RESUMO

PURPOSE: The present study evaluated the upper airway pattern of obstruction in individuals undergoing drug-induced sleep endoscopy (DISE) exam with positive airway pressure (PAP), and compared this effect through a nasal or oronasal mask. METHODS: Prospective study. Patients requiring PAP due to obstructive sleep apnea (OSA) were evaluated through DISE at three different moments: (1) a baseline condition (without PAP); (2) PAP treatment with a nasal mask; and (3) PAP with an oronasal mask at the same pressure. The conditions were compared intra-individually, following VOTE classification. A TOTAL VOTE score (the sum of VOTE scores observed for each anatomical site) was also applied to compare intra-individual results. RESULTS: Thirteen patients were enrolled in the study. All patients presented multi-level pharyngeal obstruction at baseline condition. In six patients, the pattern of obstruction differed according to the mask. Nasal mask significantly decreased the obstruction score when compared with baseline condition both in velum (P value < 0.05) and oropharynx regions (P value < 0.005). TOTAL VOTE score was also significantly lower during nasal mask evaluation when compared with basal condition (P value < 0.005). Remarkably, oronasal mask with the same pressure was not as effective as nasal masks. Obstruction levels observed at the tongue base or epiglottis levels were more resistant to PAP treatment. CONCLUSIONS: Collapse in velum and oropharyngeal sites is more compliant to PAP than obstruction at lower levels of the pharynx, either with nasal or oronasal masks. Nasal mask is superior to prevent pharyngeal collapse than oronasal devices under the same pressure.

Assuntos

RESUMO

The development of less invasive ventilatory strategies in very-low-birth-weight (VLBW) preterm newborns has been a growing concern in recent decades. This study aimed to measure differences in the clinical progression of preterm newborns using two distinct periods in a university hospital: before and after using underwater bubble continuous positive airway pressure (ubCPAP). This is a retrospective study of VLBW preterm newborns with gestational ages less than or equal to 32 weeks admitted to the neonatal intensive care unit. The time series was divided into two groups: a pre-CPAP group ( n = 45) and a post-CPAP group ( n = 40). The post-CPAP group had fewer resuscitations, required fewer surfactant doses, spent fewer days on mechanical ventilation, and demonstrated less of a need for fraction of inspired oxygen > 30%. UbCPAP is an easy to use, minimally invasive, and effective ventilatory strategy for VLBW preterm newborns that can be used in environments with limited resources. Thus, adopting this simple strategy as part of a service organization and health policy can positively impact outcomes.

Assuntos

Assuntos

RESUMO

Abstract Background: Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. Methods: With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p < 0.05). Results: Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. Conclusion: None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices.

Resumo Justificativa: A intubação guiada por fibra óptica (IGFO) através de dispositivo supraglótico (DSG) tem sido descrita como um procedimento seguro e fácil para o manejo de via aérea difícil. No entanto, a visibilização da abertura da glote é essencial para a IGFO. Vários DSGs diferentes estão comercialmente disponíveis e podem oferecer diferentes condições para a IGFO. O objetivo deste estudo foi comparar a melhor visão obtida da abertura da glote com o uso de diferentes DSGs. Métodos: Com a aprovação do Comitê de Ética local, 52 pacientes adultos submetidos à anestesia eletiva foram randomicamente designados para um dos DSGs: tubo laríngeo (TL), máscara laríngea (ML) I-Gel, ML Unique, ML Supreme, ML AuraOnce. Após a indução padronizada da anestesia, o DSG foi colocado de acordo com as recomendações do fabricante. Após ventilação bem-sucedida, a posição do DSG em relação à abertura da glote foi examinada com um endoscópio flexível. Uma abertura da glote total ou parcialmente visível foi considerada como adequada para a IGFO. A adequação para a IGFO foi comparada entre os grupos (teste-H, teste-U; p < 0,05). Resultados: Os dados demográficos não foram diferentes entre os grupos. A colocação do DSG e a ventilação adequada foram bem-sucedidas em todas as tentativas. A visão da glote adequada para a IGFO diferiu entre os dispositivos, variou de 40% para o TL, 66% para a ML Supreme, 70% para a ML I-Gel e 90% para ambas as máscaras laríngeas Unique e AuraOnce. Conclusão: Nenhum dos DSG usados ofereceu uma visão total ou parcial da glote em todos os casos. Porém, as máscaras laríngeas Unique e AuraOnce pareceram mais adequadas para a IGFO em comparação com os outros dispositivos.

Assuntos

RESUMO

BACKGROUND: Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. METHODS: With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). RESULTS: Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. CONCLUSION: None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices.

Assuntos

RESUMO

ABSTRACT BACKGROUND AND OBJECTIVES: The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT: The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS: The use of the handmade introducer guide can be a useful option for the management of difficult airways.

RESUMO JUSTIFICATIVA E OBJETIVOS: A incidência de via aérea difícil chega a 10% das intubações de emergência. Ainda que poucos estudos abordem o emprego de guia introdutor artesanal no ambiente de emergência e terapia intensiva, há descrições de guias produzidas de forma artesanal disponíveis na internet. Nosso objetivo é descrever uma série de casos sobre o uso de um guia introdutor (Bougie) artesanal para intubação de emergência em pacientes com Via Aérea Difícil. RELATO DE CASO: O guia introdutor artesanal foi utilizado em cinco pacientes consecutivos com via aérea difícil, instabilidade clínica e falta de outro método imediato para a obtenção de uma via aérea. Essa técnica proporcionou sucesso na intubação e não houve complicações. CONCLUSÕES: A utilização do guia introdutor artesanal pode ser uma opção útil para o manejo de via aérea difícil.

Assuntos

RESUMO

ABSTRACT BACKGROUND AND OBJECTIVES: The I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation. CONTENTS AND CONCLUSIONS: In this case report we described the use of the I-gel supraglottic airway along 48 h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed.

RESUMO JUSTIFICATIVA E OBJETIVOS: O dispositivo supraglótico I-gel para o manejo das vias aéreas tem um manguito não insuflável feito de um elastômero termoplástico semelhante ao gel. Há relato sobre o uso do I-gel em pacientes sob anestesia para a ventilação, espontânea ou com pressão positiva intermitente. Porém, há poucos relatos publicados sobre o uso do I-gel com ventilação controlada por pressão. CONTEÚDO E CONCLUSÕES: Descrevemos neste relato de caso o uso do dispositivo supraglótico I-gel durante 48 horas em unidade de terapia intensiva para o manejo das vias aéreas em paciente que precisou de ventilação mecânica, mas no qual a intubação traqueal não pôde ser feita.

Assuntos

RESUMO

ABSTRACT OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98 cm (0.53) and 4.54 cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99 cm (0.60) and 3.88 cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r = 0.794,p < 0.001), and between Th-l and Ig-l (r = 0.820, p < 0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

RESUMO OBJETIVOS: Uma referência anatômica prática pode ser útil para determinar o tamanho adequado dos dispositivos para vias aéreas em pacientes pediátricos. O objetivo deste estudo foi investigar a associação entre as dimensões da eminência tênar e do dispositivo I-gel em crianças. MÉTODOS: Após aprovação do Comitê de Ética Institucional, 270 pacientes com estado físico ASA I-II, entre 0-12 anos, programados para cirurgias eletivas sob anestesia geral, sem necessidade de intubação traqueal, foram recrutados para o estudo. A escolha do tamanho do I-gel foi baseada no peso corporal do paciente, de acordo com a recomendação do fabricante. Após a inserção bem-sucedida do I-gel, a dimensão da eminência tênar era determinada. O eixo longo (Th-l) foi medido do ponto de junção do polegar ao vinco do pulso e o eixo curto (Th-w) constitui a maior parte da eminência tênar da extremidade lateral do polegar à primeira linha da mão. As dimensões de fábrica do I-gel inserido no paciente foram comparadas com as dimensões obtidas a partir da eminência tênar. RESULTADOS: As médias (DP) dos valores para (Ig-w) e (Ig-l) foram 2,98 cm (0,53) e 4,54 cm (0,82) e as médias (DP) dos valores para (Th-w) e (TH l) foram 2,99 cm (0,60) e 3,88 cm (0,93), respectivamente. Houve uma correlação estatisticamente significativa entre Th-w e Ig-w (r = 0,794, p < 0,001) e entre Th-l e Ig-l (r = 0,820, p < 0,001). CONCLUSÃO: As dimensões da eminência tênar foram ajustadas àquelas do tamanho do I-gel baseado no peso e essa referência anatômica pode ser uma ferramenta prática para avaliar o tamanho apropriado em pacientes pediátricos.

Assuntos

RESUMO

OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

Assuntos

RESUMO

BACKGROUND AND OBJECTIVES: The incidence of difficult airway reaches 10% of emergency intubations. Although few studies address the use of handmade introducer guides in emergency and intensive care environment, there are descriptions of handmade guides available on the Internet. We describe a case series on the use of a handmade introducer guide (bougie) for emergency intubation in patients with difficult airway. CASE REPORT: The handmade introducer guide was used in five consecutive patients with difficult airways, and clinical instability and in the absence of another immediate method to obtain an airway. This technique provided successful intubation and there were no complications. CONCLUSIONS: The use of the handmade introducer guide can be a useful option for the management of difficult airways.

Assuntos