ABSTRACT
BACKGROUND: Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques.METHODS: This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied.RESULTS: FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups.CONCLUSIONS: The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.
Subject(s)
Child , Humans , Airway Management , Anesthesia, General , Intubation , Laryngeal Masks , Prospective Studies , Supine PositionABSTRACT
Introducción: El control de la vía aérea en el quirófano es una responsabilidad del anestesiólogo, por lo que al finalizar su formación debe haber desarrollado las habilidades necesarias para atender esta exigencia. El control adecuado de la vía aérea para garantizar una correcta ventilación y oxigenación no sólo es indispensable en muchos procedimientos anestésico-quirúrgicos sino también en todas aquellas situaciones en las que la función respiratoria está comprometida. En los últimos años se ha producido una proliferación de nuevos dispositivos y se han mejorado las técnicas antiguas de intubación y ventilación proporcionándonos una gran ayuda en el manejo de la vía aérea difícil. Objetivo: Evaluar el empleo de nuevos instrumentales para la intubación difícil. Desarrollo: Se realizó una revisión bibliográfica sobre los nuevos instrumentos para intubación difícil recién llegados a nuestro hospital como estilete luminoso, guía de Eschmann o gum elastic bougie, combitubo, con el fin de adquirir los elementos teóricos para aplicarlo en la práctica clínica. Conclusiones. De acuerdo a la experiencia con estos instrumentos y la literatura revisada, la primera opción es la utilización del combitubo, la guía de Eschmann o gum elastic bougie en segundo lugar y el estilete luminoso en tercer lugar.
The anesthesiologist is responsible for the control of the airway in the operating theatre who ending its training must to have developed the skills necessary to manage this demand. The appropriate control of the airway to guarantee a proper ventilation and oxygenation not only is essential in many anesthetic-surgical procedures but also in all those situations where the respiratory function is involved. In past years there has been appeared new devices and an improvement in past techniques of intubation and ventilation allowing us a great help in the management of this difficult airway. Objective: To assess the use of new tools for a difficult intubation. Development: A bibliographic review was carried out on the new tools for a difficult intubation now available in our hospital including a bright stylet, Eschmann's guide or gum elastic bougie, combitube to acquire the theoretical elements to be applied in the clinical practice. Conclusions: According to experience with these tools and the reviewed literature, the first option is the use of the combitube, the Eschmann guide or gum elastic bougie in the second place, and the bright stylet in the third one.
ABSTRACT
O objetivo deste estudo foi avaliar o efeito da aplicação de uma camada de compósito de alto escoamento antesda inserção do compósito restaurador sobre a infiltração marginal na interface dente-compósito da parede gengival de restaurações classe II. Foram preparadas vinte cavidades tipo slot vertical nas faces proximais de dez terceiros molares humanos íntegros. As cavidades apresentaram as seguintes dimensões: 4 mm vestibulolingual,4 mm oclusogengival e 2 mm de profundidade. Dividiram-se as cavidades em dois grupos (n =10): Grupo 1 - cavidades preparadas na face distal dos dentes, restauradas com três incrementos de compósito, sendo realizada a fotopolimerização após a inserção de cada incremento; Grupo 2 - cavidades preparadas na face mesial dos dentes, restauradas com a mesma técnica, porém precedida da aplicação, na parede gengival, de uma camada de compósito de alto escoamento. Todasas amostras foram armazenadas em água destilada a 37 oC por 24h e submetidas a 200 ciclos térmicos (5oC e 55 oC) de 30s cada. Em seguida, foram imersas em solução de azul de metileno a 2 por cento por 4h e a infiltração do corante foi avaliada utilizando escores que variaram de 0 a 3. Os dados foram submetidos ao teste estatístico de Kruskal-Wallis, que mostrou redução significativa no grau de infiltração marginal quando uma camada de resina de alto escoamento foi aplicada na parede gengival previamente à inserção da resina restauradora