Abreu BGL, Guzmán MJK

Language: Spanish
References: 10
Page: 1-8
PDF size: 234.95 Kb.

ABSTRACT

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.

REFERENCES

1. Shomaker Williams C. Tratado de Medicina Crítica y Terapia Intensiva. 3ed. Editorial Médica Panamericana. 1996:698-710.

2. Benumof JL. Management of the difficult adult Airway with especial emphasis on awake tracheal intubation. Anesthesiology 1991[acceso: 11/03/2019];75(6):1087-1105. Disponible en: https://www.ctsqena.com/2020/06/06/hagberg-and-benumofs-airway-management-4th-edition-pdf/

3. ASA Task force on management of the difficult airway: practice guidelines for management of the difficult airway, an updated report. Anesthesiology. 2003[acceso: 11/03/2019];98:1269-77. Disponible en: https://pubs.asahq.org/anesthesiology/article/118/2/251/13535/Practice-Guidelines-for-Management-of-the/

4. Paix AD, Williamson JA, Runciman WB. Crisis management during anaesthesia: difficult intubation. Qual Saf Health Care. 2005[acceso: 13/10/2009];14:e5. Disponible en: http://www.qshc.com/cgi/content/full/14/3/e5

5. Dell K. Predictors of difficult intubation and the otolaryngology perioperative consult. Anesthesiology Clin. 2015;33(2):279-90. DOI https://doi.org/10.1016/j.anclin.2016.02.002

6. Wastler KE. Difficult intubation resulting in surgical repair of esophageal and hypopharyngeal perforation. AANA J. 2016[acceso: 11/03/2019];83(1):21-7. Disponible en: http://www.onlinedigeditions.com/publication/?i=244556&article_id=1919831&view=articleBrowser&ver=html5

7. Botana A, Fernández-Villar M, Leiro V, Represas C, Méndez A, Piñeiro L. Intubación traqueal guiada por fibrobroncoscopio en pacientes con vía aérea difícil. Factores predictores del resultado. Revista Scielo. 2019[acceso: 25/08/2020];33(2):68-73. https://dialnet.unirioja.es/servlet/articulo?codigo=6156848/

8. Jaime escobar D. ¿Cuánto podemos predecir la vía aérea difícil? Rev Chil Anest. 2009[acceso: 11/03/2019];38:84-90. Disponible en: https://revistachilenadeanestesia.cl/cuanto-podemos-predecir-la-via-aerea-dificil/

9. Huitink JM, Bouwman RA. The myth of the difficult airway: airway management revisited. Anaesthesia. 2016[acceso: 11/03/2019];70(3):244-9. Disponible en: https://www.oatext.com/development-of-ultrasound-diagnostic-test-for-preoperative-airway-evaluation.php/

10. Utherford JS. Monitoring teamwork: a narrative review. Anaesthesia 2017[acceso: 11/03/2019];72 Suppl 1:84-94. Disponible en: https://psnet.ahrq.gov/issue/monitoring-teamwork-narrative-review/