INTUBACION PACIENTE DESPIERTO PDF

Download Citation on ResearchGate | On Apr 1, , Lorena España Fuente and others published Intubación de un paciente despierto con vía aérea difícil. Intubación con fibra óptica en pacientes pediátricos a menudo se requiere sobre fibra óptica despierto se recomienda para la intubación de los pacientes con. INTUBACIÓN OROTRAQUEAL CON AIRTRACK EN PACIENTE BAJO SEDACIÓN CONSCIENTE CON REMIFENTANIL EN C.N.S Hospital.

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All works go through a rigorous selection process. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.

Intubación paciente despierto by Gian Gutierrez Herrera on Prezi Next

CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same.

SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the pacienge impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Fiberoptic intubation is a mainstay of predicted difficult airway management and still represents the gold standard in this clinical setting.

However, some issues may arise during fiberoptic intubation even for the most trained anesthesiologists in the setting of cardiorespiratory comorbidity determining hypoxemia and need for respiratory support during the procedure. Janus mask Biomedical S. The unique features of this device may be, in our opinion, extremely useful in the management of a difficult intubation scenario. Therefore, we started to use it in this context and ihtubacion report our experience with the first two patients treated.

Both patients signed an informed consent for management and publication of data and images.

A year-old woman was scheduled for aortic valve replacement because of severe aortic stenosis and the preoperative anesthesiological evaluation was suggestive for a possible difficult airway, respierto the patient was overweight BMI Furthermore, she referred history of difficult endotracheal intubation during two previous surgeries. We planned elective intubation under fiberoptic guide and we administrated midazolam 5 mg i.

Intubacion Oro Traqueal – How is Intubacion Oro Traqueal abbreviated?

The procedure was successful and uneventful, but required three attempts and lasted 12 min. The Janus mask paciete then removed simply separating its two halves, without compromising in any way the correct position and depth of the endotracheal tube. We then administered fentanyl mcgpropofol mg and rocuronium 50 mgand set the mechanical ventilation cespierto volume control continuous mechanical ventilation. Anesthesiological management and surgery were performed as usual and no complications were recorded.

The procedure is also shown as a video in the supplementary material. Two weeks later we treated another patient, a 69 year-old woman scheduled for thoracoabdominal aortic aneurysm repair surgery, with the same approach. We programmed a Janus mask-aided elective awake fiberoptic intubation to manage this predicted difficult airway scenario.

The patient received topical lidocaine, i. An expert anesthesiologist performed the procedure in 5 min. After the orotracheal intubation was successfully accomplished and confirmed, we induced general anesthesia with propofol i. The surgical operation was performed as planned.

Such strategy can also be extended to all the intensive care unit ICU patients and all acute critically ill patients, who are not intubated, need to undergo endoscopic procedures fibroscopy, transesophageal echocardiography, etc.

Therefore the incidence of difficult intubation and the severity of desaturation is higher in ICU compared to the operating room. Janus mask applied during difficult airway management can significantly improve both pre-oxygenation and oxygenation during fibroscopic intubation maintaining an adequate oxygen saturation even in the event of prolonged or complex maneuvers.

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Then, HFNO was not superior to facemask in improving oxygenation in patient with severe hypoxia who needed intubation, 13 while Janus mask maintained an adequate oxygenation in fragile patients undergoing prolonged TEE for appendage closure, procedure which required more than an hour.

Finally, although there is no experience with HFNO and fibroscopy in the context of difficult intubation, the possibility to perform the CPAP with Janus mask may maintain a better gas exchange during the entire procedure.

For all the reasons mentioned above we believe that the critical ill patients who may benefit from the use of this device are several in everyday clinical intensive care practice. In addiction, the Janus mask may have a role in the training of junior colleagues with endoscopic maneuvers, as it supports ventilation and maintain oxygenation during the procedure. Therefore, long maneuvers can be tolerated, avoiding desaturation episodes.

We are aware that nowadays many simulation technologies are available and allow the acquisition of basic skills about fiberoptic intubation in a safe non-clinical scenario.

However, the simulation is not fully representative of the real clinical life, which is often more complicated and stressful. Furthermore, the Janus mask can be applied also during the endoscopy in case of oversedation or respiratory worsening of the patient, as it can be opened and then closed around the probe. Other strategies do exist to perform intubation in a planned or unplanned difficult airway scenario and were reported in literature: Teteura and colleagues, for example, sperimented successfully Intubation Using a Double-lumen Tube with a Combination of Fiberoptic Bronchoscope and the Glidescope in a Patient with difficult airway, 14 but this technique required the contemporary presence of 4 anesthesiologists, which is not generally possible in routine clinical practice especially if the difficult airway situation is unexpected.

Furthermore, intubation with a videolaryngoscope requires a deep level of sedation, and eventually the administration of a neuromuscular blocking agents. The I-gel laryngeal mask also proved to be a useful tool, when used in combination with a lightwand 15 or the Aintree intubation catheter. Tracheal puncture at the level of the chricothyroid membrane to perform retrograde intubation 17 and the use of a tracheal introducer 18 were also reported as useful strategies in this context, but they are highly invasive.

In our opinion the use of such invasive approaches cannot be encouraged, now that modern, non-invasive, and safe devices such as the Janus mask are available. Furthermore, none of the previously reported strategies is able to support the spontaneous ventilation with a positive pressure during intubation maneuver. In conclusion, we believe that the Janus mask may have an extraordinary potential in clinical practice.

In particular, the use of this device has a strong rational as a bridge to awake fiberoptic intubation, as a rescue ventilator therapy during interventional procedures, and as an educational tool for the anesthesiologists without experience in fiberoptic intubation, who can improve their confidence with this procedure in a safe real life scenario. The authors have no conflicts of interest concerning the publication of this manuscript.

Directrices para la intubación electiva de fibra óptica Pediátrica

The study was supported by departmental funds. The founding sources had no role in the study design, collection, analysis and interpretation of data, and no role in the writing of the manuscript and the decision to submit it. The following is the supplementary data to this article: Previous article Next article. April Pages e1-e4 Pages Despiertoo fiberoptic intubation in the conscious patient using the new Janus mask. Pieri aS. Sardo bC. Votta aG. Frau aA. Oriani aA.

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Zangrillo acF. This item has received. The unique features of this device may be, in our opinion, extremely useful in the management of a difficult intubation scenario. Both patients signed an informed consent for management and publication of data and images.

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Case 1 A year-old woman was scheduled for aortic valve replacement because of severe aortic stenosis and the preoperative anesthesiological evaluation was suggestive for a possible difficult airway, inthbacion the patient was overweight BMI Furthermore, she referred history of difficult endotracheal intubation during two previous surgeries. The procedure was successful and uneventful, but required three attempts and lasted 12 min.

The procedure is also shown as a video in the supplementary despoerto. Case 2 Two weeks later we treated another patient, a 69 year-old woman scheduled for thoracoabdominal aortic aneurysm repair surgery, with the same approach. The surgical operation was performed as planned. Finally, although there is no experience with HFNO and fibroscopy in the context despierro difficult intubation, the possibility to perform the CPAP with Janus mask may maintain a better gas exchange during the entire procedure.

For all the reasons mentioned above we believe that the critical ill patients who may benefit from the use of this device are several in everyday clinical intensive care practice. Therefore, long maneuvers can be tolerated, avoiding desaturation episodes. However, the simulation is not fully representative of the real clinical life, which is often more complicated and stressful.

Furthermore, the Janus mask can be applied also during the endoscopy in case of oversedation or respiratory worsening of the patient, as it can be opened and then closed around the probe.

Furthermore, none of the previously reported strategies is able to support the spontaneous ventilation with a positive pressure during intubation maneuver. In particular, the use of this device has a strong rational as a bridge to awake fiberoptic intubation, as a rescue ventilator therapy during interventional procedures, and as an educational tool for the anesthesiologists without experience in fiberoptic intubation, who can improve their confidence with this procedure in a safe real life scenario.

Contribution of the authors MP: Conflicts of dsepierto and funding sources The authors have no conflicts of interest concerning the publication of this manuscript.

The founding sources had no role in the study design, collection, analysis and interpretation of data, and no role in the writing of the manuscript and the decision to submit it. Algorithms for difficult airway management: Minerva Anestesiol, 75pp. Anesthesiol News, 35pp. Prolonged transesophageal echocardiography during percutaneous closure of the left atrial appendage without general anesthesia: A novel non-invasive ventilation mask to prevent and manage respiratory failure during fiberoptic bronchoscopy, gastroscopy and transesophageal echocardiography.

Heart Lung Vessel, 7pp. J Clin Psychopharmacol, 10pp. Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome. Signa Vitae. Continuous positive airway pressure during upper endoscopies: J Cardiothorac Vasc Anesth, 30pp. Hazards of intubation in the ICU: Minerva Anestesiol, 82pp.

The incidence and risk factors for cardiac arrest during emergency tracheal intubation: J Clin Anesth, 16pp. Extending the preoxygenation period from 4 to 8 min in critically ill patients undergoing emergency intubation. Crit Care Med, 37pp. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients.

Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med, 43pp. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: