Evolucion Laringoscopio

 

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

Laryngoscopy application using the of aMcCoy cervical laryngoscope collar  collar  after 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

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Laringoscopios Flexibles

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Laringoscopios Rígidos

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Fibrolaringoscopios de distintos calibres

 

HISTORIA: 1

HOPKINS H.

DESARROLLO DEL FIBROSCOPIO FLEXIBLE

3

MURPHY P.

5

TAYLOR P.A.

REPORTO LA PRIMERA INTUBACIÓN UTILIZANDO EL FIBROBRONCOSCOPIO DESCRIBIO LA METODOLOGÍA DEL USO DEL FIBROBRONCOSCOPIO EN

6

OVASSAPIAN

9

ROBERTS J.

ANESTESIA ESCRIBIÓ MONOGRAFÍA SOBRE FIBRO– LARINGOBRONCOSCOPIO EN EL MANEJO DE LA VÍA AÉREA IANUAL NICIO DDE E TA TLA ALA.S.A. LERES EN LA REUNIÓN

 

INDICACIONES   INDICACIONES

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Intubación en vía aérea difícil

Intubación en vía aérea traumatizada y quemada 

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Intubación de rutina

Intubación en pacientes con estomago lleno

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Intubación en pacientes con lesiones cervicales

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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 retira r laringoscopio

Tienen

forma de la curva anatómica de la vía aérea

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Evitan la necesidad de mover la cabeza/cuello 

Permiten succionar y administrar 02

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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

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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

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No apertura oral

Complicaciones: 

Dolor de garganta

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Ruptura dental

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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

 

VIDEOSEMI-RÍGI LARINGOSCOPIOS SEMI-RÍGIDOS DOS

 

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 laryngoscop laryngoscopes: es: 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.

 

AIRTRAQ IRTRAQ

 

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.

 Abst r  ract: a   ct:

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 and 2 required the AT.emergency cesarean delivery during general anesthesia,

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.

ract: a   ct:  Abst r  In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, resulted and in ease use. Tracheal intubation with the Airtraq res ulted in lessofalterations 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 Anest Anesthesia hesia  Vol 19, Issue 2 (March 2007)

Conclusions.-  Trachlight® offers a faster intubation and a milder hemodynamic response compared than with GS patients MILS. Nonetheless, bothindevices are with comparable in success rate of tracheal intubation and airway complications. 

 

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Todo anestesiólogo anestesiólogo debe estar entrenado entrenado en su uso uso

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Todo quirófano debería contar con estos instrumentos instrumentos Las residencias deben tener programas de entrenamiento

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Deben organizarse programas de capacitación a anestesiológos formados

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Se deben establecer los requisitos para certificar la competencia en su empleo

 

Airway Management in Trauma: An Update MD (2007) 603–622 Emerg Med John Clin NMcGill, Am 25 Aug

 

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 laryngoscope. 3. the TheMacintosh 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

Video- assisted laryngoscopyConclusions 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 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. 