Empleo del videolaringoscopio VALOR en pacientes con patologías de la columna cervical
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Introducción: Los pacientes con patologías de la columna cervical constituyen la población de mayor riesgo durante la intubación traqueal, pues la fuerza de tracción o el movimiento generado en la laringoscopía puede lesionar las estructuras neuroaxiales.
Objetivo: Caracterizar la intubación traqueal con el videolaringoscopio VALOR en pacientes quirúrgicos con patologías de la columna cervical.
Métodos: Se empleó el videolaringoscopio VALOR en pacientes quirúrgicos con patologías de la columna cervical a partir del estudio piloto del proyecto institucional VALOR (Videolaringoscopio ArtesanaL para entOrnos de Recursos limitados), realizado en el Servicio de Anestesiología y Reanimación del Complejo Científico Ortopédico Internacional “Frank País”, desde septiembre de 2022 hasta enero de 2024.
Resultados: La intubación traqueal resultó efectiva en la totalidad de los pacientes (n = 20), en un tiempo promedio de 54 segundos. El 85 % requirió un solo intento de intubación, con una visión adecuada de la glotis. Como eventos adversos se registraron la taquicardia refleja (35 %) y el traumatismo faríngeo leve (5 %), sin implicaciones perioperatorias. Predominaron las maniobras de manipulación laríngea externa (95 %), el uso de bougie (100 %), la elevación indirecta de la epiglotis (70 %) y la preferencia de la espátula hiperangulada (80 %).
Conclusiones: El empleo del videolaringoscopio VALOR permitió la intubación traqueal efectiva en pacientes con patologías de la columna cervical, en un tiempo breve, con una visualización endoscópica óptima y una baja incidencia de eventos adversos.
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Referencias
Gadomski BC, Hindman BJ, Poland MJ, Page MI, Dexter F, Puttlitz CM. Intubation biomechanics: Computational modeling to identify methods to minimize cervical spine motion and spinal cord strain during laryngoscopy and tracheal intubation in an intact cervical spine. J Clin Anesth. 2022;81:110909. DOI: https://doi.org/10.1016/j.jclinane.2022.110909
Gadomski BC, Hindman BJ, Page MI, Dexter F, Puttlitz CM. Intubation biomechanics: clinical implications of computational modeling of intervertebral motion and spinal cord strain during tracheal intubation in an intact cervical spine. Anesthesiol. 2021;135(6):1055-65. DOI: https://doi.org/10.1097/ALN.0000000000004024
Hindman BJ, Palecek JP, Posner KL, Traynelis VC, Lee LA, Sawin PD, et al. Cervical spinal cord, root, and bony spine injuries. A closed claims analysis. Anesthesiol. 2011;114(4):782-95. DOI: https://doi.org/10.1097/ALN.0b013e3182104859
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiol. 2022;136(1):31-81. DOI: https://doi.org/10.1097/ALN.0000000000004002
Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, et al. Airway management in neonates and infants. Eur J Anaesthesiol. 2024;41(1):1-21. DOI: https://doi.org/10.1097/EJA.0000000000001928
Gómez MÁ, Sastre JA, Onrubia X, López T, Abad A, Casans R, et al. Guía de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte II. Rev Esp Anestesiol Reanim. 2024;71(3):207-47. DOI: https://doi.org/10.1016/j.redar.2023.08.001
Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022;2022(4):CD011136. DOI: https://doi.org/10.1002/14651858.CD011136.pub3
Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev. 2018;2018(6):CD009975. DOI: https://doi.org/10.1002%2F14651858.CD009975.pub3
Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev. 2017;2017(5):CD011413. DOI: https://doi.org/10.1002%2F14651858.CD011413.pub2
Choi S, Yoo HK, Shin KW, Kim YJ, Yoon HK, Park HP, et al. Videolaryngoscopy vs. flexible fibrescopy for tracheal intubation in patients with cervical spine immobilisation: a randomised controlled trial. Anaesthesia. 2023;78(8):970-8. DOI: https://doi.org/10.1111/anae.16035
Schoettker P, Arias AP, Pralong E, Duff JM, Fournier N, Bathory I. Airtraq® vs. fibreoptic intubation in patients with an unstable cervical spine fracture: A neurophysiological study. Trends Anaesth Crit Care. 2020;31:28-34. DOI: https://doi.org/10.1016/j.tacc.2020.01.001
Jiang J, Ma DX, Li B, Wu AS, Xue FS. Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation – a systematic review and meta-analysis of randomized controlled trials. Ther Clin Risk Manag. 2018;14:1955-63. DOI: http://dx.doi.org/10.2147/TCRM.S172783
Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta-analysis. Anaesthesia. 2018;73:1058-61. DOI: https://doi.org/10.1111/anae.14299
El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg. 1996;82(6):1197-204. DOI: https://doi.org/10.1097/00000539-199606000-00017
Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiol. 2013;119(6):1360-9. DOI: https://doi.org/10.1097/ALN.0000435832.39353.20
Kohse EK, Siebert HK, Sasu PB, Loock K, Dohrmann T, Breitfeld P, et al. A model to predict difficult airway alerts after videolaryngoscopy in adults with anticipated difficult airways-the VIDIAC score. Anaesthesia. 2022;77(10):1089-96. DOI: https://doi.org/10.1111/anae.15841
Chaggar RS, Shah SV, Berry M, Saini R, Soni S, Vaughan D. The Video Classification of Intubation (VCI) score: a new description tool for tracheal intubation using videolaryngoscopy. A pilot study. Eur J Anaesthesiol. 2021;38(3):324-6. DOI: https://doi.org/10.1097/EJA.0000000000001374
Tsan SEH, Ng KT, Lau J, Viknaswaran NL, Wang CY. A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis. Braz J Anesth. 2020;70(6):667-77. DOI: https://doi.org/10.1016/j.bjan.2020.08.009
Lundstrøm LH, Duez CHV, Nørskov AK, Rosenstock CV, Thomsen JL, Møller AM, et al. Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents. Cochrane Database Syst Rev. 2017;2017(5):CD009237. DOI: https://doi.org/10.1002/14651858.CD009237.pub2
Stein ML, Park RS, Kiss EE, Adams HD, Burjek NE, Peyton J, et al. Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry. Anaesthesia. 2023;78(9):1093-101. DOI: https://doi.org/10.1111/anae.16049
Zhang J, Jiang W, Urdaneta F. Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting. J Comp Eff Res. 2021;10(10):831-44. DOI: https://doi.org/10.2217/cer-2021-0068
Fuller RG, Rossetto MA, Paulson MW, April MD, Ginde AA, Bebarta VS, et al. Market analysis of video laryngoscopy equipment for the role 1 setting. Mil Med. 2023;188(11):e3482-7. DOI: https://doi.org/10.1093/milmed/usad189
Crosby ET, Duggan LV, Finestone PJ, Liu R, Gorter RD, Calder LA. Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association. Can J Anesth. 2021;68(2):183-95. DOI: https://doi.org/10.1007/s12630-020-01846-7
Shaw M, Waiting J, Barraclough L, Ting K, Jeans J, Black B. Airway events in obese vs. non-obese elective surgical patients: a cross-sectional observational study. Anaesthesia. 2021;76(12):1585-92. DOI: https://doi.org/10.1111/anae.15513
Endlich Y, Lee J, Culwick MD. Difficult and failed intubation in the first 4000 incidents reported on webAIRS. Anaesth Intensive Care. 2020;48(6):477-87. DOI: https://doi.org/10.1177/0310057x20957657
Bicalho GP, Bessa RC, Cruvinel MCC, Carneiro FS, Castilho JB, Castro CHV. A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adults patients. Braz J Anesth. 2023;73(2):153-8. DOI: https://doi.org/10.1016/j.bjane.2021.07.028
Tanaka A, Onishi E, Hashimura T, Ota S, Takeuchi H, Tsukamoto Y, et al. Risk factors for reintubation after anteriorcervical spine surgery: comparative study of patients with cervical spine trauma and patients with cervical degenerative disease. Clin Spine Surg. 2024;37(5):203-9. DOI: https://doi.org/10.1097/BSD.0000000000001544
Singleton BN, Morris FK, Yet B, Buggy DJ, Perkins ZB. Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis. Br J Anaesth. 2021;126(5):1055-66. DOI: https://doi.org/10.1016/j.bja.2020.12.041
Hellmann Rv, Fuhr N, Maia IWA, Gerberi D, Pedrollo D, Bellolio F, et al. Effect of bougie use on first-attempt success in tracheal intubations: A systematic review and meta-analysis. Ann Emerg Med. 2023;83(2):132-44. DOI: https://doi.org/10.1016/j.annemergmed.2023.08.484
Kim YJ, Hur C, Yoon HK, Lee HC, Park HP, Oh H. Effects of external laryngeal manipulation on cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization: a randomized crossover trial. J Clin Med. 2021;10(13):2931. DOI: https://doi.org/10.3390/jcm10132931
Cheong CC, Ong SY, Lim SM, Wan WZ, Mansor M, Chaw SH. Partial vs full glottic view with CMACTM D-blade intubation of airway with simulated cervical spine injury: a randomized controlled trial. Expert Rev Med Devices. 2023;20(2):151-60. DOI: https://doi.org/10.1080/17434440.2023.2174850
Aziz MF, Berkow L. Pro-con debate: videolaryngoscopy should be standard of care for tracheal intubation. Anesth Analg. 2023;136(4):683-8. DOI: https://doi.org/10.1213/ANE.0000000000006252
D.Weingart S, Barnicle RN, Janke A, Bhagwan SD, Tanzi M, McKenna PJ, et al. A taxonomy of key performance errors for emergency intubation. Am J Emerg Med. 2023;73:137-44. DOI: https://doi.org/10.1016/j.ajem.2023.08.035
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