa hasta el
esófago
- Canal común entre
deglución y respiración
O'Rahilly, R. BASIC HUMAN ANATOMY.A Regional Study of Human Structure. Darmouth Medical School. 1983
Cavidad nasal y nasofaringe
O'Rahilly, R. BASIC HUMAN ANATOMY.A Regional Study of Human Structure. Darmouth Medical School. 1983
Intubación nasal:
- Cirugía maxilofacial
- Procedimientos dentales
- Trauma
- Oximetazolina/
Fenilefrina
Figura 2. Plexo de Kiesselbach. Adaptado de Kucik C, Clenney T. Management of epistaxis Am Fam Physician 2005;71:305-11, 312
Orofaringe
Se extiende desde el paladar blando hasta el borde superior de la epiglotis
O'Rahilly, R. BASIC HUMAN ANATOMY.A Regional Study of Human Structure. Darmouth Medical School. 1983
Laringe
Aislamiento de la vía aérea
Estructura tubular de 5 – 7 cm
2cm x 1cm
Part 2A Normal Anatomy Upper airway and Larynx Series of Web-based Bronchoscopic Images. BRONCHATLAS©. 2005
N. Laríngeo rec
Voicedoctor.net
Base de la
lengua
Epiglotis
Pared
posterior
Pliegue
aritenoepiglótico
Tubérculo corniculado
Pared posterior
Aritenoides
Nervio vago
- Laríngeo superior
- rama superior (sensitiva)
- rama inferior (motora)
- Laríngeo recurrente (motora)
Lesiones nerviosas
Norris, B. K. and Schweinfurth, J. M. (2011), Arytenoid dislocation: An Analysis of the contemporary literature. The Laryngoscope, 121: 142–146
Tráquea
Glándula
tiroides
Cartílago
tiroides
Cartílago Membrana
cricoides cricotiroidea
Cricoid Cartilage
Mallampati
Samsoon & Young
Patil – Andretti
Bellhouse
Savva
Wilson
Mallampati
1985
Mallampati SR, Gat SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34
Mallampati I
1. Pilares (palatogloso y
palatofaríngeo) paladar blando y
úvula
155 pacientes
80.6% clase I
19.3% clase II
Mallampati SR, Gat SP, Gugino LD, et al. A clinical sign to predict difficult tracheal
intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34
Mallampati II
40 pacientes
Mallampati SR, Gat SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34
Mallampati III
3. Solo paladar blando.
15 pacientes
4% grado II
34% grado IV
Mallampati SR, Gat SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective
study. Can Anaesth Soc J 1985; 32: 429–34
Mallampati SR, Gat SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34
Samsoon and Young
Mallampati modificado
1. Paladar 2. Paladar
duro, paladar duro,
blando, pilares paladar
faríngeos y blando,
100% úvula pilares
faríngeos y
2/3 úvula
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487-90
3. Paladar
4. Paladar
duro, paladar
duro.
blando y base
de la úvula
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487-90
Mallampati 0 ?
2001
1.18 %
100% Cormack 1
Ezri T, Cohen I, Geva D, et al. The incidence of class zero airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.
Anesthesia & Analgesia: October 2001 - Volume 93 - Issue 4 - p 1073–1075
Lundstrom, L. H., Vester-Andersen, M., Moller, A. M., Charuluxananan, S., L'hermite, J., & Wetterslev, J. (2011). Poor prognostic value
of the modified Mallampati score: A meta-analysis involving 177 088 patients. British Journal of Anaesthesia, 107(5), 659-667
Resultados
Lundstrom y colaboradores en 2011, Dinamarca, British
Journal of Anaesthesia
35% identificación
Finuncane B, Tsui B, Santora A. Evaluation of airway. Principles of Airway Management. 4 ed. 2011. p. 28-52.
Sensibilidad
Especificidad
Proporción de sanos correctamente identificados;
probabilidad de que un sujeto sano tenga un resultado
negativo
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian Journal of
Ophthalmology. 2008;56(1):45-50.
Valor predictivo positivo
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian Journal of
Ophthalmology. 2008;56(1):45-50.
Patil – Andretti
1988
Radiografías de
- 19 pacientes con intubación difícil
- 14 sin intubación difícil
22 mediciones
Bellhouse CP, Dore C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Anaesth Intensive Care 1988;16:329-37
Bellhouse CP, Dore C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Anaesth Intensive Care 1988;16:329-37
Restricción en la extensión de la articulación atlanto occipital
Bellhouse CP, Dore C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Anaesth Intensive Care 1988;16:329-37
A: 1%
B: 5%
C: 20%
D: 50%
E: 95%
Bellhouse CP, Dore C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Anaesth Intensive Care 1988;16:329-37
Wilson
Realizada en 1988
Predictor de laringoscopía difícil
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988, 61:211-6.
Protusión mandibular
Finuncane B, Tsui B, Santora A. Evaluation of airway. Principles of Airway Management. 4 ed. 2011. p. 28-52
Savva D. Prediction of difficult tracheal intubation. British Journal of Anaesthesia 1994;73:149-53
Savva
Distancia medida desde la escotadura esternal hasta la
punta del mentón con el cuello en extensión.
Brosky et al. Morbid Obesity and Tracheal Intubation. Anesth Analg 2002;94:732–6
Distancia tiromentoniana
Distancia esternomentoniana
Mallampati
Circunferencia del cuello
Movilidad limitada de cabeza, cuello y mandíbula
Retrognatia
Dientes prominentes
Resultados
Brosky et al. Morbid Obesity and Tracheal Intubation. Anesth Analg 2002;94:732–6
Brosky et al. Morbid Obesity and Tracheal Intubation. Anesth Analg 2002;94:732–6
Síndrome de articulación rígida
Reissell E, Orko R, Maunuksela EL, Lindgren L. Predictability of difficult laryngoscopy in patients with long term diabetes mellitus. Anaesthesia. 1990;45:1024-1027
Finuncane B, Tsui B, Santora A. Evaluation of airway. Principles of Airway Management. 4 ed. 2011. p. 28-52
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
Apertural oral
Mallampati modificado
Movimiento de cabeza y cuello
Distancia mandibular
Distancia esternomentoniana
Distancia tiromentoniana
Prueba de mordida labio superior (ULBT)
Radio de altura de distancia tiromentoniana (RHTMD)
= altura (cm) / DTM (cm)
Grado I < 23.5
Grado II > 23.5
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
S Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests
for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016 vol 20 Issue 1
Ventilación
Video de laringoscopia
Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height
to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation.
Indian J Crit Care Med 2016 vol 20 Issue 1
Bellhouse CP, Dore C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the
Macintosh laryngoscope. Anaesth Intensive Care 1988;16:329-37.
Brosky et al. Morbid Obesity and Tracheal Intubation. Anesth Analg 2002;94:732–6
Crosby et. Al. Canadian Journal of Anaesthesia.1998 / 45:7 / pp 757-776
Ezri T, Cohen I, Geva D, et al. The incidence of class zero airway and the impact of Mallampati score, age,
sex, and body mass index on prediction of laryngoscopy grade. Anesthesia & Analgesia: October 2001 -
Volume 93 - Issue 4 - p 1073–1075
Iohom G, Ronayne M, Cunningham AJ. Prediction of difficult tracheal intubation. Eur J Anaesthesiol
2003;20:31-6.
Finuncane B, Tsui B, Santora A. Evaluation of airway. Principles of Airway Management. 4 ed. 2011. p. 28-52.
Frerk CM. Predicting difficult intubation. Anaesthesia 1991;46:1005-8
Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (meta-analysis) of
the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg
2006;102:1867-1878
Lundstrom, L. H., Vester-Andersen, M., Moller, A. M., Charuluxananan, S., L'hermite, J., &
Wetterslev, J. (2011). Poor prognostic value of the modified Mallampati score: A meta-
analysis involving 177 088 patients. British Journal of Anaesthesia, 107(5), 659-667.
Mallampati score, age, sex and body mass on prediction of laryngoscopy grade. Anesth
Analg. 2001;93:1073–1075.
Practice Guidelines for Management of the Difficult Airway: An Updated Report by the
American Society of Anesthesiologists Task Force on Management of the Difficult
Airway. Anesthesiology 2013;118(2):251-270
Reed MJ et al. Can an airway assessment score predict difficulty at intubation in the
emergency department? Emerg Med J 2005 Feb; 22:99-102.
Reissell E, Orko R, Maunuksela EL, Lindgren L. Predictability of difficult laryngoscopy in
patients with long term diabetes mellitus. Anaesthesia. 1990;45:1024-1027
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia
1987;42:487-90
Savva D. Prediction of difficult tracheal intubation. British Journal of Anaesthesia
1994;73:149-53
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J
Anaesth 1988, 61:211-6.