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    Evolucion Laringoscopio

    Cargado por

    Irene Cristina
    evolución del laringoscopio a traves de la historia

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    Evolucion Laringoscopio

    Cargado por

    Irene Cristina
    4K vistas43 páginas
    evolución del laringoscopio a traves de la historia

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    © Attribution Non-Commercial (BY-NC)

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    evolución del laringoscopio a traves de la historia

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Descargue como PPS, PDF, TXT o lea en línea desde Scribd
    Descargar como pps, pdf o txt
    4K vistas43 páginas

    Evolucion Laringoscopio

    Cargado por

    Irene Cristina
    evolución del laringoscopio a traves de la historia

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Descargue como PPS, PDF, TXT o lea en línea desde Scribd
    Descargar como pps, pdf o txt
    de 43

    Huffman Prism

    Fiber Optic Howland Lock

    Laryngoscope Blade –
    Blechman
    McCoy

    Light Intensity Meter


    A Clinical Comparison of the Flexiblade™ and
    Macintosh Laryngoscopes for Laryngeal Exposure in
    Anesthetized Adults
    Rochelle W. Cheun, Anesth Analg 2006;102:626–30

    The Flexiblade™, after lever activation, is signi-


    ficantly better than the Macintosh laryngoscope
    for laryngeal visualization in paralyzed adults

    Laryngoscopy using the McCoy laryngoscope after


    application of a cervical collar
    GABBOTT, D. A. Vol 51(9) Sep 1996
    Dep. of Anaesthesia, Gloucestershire Royal NHS Trust, Gloucester

    The McCoy laryngoscope significantly improves


    identification of glottic structures in patients
    wearing a rigid, cervical neck collar.
    Permiten la visualización directa

    de la vía aérea desde la laringe hasta los

    bronquios de segunda y tercera generación

     Laringoscopios Flexibles

     Laringoscopios Rígidos

     Fibrolaringoscopios de distintos calibres


    HISTORIA:
    1 HOPKINS H. DESARROLLO DEL FIBROSCOPIO
    FLEXIBLE
    3 MURPHY P. REPORTO LA PRIMERA INTUBACIÓN
    UTILIZANDO EL FIBROBRONCOSCOPIO
    5 TAYLOR P.A. DESCRIBIO LA METODOLOGÍA DEL
    USO DEL FIBROBRONCOSCOPIO EN
    ANESTESIA
    6 OVASSAPIAN ESCRIBIÓ MONOGRAFÍA SOBRE FIBRO–
    LARINGOBRONCOSCOPIO EN EL
    MANEJO DE LA VÍA AÉREA
    9 ROBERTS J. INICIO DE TALLERES EN LA REUNIÓN
    ANUAL DE LA A.S.A.
    INDICACIONES
     Intubación de rutina
     Intubación en vía aérea difícil
     Intubación en vía aérea traumatizada y quemada
     Intubación en pacientes con estomago lleno
     Intubación en pacientes con lesiones cervicales
     Intubación en pacientes con patología traqueal
     Colocación de tubos para ventilación de un solo
    pulmón
     Diagnóstico y manejo de broncoaspiración
    LARINGOSCOPIOS RIGIDOS DE FIBRA ÓPTICA

    Laringoscopios rígidos ópticos


    Permiten verificar posición antes de retirar laringoscopio

    Tienen forma de la curva anatómica de la vía aérea

     Evitan la necesidad de mover la cabeza/cuello

     Permiten succionar y administrar 02

     Visualización del paso del tubo E - T


    Laringoscopios rígidos ópticos
    Indicaciones:

     Patología de tejidos blandos de cavidad oral y oro-faringe

     Apertura oral limitada

     Incisivos de gran tamaño

     Patología columna cervical

     Revisión de laringe

     Intubación despierto con estomago lleno

     Intubación en pacientes con fácil desaturación


    Laringoscopios rígidos ópticos

    Contraindicaciones:

     Deformidad exagerada del cuello en flexión

     No apertura oral

    Complicaciones:
     Dolor de garganta

     Ruptura dental

     Daño en mucosa
    UPSHERSCOPE
    TrachView Intubating
    Videoscope
    VETT TM
    A clinical assessment of the Glidescope videolaryngoscope
    in nasotracheal intubation with general anesthesia

    Journal of Clinical
    Anesthesia
    Vol 18, Issue 8, Dec 2006

    Conclusions
    The GSVL is an effective device for nasotracheal intubation and
    may be incorporated easily into routine clinical practice.
    Compared with the Macintosh laryngoscope, the GSVL can
    provide an improved laryngeal view in the patient with difficult
    airway.
    WUSCOPE

    BULLARD
    UPSHERSCOPE
    VIDEO LARINGOSCOPIOS
    SEMI-RÍGIDOS
    Shikani Optical Stylet

    Bonfils Retromolar
    Intubation Fiberscope

    Levitan
    Equipment for airway
    management
    Kathryn Jackson, Tim Cook

    ANAESTHESIA AND INTENSIVE CARE MEDICINE 7:10

    Rigid fibreoptic laryngoscopes:

    Some devices are designed to be inserted within the TT (Shikani


    stylet, Bonfils), others are bladed devices (Wuscope, Bullard,
    Upsherscope, Glidescope, McGrath 5, Airtraq) and these provide
    a better facility for manipulating the soft tissues. The c-Trach, an
    ILMA with built in fibreoptic camera and digital screen fulfils a
    similar role.
    AI RTRAQ
    Tracheal intubation by inexperienced medical residents using
    the Airtraq and Macintosh laryngoscopes
    Chrisen H. Maharaj MB

    Am J of Emergency Med
    2006) 24, 769–774

    In all scenarios tested, the Airtraq decreased the duration of intubation


    attempts, reduced the number of optimization maneuvers required, and reduced
    the potential for dental trauma. The residents found the Airtraq easier to use in
    all scenarios compared with the Macintosh laryngoscope. The Airtraq may
    constitute a superior device for use by personnel infrequently required to
    perform tracheal intubation.
    A comparison of tracheal intubation using the Airtraq or
    the Macintosh laryngoscope in routine airway
    management: A randomised, controlled clinical trial

    Maharaj CH - Anaesthesia - 01-NOV-2006; 61(11): 1093-9

    Dep. of Anaesthesia, Un. College Hospital, Galway, Ireland.

    Abstract:
    The Airtraq laryngoscope is a novel single use tracheal intubation device. We
    compared the Airtraq with the Macintosh laryngoscope.

    All but one patient, in the Macintosh group, was successfully intubated on the
    first attempt. There was no difference between groups in the duration of
    intubation attempts.

    In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest


    improvements in the intubation difficulty score, and in ease of use. Tracheal
    intubation with the Airtraq resulted in less alterations in heart rate.

    These findings demonstrate the utility of the Airtraq laryngoscope for tracheal
    intubation in low risk patients.
    Tracheal Intubation Using the Airtraq in Morbid Obese
    Patients Undergoing Emergency Cesarean Delivery
    Gilles Dhonneur, M.D., Ph.D.
    Anesthesiology 2007; 106:629–30

    We decided that after 2 min of failed tracheal intubation using direct


    laryngoscopy, rescue AT tracheal intubation should be attempted. After 6
    months, this algorithm has been applied by the obstetric anesthesia team; 69
    parturient underwent emergency cesarean delivery during general anesthesia,
    and 2 required the AT.

    We are now considering placing the AT as a


    primary airway management device in the case
    of emergency cesarean delivery in women
    showing predictive difficult airway factors at
    labor or operating room clinical evaluation.
    Journal of Clinical Anesthesia (2007) 19, 485-488
    Adrian A. Matioc MD
    The Airtraq to facilitate endotracheal tube exchange
    in a critically ill, difficult-to-intubate patient

    A comparison of tracheal intubation using the Airtraq or the


    Macintosh laryngoscope in routine airway management: A
    randomised, controlled clinical trial

    Maharaj CH - Anaesthesia - 01-NOV-2006; 61(11)

    Dep. of Anaesthesia, Un. College Hospital, Galway, Ireland.

    Abstract:
    In comparison to the Macintosh laryngoscope, the Airtraq
    resulted in modest improvements in the intubation
    difficulty score, and in ease of use. Tracheal intubation
    with the Airtraq resulted in less alterations in heart rate.
    Laryngoscopy vs. Optical Stylet vs. Optical
    Laryngoscope (Airtraq) for Extubation Evaluation
    Thomas C. Mort, M.D.
    Anesthesiology, Hartford Hospital, Connecticut
    Anesthesiology 2006; 105: A823

    The Airtraq, a disposable optical scope, with its specially designed lenses
    and mirrors, offered a wide angle (panoramic) view of the periglottic
    structure regardless of the extent of swelling or edema or any limitation of a
    restricted “line of sight”.

    VISTA DE LA GLOTIS

    The Airtraq performed extremely well


    compared to standard laryngoscopy
    and an optical stylet.
    Clinical comparisons between GlideScope®
    video laryngoscope and Trachlight® in
    simulated cervical spine instability
    Journal of Clinical Anesthesia
    Vol 19, Issue 2 (March 2007)

    Conclusions.-
    Trachlight® offers a faster intubation and a
    milder hemodynamic response compared
    than with GS in patients with MILS.
    Nonetheless, both devices are comparable
    in success rate of tracheal intubation and
    airway complications.
     Todo anestesiólogo debe estar entrenado en su uso
     Todo quirófano debería contar con estos instrumentos
     Las residencias deben tener programas de entrenamiento
     Deben organizarse programas de capacitación a aneste-

    siológos formados
     Se deben establecer los requisitos para certificar la compe-

    tencia en su empleo
    Airway Management in
    Trauma:
    An Update
    John McGill, MD
    Emerg Med Clin N Am 25 Aug (2007) 603–622
    Tracheal intubation by inexperienced medical residents using
    the Airtraq and Macintosh laryngoscopes
    Chrisen H. Maharaj MB

    American Journal of Emergency


    Medicine
    2006) 24, 769–774

    1. The Airtraq decreased the duration of intubation attempts, reduced the


    number of optimization maneuvers required, and reduced the potential for
    dental trauma.
    2. The residents found the Airtraq easier to use in all scenarios compared with
    the Macintosh laryngoscope.
    3. The Airtraq may constitute a superior device for use by personnel
    infrequently required to perform tracheal intubation.
    Journal of Clinical Anesthesia (2006) 18, 357–362

    Comparison of direct and video-assisted views


    of the larynx during routine intubation
    Marshal B. Kaplan MD, Carin A. Hagberg MD, Denham S. Ward MD, PhD, Ansgar Brambrink MD, Ashwani
    K. Chhibber MD, Thomas Heidegger MD, Leonardo Lozada MD, Andranik Ovassapian M, David Parsons
    MDh, James Ramsay MD, Wolfram Wilhelm MD, Bernhard Zwissler MD, Haus J. Gerig MD, Christian
    Hofstetter MD, Suzanne Karan MD, Nevin Kreisler MD, Robert M. Pousman M, Andreas Thierbach MD,
    Marc Wrobel MD, George Berci MD

    Conclusions
    Video- assisted laryngoscopy provides an improved view of the larynx, as
    compared with direct visualization. This technique may be useful for cases of
    difficult intubation and reintubation as well as for teaching laryngoscopy and
    intubation.

    Aunque este estudio demuestra la mejoría de la visión


    de las estructuras glóticas con el video laringoscopio,
    no provee evidencia de una disminución en la
    incidencia de intubaciones fallidas.
    La vida nunca esta libre de riesgos: solo nos
    toca decidir cual riesgo es aceptable y cual no.

    La 3ra. Ley de Arthur C. Clarke:


    Cualquier tecnología suficientemente avanzada es indistinguible
    de la magia
    Corolario:
     Cualquier tecnología distinguible de la magia, no esta
    suficientemente avanzada.
     Cualquier tecnología, no importa cuan primitiva sea, es magia
    para quienes no lo entienden.
     A mayor empleo de técnicas anestésicas con no intubación, la
    experiencia de los Anestesiologos, en ella, irá disminuyendo.
     El éxito de un procedimiento depende de una buena técnica y
    una práctica regular, a pesar de la excelencia del instrumento
    empleado.
     En ciertas circunstancias cuentan más las habilidades que los
    instrumentos.

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