Complications Of Airway Management Research Articles

Complications of Airway Management

Complications of Airway Management

Complicated Airway Management Because of Multiple Tracheal Diverticula in a Patient with Mounier-Kuhn Syndrome.

Complicated Airway Management Because of Multiple Tracheal Diverticula in a Patient with Mounier-Kuhn Syndrome.

Use of dexmedetomidine and low-dose ketamine as conscious sedation for fibreoptic bronchoscopy intubation for temporomandibular joint ankylosis secondary to an unsuspecting childhood trauma: a case report

Airway management in the paediatric population is known to be challenging due to its unique anatomical and physiological differences. Maxillofacial injuries further complicate airway management. To date, there is limited evidence to support the technique of airway management and the choice of drugs used in the paediatric population. This case report aims to describe the technique of conscious sedation using dexmedetomidine and ketamine to perform an awake fibreoptic intubation in the case of an 8-year-old boy with limited mouth opening due to a temporo-mandibular joint ankylosis secondary to childhood trauma. The endpoint of this case report showed that this technique proved effective with a good margin of safety in this paediatric patient with an airway concern. Further studies are needed to validate this observation.

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.

Out-of-OR Airway Management: Anticipating and Mitigating Physiologic Difficulty

Committee News| June 2023 Out-of-OR Airway Management: Anticipating and Mitigating Physiologic Difficulty Craig S. Jabaley, MD, FCCM; Craig S. Jabaley, MD, FCCM Search for other works by this author on: This Site PubMed Google Scholar Catherine M. Kuza, MD, FASA, FCCM; Catherine M. Kuza, MD, FASA, FCCM Search for other works by this author on: This Site PubMed Google Scholar Jarva Chow, MD, MPH; Jarva Chow, MD, MPH Search for other works by this author on: This Site PubMed Google Scholar Nathan J. Smischney, MD, MSc, FASA Nathan J. Smischney, MD, MSc, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2023, Vol. 87, 30–31. https://doi.org/10.1097/01.ASM.0000938848.86076.f4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Craig S. Jabaley, Catherine M. Kuza, Jarva Chow, Nathan J. Smischney; Out-of-OR Airway Management: Anticipating and Mitigating Physiologic Difficulty. ASA Monitor 2023; 87:30–31 doi: https://doi.org/10.1097/01.ASM.0000938848.86076.f4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: airway maintenance, intubation As a discipline, anesthesiology has served to meaningfully advance patient safety. In this context, airway management in dedicated procedural settings has benefited from algorithmic guidance, novel pharmaceuticals, and technological advancements. Out of the OR, however, myriad physiologic and contextual factors conspire to complicate airway management. Such intubations are often emergent, performed in patients who are unstable, and require the clinician to work in suboptimal conditions with little time to prepare or examine the patient (West J Emerg Med 2015;16:1109-17). A recent international prospective observational study (INTUBE) of 2,964 critically ill adults undergoing intubation in the ICU demonstrated that physiologic difficulty associated with airway management is more common than technical, or anatomic, difficulty (JAMA 2021;325:1164-72). Peri-intubation cardiovascular instability accompanied 42.6% of all intubations, followed by severe hypoxemia in 9.3%, and cardiac arrest in 3.1%. Meanwhile, only 4.5% of intubations required more than two attempts, and only five... You do not currently have access to this content.

Effect of video laryngoscopy for non-trauma out-of-hospital cardiac arrest on clinical outcome: A registry-based analysis

AimVideolaryngoscopy (VL) is a promising tool to provide a safe airway during cardiopulmonary resuscitation (CPR) and to ensure early reoxygenation. Using data from the German Resuscitation Registry, we investigated the outcome of non-traumatic out-of-hospital cardiac arrest (OHCA) patients treated with VL versus direct laryngoscopy (DL) for airway management. MethodsWe analysed retrospective data of 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories one and two (CPC1/2). Secondary endpoints were the rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used multivariate binary logistic regression analysis to identify the effects on outcome of known influencing variables and of VL vs DL. ResultsThe multivariate regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.34, 95% CI = 1.12–1.61, p = 0.002) and of hospital discharge/30-day survival (OR = 1.26, 95% CI = 1.08–1.47, p = 0,004). ConclusionVL for endotracheal intubation (ETI) at OHCA was associated with better neurological outcome in patients with ROSC. Therefore, the use of VL for OHCA offers a promising perspective. Further prospective studies are required.

Creating an easy to construct, low-cost aspiration simulator for airway training

Aspiration of gastric contents remains the commonest cause of death during anaesthesia, accounting for 50% of deaths and occurring more frequently than cannot intubate, cannot oxygenate (CICO) events [1]. Despite this, training for CICO is ubiquitous while rehearsal of aspiration management is rare. Soiled airway simulation has been shown to reduce the time to intubation with less volume entering the lungs, a factor known to correlate with the severity of aspiration [2]. Initially developed by Dr DuCanto, high-fidelity vomit simulators have existed since 2014 however cost (£1,595) precludes their widespread use. Low-cost models have since been described, however, the materials are sourced from hardware stores, relatively expensive, require skills to construct, utilise noisy pumps, and some even require electrical safety considerations [3]. We aimed to improve access to aspiration training by designing an aspiration simulator that is easy to construct and low-cost. Employing an iterative design process we created an aspiration simulator using materials readily available in the operating theatre. The final model requires an intubatable manikin with an oesophagus, such as the Laerdal Airway Management Trainer The setup silently produces a titratable flow of up to 250 ml per minute, sufficient to flood the oropharynx within 30 seconds. The simulation itself can be set up in under 10 minutes, used several times before requiring refilling, and is easily transported between theatres as a part-task trainer or concealed for a multi-disciplinary simulation (Figure 1, bottom left). All parts are reusable and the total cost equals £9.90 (excluding the manikin, which is undamaged). Our simulator was tested on a cohort of 16 middle-grade anaesthetic trainees and its performance was evaluated using pre and post-course questionnaires (scale 0–10). All successfully intubated the simulator. Average user-rating scores for realism were 8.4/10 while confidence in managing soiled airways improved from 6.2/10 to 8.9/10 after exposure to the simulation. Soiled airway simulation can be simple and affordable, creating a realistic environment to practise the unique skills necessary to manage this important yet under-rehearsed cause of death during anaesthesia. 1. Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia †. British Journal of Anaesthesia. 2011;106(5):617–631 2. Jensen M, Louka A, Barmaan B. Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD) Training on Intubation Quality Metrics. Air Medical Journal. 2019;38(5):325. 3. Sampson C, Pauly J, Horner J. Low-cost Portable Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) Simulator for Dynamic Emesis. Journal of Education and Teaching in Emergency Medicine. 2019;4(2).

Swiss Latin Airway Guidelines: a holistic approach for improving airway management.

Airway management is a core competency for many different medical specialties. Despite continuous improvements in equipment, clinical understanding, education and training, airway management complications remain a significant cause of morbidity and mortality worldwide. Several international airway management guidelines already exist, but there has never been a national consensus document for Switzerland. The Fondation Latine des Voies Aériennes (FLAVA) has developed a new set of airway management guidelines based on the latest scientific evidence and the authors' extensive clinical experience. These recommendations are intended to guide and assist clinicians in managing a wide array of airway situations. They are applicable to the daily routine management of anticipated and unanticipated airway difficulties. The new 2022 FLAVA Airway Guidelines (FLAGs) combine cognitive aids for using the latest technical skills and non-technical skills. Specially-designed key mnemonics and ergonomic tools complement these guidelines, including a colour-coded airway cart.

Major complications of airway management: a prospective multicentre observational study.

We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with 'predicted easy' airways were rare (approximately 1 in 14,200), but 45 times more common in those with 'predicted difficult' airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.

Трудная ларингоскопия в плановой анестезиологии

Введение. Обеспечение проходимости дыхательных путей — одна из ключевых задач плановой анестезиологии. Почти треть всех случаев анестезиологической смертности связана с трудностями при вентиляции пациентов после индукции в наркоз. Причем большинство из них обусловлены непосредственно интубацией трахеи и трудностями последующей вентиляции. Причиной 80 % закрытых исков Американской ассоциации анестезиологов по поводу повреждения гортани были повторные попытки интубации трахеи во время плановой анестезии. Цель исследования: повышение эффективности и уменьшение частоты осложнений обеспечения проходимости дыхательных путей при трудной ларингоскопии в плановой анестезиологии. Материалы и методы исследования. Нами проанализированы результаты 66 случаев трудной ларингоскопии при плановых оперативных вмешательствах на базе Полтавской областной клинической больницы за 2013–2015 годы. У всех пациентов во время прямой ларингоскопии на фоне миоплегии голосовая щель не визуализировалась. Пациентам I группы применялся клинический протокол оказания медицинской помощи больным с трудной интубацией трахеи, пациентам II группы после неудачной попытки интубации сразу устанавливалась ларингеальная маска соответствующего размера. Исследовалась частота удачных попыток восстановления проходимости дыхательных путей методом интубации трахеи и с помощью ларингеальной маски, частота и причины осложнений. Результаты исследования. У пациентов I группы вторая попытка интубации трахеи была удачной в 43,8 % случаев. Со следующими попытками интубации трахеи эффективность манипуляции прогрессивно уменьшалась до 6,2 % с четвертой попытки. Эффективность последующего использования ларингеальной маски составила 45,4 %; причины несостоятельности: травматизация слизистой, гиперсаливация, бронхорея, ларинго- и бронхоспазм. У пациентов II группы в 91,2 % случаев постановка ларингеальной маски обеспечила герметичность дыхательного контура и адекватную вентиляцию во время оперативного вмешательства. Осложнений практически не наблюдалось. Выводы. Использование клинического протокола оказания медицинской помощи больным с трудной интубацией трахеи в плановой анестезиологии менее эффективно и имеет высокую частоту осложнений, связанных с прямой ларингоскопией, по сравнению с единственной попыткой интубации трахеи и последующим использованием ларингеальной маски.

High-Fidelity Simulation-Based Education: Description of an Original Crisis Resource Management and Sedation Learning for Dental Surgeons.

Dental surgery includes invasive procedures performed under sedation or monitored anesthesia care (MAC). It is associated with respiratory risks, resulting in death or neurological sequelae without prompt and appropriate management. Management of airway complications also implies mastering crisis resource management (CRM) principles, essentially non-technical skills to improve patient safety. In response to the need to enhance patient safety and to securely perform surgical procedures outside the operating room due to reduced surgical activity during the worldwide spread of the COVID-19 pandemic, we realized, in our simulation center, a course based on high fidelity simulation to teach procedural sedation and management of related complications. The simulation center accredited this educational program as a continuing professional development formation. The course includes technical skills practice, theoretical presentation, and mastering non-technical skills related to CRM principles. This brief report describes a relatively innovative teaching technique in dentistry, highlights its interest, and reports the subjective opinion of learners as to the pedagogical and professional impact of this training. A learner’s satisfaction survey supports the utility of our sedation and CRM programs. A high degree of satisfaction and perceived value reflect robust learners’ engagement. All medical specialties should encourage high-fidelity simulation continuing professional development courses that incorporate technical skills and crisis management principles.

Http://www.samj.org.za/index.php/samj/article/view/13517

Background. Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. Objectives. To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). Method. A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. Results. Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%; n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5; p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). Conclusions. The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.

O.10 Morbid obesity and caesarean section: The impact of BMI on anaesthesia and surgical duration

Introduction: Obesity is associated with increased operative time at caesarean section (CS). [1] Girsen A, Osmundson S, Naqvi M et al. Body Mass Index and Operative Times at Caesarean Delivery. Obstet Gynecol 2014; 124: 684 –9. Google Scholar Obesity, pregnancy and emergency surgery all increase the risk of general anaesthesia (GA). [2] Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia, Br J Anaesth 2011;106:617 –31. Google Scholar On labour ward, urgency to deliver is challenged by raised body mass index (BMI). Conversion to GA during CS is challenging and potentially distressing for the mother. The study aims were to quantify how surgical time (ST) and anaesthesia time (AT), at CS, vary by BMI.

Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project

IntroductionAdvanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway...

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

Pulmonary transplantation (LuTx) is established as a treatment option for patients with end-stage lung diseases, such as chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, and pulmonary arterial hypertension. Acute rejection and infection are implicated as potential risk factors in developing complications such as bronchiolitis obliterans syndrome (BOS) and chronic rejection, leading to high morbidity and mortality rates after the LuTx. Thus, surveillance procedures after transplantation are crucial to prevent further complications. Clinical monitoring is done through pulmonary function tests and procedural methods such as surveillance bronchoscopy and transbronchial biopsy of lung allografts, which are the most commonly used diagnostic tests. In this review, we aim to analyze the role of bronchoscopy as a surveillance procedure in determining the presence of infection or rejection as well as the management of airway complications after LuTx. We have also discussed the risk and benefit ratio of standard transbronchial biopsy (TBB) and transbronchial cryobiopsy (TCB) as routine performance after LuTx.

Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry

BackgroundIn South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related maternal deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation. MethodsData from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO2 <90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO2 nadir was performed to identify confounding variables associated with, and mediators of, hypoxaemia. ResultsIn the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO2 nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship. ConclusionsClinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified.

MUMS THE WORD: UNSPOKEN COMPLICATIONS OF INTUBATION

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Intubation is one of the most common and basic procedures performed in intensive care units and other emergent settings. Some of the more well-known potential complications include direct airway injury, soft tissue injury, lacerations, bleeding, and vocal cord paralysis. Patients with intubation related injury can increase their hospital cost by 20% and lengthen their hospital stay by at least one day compared to those who did not have an intubation related injury (Pacheco-Lopez 1006). Here we will discuss a more rare potential complication of intubation. CASE PRESENTATION: The patient was a 79 year old male with a past medical history of multiple strokes, cardiomyopathy and tobacco use. He was admitted to the hospital after a mechanical fall. X-ray of his left hip showed a femoral neck fracture. Patient underwent successful left hip ORIF by orthopedic surgery. Following surgery, patient complained of dysarthria, facial droop and inability to eat. With concern for stroke, a stat CT head was obtained showing no acute findings. Three days later, an x-ray of the mandible showed bilateral anterior mandible dislocations. Patient was transferred to another facility for oral maxillary surgery for reduction of his mandible. DISCUSSION: Mandible dislocation during intubation is an unusual occurrence, but providers and even radiologists should be aware of this possible complication. It is often overlooked, and treatment can be delayed. Our patient’s hospital stay was increased by three days due to lack of prompt diagnosis clinically and on imaging. He required transfer to another facility for oral maxillary surgery. A conscious patient with temporomandibular joint (TMJ) dysfunction most often presents with an inability to close the mouth, salivation, impaired speech and a depression that is palpable in the preauricular area. Anterior and anteromedial dislocations are the most common types (Chung 75). The exact prevalence of mandibular dislocation after intubation is unknown, however several studies have shown TMJ dysfunction occurs in at least 5% of cases after intubation (Pillai 243). CONCLUSIONS: Prompt diagnosis and treatment of mandibular dislocation due to intubation is essential to prevent long term sequelae due to this complication. Providers should be aware and vigilant in diagnosing and treating this condition should it present post intubation. Reference #1: Paulette C Pacheco-Lopez, Lauren C Berkow, Alexander T Hillel and Lee M Akst. “Complications of Airway Management.” Respiratory Care (June 2014): 1006-1021. Reference #2: Sang-Bong Chung, Hyoungbae Jeon, and Taikwan Kim. “Unrecognized Bilateral Dislocation of Temporomandibular Joint during Orotracheal Intubation.” Journal of Trauma and Injury (2015): 75-78. Reference #3: Konia, Suri Pillai and Mojca Remskar. “ Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a.” Journal of Medical Case Reports (2013): 243. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response no disclosure on file for Mahmoud Amarna; No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Beverly Smith, source=Web Response No relevant relationships by Sana Yakoob, source=Web Response

Advanced Techniques for Securing Airway in Mucopolysaccharidoses and the Impact of New Therapeutic Approaches.

Airway management in patients suffering from mucopolysaccharidoses (MPS) is one of the most difficult anesthesiologic challenges. MPS is a group of rare, inherited diseases caused by the absence or malfunctioning of lysosomal enzymes needed to break down macromolecules called glycosaminoglycans (GAGs). MPS is associated with clinical symptoms and physical features, which all together contribute to the high incidence of difficulty in providing airway during surgical procedures. We used PubMed as our main database (PubMed Advanced Search Builder) to search for relevant literature. At first, we looked for the prevalence of MPS worldwide. Then, we searched for airway management complications in the MPS population using the keywords: “Mucopolysaccharidoses,” “Anesthesia complications,” and “airway management.” Another search was carried out to look for new therapeutic agents and explore their impacts on body organs. We reviewed the finalized articles to explore how anesthesiologists used different airway techniques. We discovered that video laryngoscope and I-gel aided fiber-optic intubation have been available in recent years and have been used uneventfully in several patients. We presented recommendations regarding preoperative and intraoperative preparation to avoid airway-related complications in the future. We realized that many therapy approaches had been suggested, especially after further understanding of the pathophysiology of MPS. However, more investigation needs to be conducted to determine their efficacy and explore if there is any impact on airway management.

¿Equivale una mejor visión a una mejor intubación? Artículo original: MazzinariG, Rovira L, Henao L, Ortega J, Casasempere A, Fernandez Y. Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial. Anesthesia-Analgesia. June 2019.Volume 128.Number 6.

El fracaso de intubación en un paciente con Vía Aérea Difícil (VAD) todavía no es infrecuente, es por ello que la amplia utilización de dispositivos de rescate de la laringoscopia directa sigue en auge. Es en este ámbito donde cobran fuerza los videolaringoscopios, que ofrecen una laringoscopia indirecta a través de un montaje multivariado de lentes y ópticas. Los videolaringoscopios nos han aportado en la especialidad de Anestesiología una visión enormemente nítida en muchos casos de glotis prácticamente imposibles, mejorando por tanto el grado de visibilidad ( clasificado en la Escala de Cormack-Lehane), pero esta ventaja no siempre conduce a un aumento en la tasa de éxito de intubación traqueal, debido a que la adecuada inserción del tubo a través de las cuerdas vocales es un factor limitante. Por ello se precisa de guías que permitan dar al tubo endotraqueal una forma adecuada para una correcta intubación. En este estudio se pretende evaluar la tasa de éxito con un videolaringoscopio usando una guía tradicional preformada con cierto ángulo de movilidad anteroposterior vs guía flexible que permite movilidad anteroposterior y lateral como es un fibrobroncospio con la fibra óptica apagada. Los resultados muestran una mejor tasa éxito en la intubación en el primer intento y menor tasa de complicaciones en el manejo de las vías respiratorias. ABSTRACT Better vision makes better intubation? The failure of intubation in a patient with Difficult Airway (VAD) is not yet uncommon, which is why the wide use of rescue devices for direct laryngoscopy is still booming. It is in this area where videolaryngoscopy gain strength, offering indirect laryngoscopy through a multivariate assembly of lenses and optics. Videolaryngoscopy have given us in Anesthesiology an enormously clear vision in many cases of practically impossible glottis, thus improving the degree of visibility (classified in the Cormack-Lehane Scale), but this advantage does not always lead to an increase in the success rate of tracheal intubation, due to the proper insertion of the tube through the vocal cords is a limiting factor. Therefore, stylet-guides are required that need to give the endotracheal tube a suitable form for proper intubation. In this study, it is expected to evaluate the success rate with a videolaryngoscope using a traditional preformed stylet-guide with a certain angle of anteroposterior mobility vs. flexible guidance that allows anteroposterior and lateral mobility such as a fiberscope with the optical fiber turned off. The results experienced a better success rate in intubation on the first attempt and a lower rate of complications in airway management with glidescope+fiberscope.

Ultrasound-guided superior laryngeal nerve block - A description of the technique

Complications in airway management remain a common cause of anesthesia-associated mortality. When a patient is considered with anticipated difficult airway, the management depends on several variables, however, at present, the standard of management continues to be the patient awake approach. In scenarios of acute upper airway obstruction, the only way to guarantee adequate ventilation is to obtain a translaryngeal or transtracheal access, for which, it is necessary to use local anesthesia and grade I / II sedation, avoiding loss of spontaneous ventilation. For this purpose, we propose ultrasound-guided superior laryngeal nerve block, in order to standardize an ultrasound landmark that is reproduceable, with a high success rate, which allows limiting complications related to regional anatomic techniques and thus facilitating the securing of the airway in these patients.