Tecnología, limitaciones y aplicaciones de la videolaringoscopia en cirugía ortopédica y traumatológica
Palabras clave:
manejo de la vía aérea, intubación intratraqueal, laringoscopía, laringoscopiosResumen
Introducción: Los videolaringoscopios se han convertido en instrumentos de referencia para el manejo de la vía aérea difícil. Se consideran equivalentes a los fibroscopios flexibles por su efectividad para garantizar la intubación en pacientes adultos y pediátricos, tanto en el ámbito clínico como quirúrgico, y la baja incidencia de complicaciones.
Objetivo: Describir los principios tecnológicos, las limitaciones y las aplicaciones de los videolaringoscopios.
Métodos: Se realizó una revisión no sistemática de la literatura, en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed, Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, Springer Link y el buscador académico Google Scholar en marzo de 2024.
Desarrollo: Los videolaringoscopios incorporan una cámara de alta resolución que provee una visión indirecta de las estructuras laríngeas con un campo de visión panorámico. Las espátulas pueden ser canaladas o no canaladas, cuya geometría es diversa, pues además de las palas Miller y Macintosh usuales, se han diseñado variantes denominadas “hiperanguladas”, con ángulos que oscilan entre los 60° y 90° de curvatura, más efectivas para la vía aérea difícil. Su versatilidad ha posibilitado que se utilicen en otros procedimientos clínicos o complementarios a las técnicas convencionales.
Conclusiones: La videolaringoscopia se ha instituido como técnica de referencia para el manejo de la vía aérea difícil, porque integra los principios de la laringoscopía directa convencional con funcionalidades audiovisuales avanzadas y pocas limitaciones; además de otras utilidades terapéuticas y diagnósticas que trascienden su indicación primaria.
Descargas
Citas
1. 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
2. Cook TM, Ogelsby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthes. 2023;79(4):368-79. DOI: https://doi.org/10.1111/anae.16187
3. 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
4. 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: http://dx.doi.org/10.1177/0310057X20957657
5. Fornebo I, Simonsen KA, Bukholm IRK, Kongsgaard UE. Claims for compensation after injuries related to airway management: a nationwide study covering 15 years. Acta Anaesthesiol Scand. 2017;61(7):781-9. DOI: https://doi.org/10.1111/aas.12914
6. Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation. a closed claims analysis. Anesthesiol. 2019;131(4):818-29. DOI: https://doi.org/10.1097/ALN.0000000000002815
7. Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021;325(12):1164-72. DOI: https://doi.org/10.1001/jama.2021.1727
8. Heidegger T. Management of the Difficult Airway. N Eng J Med. 2021;384(19):1836-47. DOI: https://doi.org/10.1056/NEJMra1916801
9. Huitink JM, Cook TM. The epidemiology of airway management complications. En: Cook TM, Kristensen MS, editor. Core topics in airway management. 3rd ed. Cambridge University Press; 2021. p. 22-37. DOI: https://doi.org/10.1017/9781108303477.005
10. 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
11. Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev. 2018;2018(6):CD00997]. DOI: https://doi.org/10.1002%2F14651858.CD009975.pub3
12. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Preanesthetic” Era, 1700 to 1846. Anesthesiol. 2016;124(2):301-11. DOI: https://doi.org/10.1097/ALN.0000000000000955
13. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Artisanal Anesthetic” Era, 1846 to 1904. Anesthesiol. 2017;126(3):394-40. DOI: https://doi.org/10.1097/ALN.0000000000001508
14. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Progressive” Era, 1904 to 1960. Anesthesiol. 2018;128(2):254-71. DOI: https://doi.org/10.1097/ALN.0000000000001975
15. Berkow LC, Morey TE, Urdaneta F. The Technology of Video Laryngoscopy. Anesth Analg. 2018;126(5):1527-34. DOI: https://doi.org/10.1213/ANE.0000000000002490
16. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anesth. 2005;52(2):191-8. DOI: https://doi.org/10.1007/BF03027728
17. Maguire S, Schmitt PR, Sternlicht E, Kofron CM. Endotracheal intubation of difficult airways in emergency settings: a guide for innovators. Med Devices Evid Res. 2023;16:183-99. DOI: https://doi.org/10.2147/MDER.S419715
18. Guzmán J. El videolaringoscopio C-MAC. Una guía para optimizar su uso ilustrando experiencias clínicas. Endo Press; 2016 [acceso 12/03/2024]. Disponible en: https://simuvad.aymonline.events/wp-content/uploads/SILVERBOOK-guia-para-optimizar-el-uso-de-videolaringoscopios-CMAC.pdf
19. Lee J, Cho Y, Kim W, Choi KS, Jang BH, Shin H, et al. Comparisons of videolaryngoscopes for intubation undergoing general anesthesia: systematic review and network meta-analysis of randomized controlled trials. J Pers Med. 2022;12:363. DOI: https://doi.org/10.3390/jpm12030363
20. Hoshijima H, Mihara T, Denawa Y, Shiga T, Mizuta K. Airtraq versus GlideScope for tracheal intubation in adults: a systematic review and meta-analysis with trial sequential analysis. Can J Anesth. 2022;69(5):605-13. DOI: https://doi.org/10.1007/s12630-022-02217-0
21. Wünsch VA, Köhl V, Breitfeld P, Bauer M, Sasu PB, Siebert HK, et al. Hyperangulated blades or direct epiglottis lifting to optimize glottis visualization in difficult Macintosh videolaryngoscopy: a non-inferiority analysis of a prospective observational study. Front Med. 2023;10:1292056. DOI: https://doi.org/10.3389/fmed.2023.1292056
22. Irouschek A, Moritz A, Kremer S, Fuchte T, Danzl A, Schmidt J, et al. An approach to difficult airway in infants: Comparison of GlideScope® Spectrum LoPro, GlideScope® Spectrum Miller and conventional Macintosh and Miller blades in a simulated Pierre Robin sequence performed by 90 anesthesiologists. PLoS One. 2023;18(8):e0288816. DOI: https://doi.org/10.1371/journal.pone.0288816
23. Kumari A, Choudhuri P, Agrawal N. A comparative study of the C-MAC D-blade videolaryngoscope and McCoy laryngoscope for oro-tracheal intubation with manual in-line stabilization of neck in patients undergoing cervical spine surgery. J Anaesth Clin Pharm. 2022;39(3):435-43. DOI: https://doi.org/10.4103/joacp.joacp_471_21
24. 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
25. Correa JBB, Felice VB, Sbruzzi G, Friedman G. Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis. Emerg Med J. 2023;40:300-7. DOI: https://doi.org/10.1136/emermed-2021-211160
26. Moraes ACBK, Nascimento CdDd, Souza EG, Kraemer MB, Moraes M, Carreno NLV, et al. Advancements in additive manufacturing for video laryngoscopes: a comprehensive scoping and technological review. Syst Rev. 2023;12:236. DOI: https://doi.org/10.1186/s13643-023-02406-y
27. 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
28. Popal Z, Dankert A, Hilz P, Wünsch VA, Grensemann J, Plümer L, et al. Glidescope video laryngoscopy in patients with severely restricted mouth opening. A pilot study. J Clin Med. 2023;12:5096. DOI: https://doi.org/10.3390/jcm12155096
29. Khader A, Singh T, Singh A, Kour A. Comparing Intubating conditions and stress response with CMAC D-Blade and McCoy laryngoscope: A guide to new anesthetists. Apollo Med. 2023;20(3):196-202. DOI: https://doi.org/10.4103/am.am_160_22
30. Sbeghen V, Verdonck O, McDevitt J, Zaphiratos V, Brulotte V, Loubert C, et al. A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anesth. 2021;68(6):855-67. DOI: https://doi.org/10.1007/s12630-021-01936-0
31. Hindman BJ, Dexter F, Gadomski BC, Bucx MJ. Sex-Specific intubation biomechanics: intubation forces are greater in male than in female patients, independent of body weight. Cureus. 2020;12(6):e8749. DOI: https://doi.org/10.7759/cureus.8749
32. Gadomski BC, Shetye SS, Hindman BJ, Dexter F, Santoni BG, Todd MM, et al. Intubation biomechanics: validation of a finite element model of cervical spine motion during endotracheal intubation in intact and injured conditions. J Neurosurg Spine. 2018;28(1): 10-22. DOI: https://doi.org/10.3171/2017.5.SPINE17189
33. Hindman BJ, Fontes RB, From RP, Traynelis VC, Todd MM, Puttlitz CM, et al. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers - effect of severe distractive-flexion injury on C3–4 motion. J Neurosurg Spin. 2016;25(5):545-55. DOI: https://doi.org/10.3171/2016.3.SPINE1640
34. Fonternel T, Rooyen Hv, Joubert G, Turton E. Evaluating the Usability of a 3D-Printed video laryngoscope for tracheal intubation of a manikin. Med Devices Evid Res. 2023;16:157-65. DOI: https://doi.org/10.2147/MDER.S405833
35. Gorman L, Dickson AN, Monaghan M, Vaughan F, Murphy B, Dowling DP, et al. Novel co-axial, disposable, low-cost 3D printed videolaryngoscopes for patients with COVID-19: a manikin study. Eur J Anaesthesiol Intensive Care Med. 2022;2(1):e0015. DOI: https://doi.org/10.1097/EA9.0000000000000015
36. Choi J, Song Y, Lee H, Cho Y, Ha TH, Lim TH. Comparison of the strength of various disposable videolaryngoscope blades. Can J Anesth. 2021;68:1651-8. DOI: https://doi.org/10.1007/s12630-021-02069-0
37. Hamal PK, Chaurasia RB, Pokhrel N, Pandey D, Shrestha GS. An affordable videolaryngoscope for use during the COVID-19 pandemic. Lancet Glob Health. 2020;8(7):e893-e4. DOI: https://doi.org/10.1016/S2214-109X(20)30259-X
38. Freitas JD, Moreno JE, Silva M. Prototipo de videolaringoscopio: Wi-Mac-Multivision. Rev Chil Anest. 2020;49:262-70. DOI: https://doi.org/10.25237/revchilanestv49n02.11
39. Karippacheril JG, Cong ML. Videolaryngoscopy using an Android smartphone: A direct digital technique. Indian J Anaesth. 2016;60(2):143-5. DOI: https://doi.org/10.4103/0019-5049.176288
40. Karippacheril JG, Umesh G, Ramkumar V. Inexpensive video-laryngoscopy guided intubation using a personal computer: initial experience of a novel technique. J Clin Monit Comput. 2014;28(3):261-4. DOI: https://doi.org/10.1007/s10877-013-9522-x
41. HamalI PK, Yadav RK, Malla P. Performance of custom made videolaryngoscope for endotracheal intubation: A systematic review. PLoS One. 2022;17(1):e0261863. DOI: https://doi.org/10.1371/journal.pone.0261863
42. Lotlikar A, Hoogenboom EM. Importance of standardisation and human factors in ensuring patient safety with videolaryngoscopes. Anaesthesia. 2024;79(1):103-4. DOI: https://doi.org/10.1111/anae.16126
43. Sukmono B, Manggala SK, Auerkari AN, Christina B. Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial. Indian J Anaesth. 2022;66(5):350-7. DOI: https://doi.org/10.4103/ija.ija_300_21
44. 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
45. 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
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Antonio Ismael Aparicio Morales
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
