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      Efecto de la maniobra de fijación en línea en la clasificación de Cormack-Lehane Translated title: Effect of the in-line fixation maneuver on Cormack-Lehane classification


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          Resumen: Introducción: El manejo correcto de la vía aérea en los pacientes politraumatizados es crucial, ya que es necesario tener una vía aérea segura y proveer adecuada ventilación sin emperorar una probable lesión medular. Objetivo: Determinar el efecto de la maniobra de fijación en línea (MILS del inglés Manual In-Line Stabilisation) en la clasificación de Cormack-Lehane (CL), así como la correlación con el índice de masa corporal (IMC). Material y métodos: En un estudio descriptivo en el Centro Hospitalario del Estado Mayor Presidencial en la Ciudad de México se incluyeron 56 pacientes con estado físico ASA I a IV. El anestesiólogo realizó la laringoscopía directa bajo MILS y valoró el grado de CL. Inmediatamente después se reposicionó al paciente en posición de olfateo, se efectuó nueva laringoscopía directa y se revaloró de nuevo el grado de CL. Resultados: Los grados del CL fueron significativamente diferentes entre la posición MILS versus olfateo. Los grados de CL fueron en su mayoría altos cuando se posicionó al paciente en MILS (75% de los pacientes clasificados entre III y IV) y disminuyeron significativamente al ser cambiados a posición de olfateo. Conclusión: Se observa mejoría del CL cuando se cambia de posición MILS a olfateo.

          Translated abstract

          Abstract: Introduction: Correct airway management of polytraumatized patients is crucial because of the necessity of securing the airway and providing adequate ventilation without worsening a probable spinal cord injury. Objective: Determine the effect of manual inline stabilization (MILS) on Cormack-Lehane classification and if there is any correlation with body mass index (BMI). Material and methods: In a descriptive study at the Centro Hospitalario del Estado Mayor Presidencial in Mexico City, we included 56 patients with ASA physical status I to IV. The anesthesiologist performed direct laryngoscopy while MILS was performed and observed the CL grade. Immediately after, the patient was repositioned into the sniffing position, direct laryngoscopy was performed, and the CL grade was observed again. Results: The CL grades observed were significantly different between MILS vs. Sniffing position. CL grades were mainly high when positioned in MILS (75% classified as grades III and IV) and diminished significantly when changed to the sniffing position. Conclusion: Improvement of CL grade was observed when changing from MILS to sniffing position.

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          Complications and failure of airway management.

          Airway management complications causing temporary patient harm are common, but serious injury is rare. Because most airways are easy, most complications occur in easy airways: these complications can and do lead to harm and death. Because these events are rare, most of our learning comes from large litigation and critical incident databases that help identify patterns and areas where care can be improved: but both have limitations. The recent 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society provides important detailed information and our best estimates of the incidence of major airway complications. A significant proportion of airway complications occur in Intensive Care Units and Emergency Departments, and these more frequently cause patient harm/death and are associated with suboptimal care. Hypoxia is the commonest cause of airway-related deaths. Obesity markedly increases risk of airway complications. Pulmonary aspiration remains the leading cause of airway-related anaesthetic deaths, most cases having identifiable risk factors. Unrecognized oesophageal intubation is not of only historical interest and is entirely avoidable. All airway management techniques fail and prediction scores are rather poor, so many failures are unanticipated. Avoidance of airway complications requires institutional and individual preparedness, careful assessment, good planning and judgement, good communication and teamwork, knowledge and use of a range of techniques and devices, and a willingness to stop performing techniques when they are failing. Analysis of major airway complications identifies areas where practice is suboptimal; research to improve understanding, prevention, and management of such complications remains an anaesthetic priority.
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            The failed intubation attempt in the emergency department: analysis of prevalence, rescue techniques, and personnel.

            The aims of this study were: To describe the prevalence of Emergency Department (ED) airway management failures requiring rescue maneuvers, to describe successful rescue methods used when the primary method chosen is unsuccessful, and to characterize the roles of emergency physicians and other specialists in rescue airway management. A prospective observational study was conducted of ED airway management in 30 hospitals in the USA, Canada, and Singapore participating in the National Emergency Airway Registry (NEAR) database project. Patients were entered in the study if they underwent ED airway management, the first method chosen was not successful in achieving intubation, and a rescue technique was required. Data were collected on a structured data form for entry into a relational database with subsequent search for subjects fulfilling inclusion and exclusion criteria. Descriptive statistics were used for analysis of these data. There were 7,712 patients identified who underwent emergency intubation during the study period from January 1998 to February 2001. A total of 207 (2.7%) patient intubations met the inclusion criteria. Of these, 102 (49%) patients underwent rescue rapid sequence intubation (RSI). RSI was used after failure of oral intubation with sedation alone (n = 29), oral intubation without medications (n = 37), or blind nasotracheal intubation (n = 36). Forty-three (21%) patients underwent rescue cricothyrotomy after failure of RSI (n = 26) or other intubation methods (n = 17). Seventy-nine percent of rescue RSIs and 53% of rescue surgical airways were performed by emergency physicians. In conclusion, a total of 2.7% of emergency intubations required rescue. RSI is the most commonly used first line technique for ED airway management and is also the principal back-up technique when other oral or nasal intubation methods fail. Emergency physicians manage the majority of ED intubations, including those requiring rescue techniques.
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              Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial.

              Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy. Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/105) in the control group (P < 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 +/- 8.5 sec and 8.7 +/- 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI(95%) 5.0-9.3, P < 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy.

                Author and article information

                Revista mexicana de anestesiología
                Rev. mex. anestesiol.
                Colegio Mexicano de Anestesiología A.C. (Ciudad de México, Ciudad de México, Mexico )
                March 2022
                : 45
                : 1
                : 30-34
                [3] Huixquilucan Estado de México orgnameHospital Ángeles Lomas Mexico
                [1] Huixquilucan Estado de México orgnameHospital Ángeles Lomas Mexico
                [2] Ciudad de México orgnameInstituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán» Mexico
                S0484-79032022000100030 S0484-7903(22)04500100030

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                : 11 May 2021
                : 12 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 5

                SciELO Mexico

                Investigaciones originales

                difficult intubation,lesión medular,maniobra fijación en línea,videolaringocopio,intubación difícil,laringoscopía difícil,Traumatismo columna cervical,spinal cord injury,manual in-line stabilization,videolaryngoscope,difficult laryngoscopy,Cervical spine trauma


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