Median effective dose of alfentanil combined with propofol inhibiting responses to laryngeal mask airway insertion in children / 中华麻醉学杂志

Objective:To determine the median effective dose(ED 50) of alfentanil combined with propofol inhibiting responses to the laryngeal mask airway(LMA) insertion in children. Methods:American Society of Anesthesiologists Physical Status classification Ⅰ children, aged 6-10 yr, with body mass index of 18-24 kg/m 2, undergoing facial skin pigmented nevus resection, were selected. Propofol(target plasma concentration 3 μg/ml) was given by the target-controlled infusion, alfentanil was intravenously injected, 2 min later LMA was inserted, and anesthesia was maintained with 2%-3% sevoflurane until the end of surgery. The dose of alfentanil was determined by the up-and-down sequential method, the initial dose of alfentanil was 15 μg/kg, when the response to LMA insertion was positive/negative, the dose of alfentanil increased/decreased by 1 μg/kg in the next case. The LMA insertion response was defined as swallowing, bucking, body movement occurred during insertion of the LMA, and this process was repeated until 7th turning points appeared. The ED 50 and 95% confidence interval of alfentanil combined with propofol inhibiting responses to LMA insertion in children were calculated using probit method. Results:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion was 13.18(95% confidence interval 12.43-13.79) μg/kg in children. Conclusions:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion is 13.18 μg/kg in children.

Inserção da máscara laríngea por enfermeiros: revisão integrativa da literatura / Laryngeal mask insertion by nurses: an integrative literature review

Objetivo: Identificar as evidências científicas da literatura sobre a inserção de máscara laríngea por enfermeiros. Método: Revisão integrativa de literatura, realizada em novembro de 2020, cuja busca ocorreu nas bases de dados Cumulattive Index to Nursing and Allied Health Literature, Cochrane, Excerpta Médica Database, Literatura Latino-Americana e do Caribe em Ciências da Saúde, US National Library of Medicine National Institutes Database Search of Healthe Web of Sciencepor meio do programa Rayyan para seleção dos estudos. Resultados: Identificaram-se 1.156 estudos, do quais oito atenderam aos critérios de inclusão. Os estudos foram categorizados em dispositivos de primeira e segunda geração. Conclusão: Conclui-se que o uso de máscara laríngea de primeira e segunda geração por enfermeiros é uma alternativa recomendada por sua rapidez, sucesso e eficácia em garantir a via aérea avançada, em especial, em situações de parada cardiorrespiratória em adultos, porém, recomenda-se verificar os efeitos adversos de seu uso.

Objective: To identify evidence-based literature on the laryngeal mask airway insertion by nurses. Method: Integrative literature review conducted in November 2020, searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, Excerpta Medica Database, Latin American and Caribbean Health Sciences Literature, US National Library of Medicine National Institutes Database Search of Health and Web of Science through the Rayyan Study Selection Program. Results: Eight out of the 1,156 studies identified met the inclusion criteria. Studies were categorized into first and second-generation devices. Conclusion: The use of a first and second-generation laryngeal mask airway by nurses is a recommended alternative for its speed, success and effectiveness in ensuring the advanced airway, especially in situations of cardiopulmonary arrest in adults. However, adverse effects of its use should be evaluated.

Efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway insertion / 中华麻醉学杂志

Objective:To evaluate the efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway (LMA) insertion.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing elective surgery with ventilation using LMA under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: paraffin oil group (group A), compound lidocaine cream group (group B), and compound chamomile and lidocaine hydrochloride gel group (group C). The paraffin oil, compound lidocaine cream, and compound chamomile and lidocaine hydrochloride gel were evenly applied on the front, shoulder and back of the LMA before inserting the LMA in A, B and C groups, respectively.The severity of sore throat, oropharyngeal mucositis score, hoarseness score and occurrence in each time period (0-1 h, >1-6 h, >6-24 h, > 24-48 h) were recorded at 1, 6, 24 and 48 h after removal of the laryngeal mask.The stress responses during removal of the LMA and occurrence of drug-related adverse reactions within 48 h after removal of LMA were recorded. Results:Twenty-nine cases in group A, 28 cases in group B and 27 cases in group C completed the trial.Compared with group A, the severity of sore throat at each time point after removal of the LMA and incidence of sore throat in each time period were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and the incidence of oropharyngeal mucositis in the time period >1-48 h were decreased, and the incidence of drug-related adverse reactions was increased in group C ( P<0.05). Compared with group B, the severity of sore throat at 6 h after removal of the LMA and incidence of sore throat > 1-48 h after removal of the LMA were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and incidence of oropharyngeal mucositis in the time period >1-48 h after LMA removal were reduced, and the incidence of drug-related adverse reactions was decreased in group C ( P<0.05). There was no significant difference in the hoarseness score and incidence of hoarseness after removal of the LMA and incidence of stress responses during removal of the LMA among the three groups ( P>0.05). Conclusions:Compound chamomile and lidocaine hydrochloride gel has a certain efficacy in preventing complications related to LMA placement.

Effects of one-lung ventilation with a laryngeal mask airway combined with a bronchial blocker on respiratory function in older adult patients undergoing thoracoscopic surgery / 中国基层医药

Objective:To investigate the effects of one-lung ventilation with a laryngeal mask airway combined with a bronchial blocker on respiratory function in older adult patients undergoing thoracoscopic surgery.Methods:Sixty older adult patients who underwent thoracoscopic surgery in Zhejiang Veteran Hospital from January 2019 to December 2020 were included in this study. They were randomly divided into a single group (a simple bronchial blocker) and a combined group (a bronchial blocker combined with a laryngeal mask airway), with 30 patients in each group. Awakening (time to extubation, spontaneous respiration and eye opening), respiratory function [peripheral oxygen saturation, vital capacity, maximum voluntary ventilation measured before and 3 days after surgery], hemodynamics [heart rate and mean arterial pressure were recorded before (T 1) and immediately after placement of a bronchial blocker or a laryngeal mask (T 2) and at the time of removal of a bronchial block or a laryngeal mask (T 3)], and adverse events (hoarseness, throat pain, dysphagia and choking) were recorded. Results:Time to extubation, time to spontaneous respiration, and time to eye opening in the combined group were (5.62 ± 1.23) minutes, (6.85 ± 1.34) minutes, and (7.34 ± 1.52) minutes, respectively, which were significantly shorter than (8.62 ± 1.55) minutes, (10.25 ± 1.78) minutes, (11.38 ± 1.85) minutes in the single group ( t = 9.94, 10.00, 11.06, all P < 0.05). At 3 days after surgery, peripheral oxygen saturation, vital capacity, and maximum voluntary ventilation in the combined group were (98.23 ± 1.05)%, (2.18 ± 0.60) L, (54.23 ± 5.36) L, respectively, which were significantly higher than (96.23 ± 1.01)%, (1.82 ± 0.50) L, (48.12 ± 4.23) L in the single group ( t = 7.51, 2.52, 4.90, all P < 0.05). Mean arterial pressure measured at T 3 was significantly lower in the combined group than that in the single group [(98.25 ± 2.32) mmHg vs. (93.35 ± 2.48) mmHg, t = 7.90, P < 0.05]. The incidences of hoarseness, throat pain and choking in the combined group were 6.66% (2/30), 10.00% (3/30), 6.66% (2/30), respectively , which were significantly lower than 33.33% (10/30), 43.33% (13/30), 43.33% (13/30) in the single group (χ 2 = 6.66, 8.52, 10.75, all P < 0.05). There was no significant difference in the incidence of dysphagia between the two groups ( P > 0.05). Conclusion:Use of a laryngeal mask airway combined with a bronchial blocker during thoracoscopic surgery in older adult patients facilitates postoperative recovery, has little impact on hemodynamics, and is highly safe.

Effects of the second generation laryngeal mask airway under general anesthesia on maternal and neonatal outcomes in cesarean delivery / 中华围产医学杂志

Objective:To evaluate the effects of the second generation laryngeal mask airway (LMA) under general anesthesia on maternal and neonatal outcomes in cesarean delivery.Methods:This study retrospectively enrolled 544 patients who underwent cesarean delivery under general anesthesia with airway intervention in Peking University First Hospital between January 2015 and December 2019. Patients were divided into endotracheal tube group (ETT group, n=379) and LMA group (Supreme TM LMA, n=165) according to the airway devices used under general anesthesia. Propensity score matching was carried out using a multivariable logistic regression model and 133 cases of singleton pregnancies were matched in each group. The main outcome was the incidence of neonatal asphyxia at one minute after birth (1 min Apgar score ≤7). The secondary neonatal outcomes were the incidence of severe asphyxia at one minute after birth (1 min Apgar score ≤3) and asphyxia at five minutes after birth (5 min Apgar score ≤7) and the percentage of neonates transferred to neonatal intensive care unit. The secondary maternal outcomes included the incidence of regurgitation, aspiration and hypoxemia, the percentage transferred to intensive care unit, post-operation all-cause morbidity and fatality before discharge. Two independent samples t-test, Mann-Whitney U test and Chi-square test were used for statistical analysis. Results:Two of the 544 (0.4%) patients had difficulty in intubation and one of them was successfully ventilated with LMA after failed intubation. No regurgitation, aspiration or anesthesia-related death was reported. After the propensity score matching, the incidence of neonatal asphyxia at one minute after birth in the LMA group and the ETT group had no significant difference [15.8% (21/133) vs 19.5% (26/133), χ2=0.646, P=0.422]. Moreover, there were no differences between the LMA and ETT group regarding the incidence of severe asphyxia at one minute after birth [2.3% (3/133) vs 3.0% (4/133), χ2<0.001, P>0.999] or asphyxia at five minutes after birth [4.5% (6/133) vs 4.5% (6/133), χ2<0.001, P>0.999], neonatal intensive care unit admission [27.8% (37/133) vs 38.3% (51/133), χ2=3.328, P=0.068], maternal hypoxemia during the operation [1.5% (2/133) vs 4.5% (6/133), χ2=1.160, P=0.281], maternal intensive care unit admission [3.8% (5/133) vs 9.0% (12/133), χ2=3.079, P=0.079] or post-operation all-cause morbidity [2.3% (3/133) vs 2.3% (3/133), χ2=0.171, P=0.680]. Conclusions:Like tracheal intubation, the second generation LMA (Supreme TM) can be used in cesarean section under general anesthesia without increasing the risk of adverse maternal and neonatal outcomes.

Effect of gender factor on potency of remimazolam inhibiting responses to laryngeal mask airway insertion / 中华麻醉学杂志

Objective:To evaluate the effect of gender factor on the potency of remimazolam inhibiting responses to laryngeal mask airway (LMA) insertion.Methods:Patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-60 yr, with body mass index of 18-28 kg/m 2, requiring LAM insertion, undergoing elective surgery, were divided into 2 groups according to the gender: male group (group M) and female group (group F). The dose of remimazolam was determined by using modified Dixon′s up-and-down method.Remimazolam 0.3 mg/kg was injected intravenously in the first patient.When the patients lost consciousness, bispectral index value ≤60 or modified Observer′s Assessment of Alertness/Sedation score <1, sufentanil 0.3 μg/kg and rocuronium 0.6 mg/kg were injected intravenously, and the LMA was inserted 3 min later.The positive response to LMA insertion was defined as swallowing, biting LMA, bucking, body movement during insertion, or an increase in the maximum mean arterial pressure or the maximum heart rate >20% of the baseline value with 2 min after insertion.When the response to LMA insertion was positive or modified Observer′s Assessment of Alertness/Sedation score >1 after injection of remimazolam, the dose of remimazolam was increased in the next patient, otherwise the dose was decreased, and the difference between the two successive doses was 0.03 mg/kg.This process was repeated until the 7th turning point occurred.The median effective dose (ED 50) and 95% confidence interval (CI) of remimazolam inhibiting responses to LMA insertion were calculated by Probit. Results:A total of 29 cases in group F and 22 cases in group M completed the study.The ED 50 (95% CI) of remimazolam was 0.146 (0.106-0.175) mg/kg in group F. The ED 50 (95% CI) of remimazolam was 0.203 (0.131-0.237) mg/kg in group M. The ED 50 of remazolam was significantly higher in group M than in group F ( P<0.05). Conclusion:The potency of remimazolam inhibiting responses to LMA insertion is more effective in female patients than in male patients.

Effect of acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway implantation / 中华麻醉学杂志

Objective:To investigate the effect of acute hypervolemic hemodilution (AHH) with 6% hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway (LMA) implantation.Methods:American Society of Anesthesiology physical status Ⅰ or Ⅱ patients, aged 30-60 yr, with body mass index of 18.5-25.0 kg/m 2, undergoing elective extensive total hysterectomy under general anesthesia, were divided into 2 groups: AHH group (group A) and control group (group C). In group A, 6% hydroxyethyl starch 130/0.4 was infused at a rate of 20 ml/min for AHH, and the target hematocrit was 30%.In group C, lactated Ringer′s solution was infused according to the " 4-2-1" rule to supplement physiological requirements, and anesthesia induction was performed after 10 min of stabilization.Sufentanil was administered by target-controlled infusion using Bovil pharmacokinetic model with effect-site concentration (Ce) of 0.25 ng/ml, 3 min later propofol was given by target-controlled infusion using Schnider model.The Ce of propofol in the first patient was set at 5.0 μg/ml.Each time the concentration of propofol was increased/decreased by 0.5 μg/ml according to the sequential method.LMA was inserted following 1 min equilibration between plasma concentration and Ce of propofol.The trial was terminated when 8 consecutive inflection points of failed/successful LMA insertion occurred.The EC 5, EC 50, EC 95 and 95% confidence interval (95% CI) of propofol were calculated by probit regression analysis. Results:In group A, the EC 5 (95% CI), EC 50 (95% CI) and EC 95 (95% CI) of propofol when LMA was successfully placed were 4.237 (3.090-4.514) μg/ml, 4.802 (4.500-5.078) μg/ml and 5.443 (5.125-7.304) μg/ml, respectively.In group C, the EC 5 (95% CI), EC 50 (95% CI) and EC 95 (95% CI) of propofol when LMA was successfully placed were 2.408 (1.190-2.756) μg/ml, 3.120 (2.690-3.472) μg/ml and 4.042 (3.582-7.431) μg/ml, respectively.There was significant difference in EC 5, EC 50 and EC 95 between the two groups ( P<0.01). Conclusion:AHH with 6% hydroxyethyl starch 130/0.4 can decrease the efficacy of propofol when LMA is successfully implanted.

Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies / Tubo orotraqueal versus dispositivos supraglóticos en desastres biológicos, químicos y radiológicos: metaanálisis en estudios de maniquíes

ABSTRACT Objective: To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Methods: Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Results: Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir's subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Conclusion: Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

RESUMEN Objetivo: Comparar el tiempo medio de intubación orotraqueal e inserción de dispositivos de vía aérea supraglótica, considerando profesionales de la salud con overol impermeable, guantes, botas, protección ocular y mascarilla en el contexto químico, biológico, radiológico y nuclear en un escenario de simulación. Métodos: Se realizaron búsquedas en seis bases de datos. Los estudios seleccionados se pusieron en un conjunto de resultados mediante un metaanálisis de efectos aleatorios con diferencias de medias estandarizadas y cálculo de intervalos de confianza del 95%. Resultados: Se incluyeron nueve estudios observacionales. Con respecto a la reducción del tiempo para proporcionar soporte ventilatorio, se realizaron análisis de subgrupos. El subgrupo del entorno de emergencia: -12,97 [-16,11; -9,83]; I2 = 64%. El subgrupo del entorno quirúrgico: -14,96 [-18,65; -11,27]; I2 = 75%. Otro análisis fue realizado por subgrupos de la metodología reproductiva. Subgrupo Ophir: -15,70 [-17,04; -14,37]; I2 = 0%. En todos los metaanálisis, se utilizó el tubo orotraqueal como comparador. Conclusión: Nivel de evidencia moderado a favor de la inserción de dispositivos supraglóticos debido a la aplicación más rápida.

Comparación de máscaras laríngeas (I-gel Fastrach) para realización de intubación endotraqueal guiada con broncofibroscopio flexible / Comparison of I-gel Fastrach laryngeal masks in conducting flexible bronchofiberscope-guided

GOALS: Determine the success rate of guided intubation with a flexible bronchofibroscope (BFC) through supraglottic devices: I-gel or Fastrach, establish the degree of fibroscopic visualization and determine the insertion time of the laryngeal mask airway (LMA) and endotracheal intubation. METHODS: Experimental, prospective, comparative and randomized study of 60 ASA I-II-III patients, older than 18 years, undergoing elective surgeries that required general anesthesia and endotracheal intubation. After anesthetic induction, the assigned LMA was placed and intubation with BFC was performed through it. Both the success of laryngeal mask insertion and intubation were recorded, as well as the time (in seconds) equired for these procedures. The vision of the laryngeal structures was classified according to the Brimacombe Scale. RESULTS: The groups analyzed presented similar general characteristics. Insertion time of he LMA was significantly lower with I-gel than Fastrach (median 12 s vs 16 s. Respectively, p = 0.001). Also, in the intubation time BFC guided through the laryngeal mask, differences in favor of I-gel were found, with a median of 72 s. vs 89 s. (p = 0.001). Regarding the degree of glottic visualization with BFC, no statistically significant differences were found between both groups.CONCLUSIONS: Although both devices had the highest success rate (both in their placement and in intubation through them), with I-gel the intubation was performed quicker.

OBJETIVOS: Determinar la tasa de éxito de intubación guiada con broncofibroscopio flexible (BFC) a través de los dispositivos supraglóticos: I-gel o Fastrach, establecer el grado de visualización fibroscópica y determinar el tiempo de inserción de la máscara laríngea y de intubación endotraqueal. MATERIALES Y MÉTODOS: Estudio experimental, prospectivo, comparativo y aleatorizado de 60 pacientes ASA I- II ­III, mayores de 18 años, sometidos a cirugías electivas que requerían anestesia general e intubación endotraqueal. Luego de la inducción anestésica, se procedió a colocar la máscara laríngea asignada y se realizó la intubación con BFC a través de la misma. Tanto el éxito de inserción de máscara laríngea como de intubación fueron registrados, así como el tiempo (en segundos) requerido para dichos procedimientos. La visión de las estructuras laríngeas fue clasificada de acuerdo a Escala de Brimacombe. RESULTADOS: Los grupos analizados presentaron características generales similares. El tiempo de inserción de la ML fue significativamente menor con I-gel que con Fastrach (medianas: 12 s. vs 16 s. respectivamente, p = 0,001). También en el tiempo de intubación guiada con BFC a través de la máscara laríngea, se encontraron diferencias en favor de I-gel, con una mediana de 72 s. vs 89 s. (p = 0,001). Respecto al grado de visualización glótica con BFC, no se encontraron diferencias estadísticamente significativas entre ambos grupos. CONCLUSIONES: Aunque ambos dispositivos tuvieron la máxima tasa de éxito (tanto en su colocación como en la intubación a través de ellos), con I-gel se realizó la intubación de manera más rápida.

Complicaciones del uso de la Máscara Laríngea en Pacientes Pediátricos. Estudio Multicéntrico / Complications of the use laryngeal mask in Pediatric Patients. Multicenter Study

Introducción: La máscara laríngea es el equipamiento con el objetivo de aumentar la calidad, seguridad, cuidado, sin embargo, a pesar de tener uso universal y alta eficacia para la ventilación no está exenta de complicaciones. El objetivo de la presente Investigación fue identificar la frecuencia de complicaciones con el uso de mascara laríngea en los hospitales públicos Vicente Corral Moscoso y José Carrasco en la ciudad de Cuenca. Métodos: Es un estudio observacional, descriptivo, prospectivo, en 220 pacientes pediátricos, ASA I , II y III intervenidos en cirugías electivas y emergentes bajo anestesia general en un intervalo de tiempo de 30 a 240 minutos, de todas las especialidades médicas quirúrgicas del año 2018 ,se utilizaron los diferentes tipos de máscara. La muestra se obtuvo aplicando la fórmula para población desconocida (n = (Z2 x p x q)/ e2), nivel de confianza (Z): 95%. (1.96) Margen de error (e): 5% Probabilidad de ocurrencia del evento (p): 15% Probabilidad de no ocurrencia del evento (q): 85%. Resultados: 220 casos ingresados al estudio. El índice de complicaciones laríngeas es 5.9% , frecuentemente la tos y secreción sanguinolenta, asociándose factores como mascara clásica, edad (2-5 años), tiempo mayor de 60 minutos, mayor número de intentos, ASA> I, estado nutricional sobrepeso, e insertar en formación. Conclusión: La máscara laríngea es validada como dispositivo en anestesia pediátrica por aprendizaje rápido, baja tasa de fracaso, menores complicaciones y utilidad en vías aéreas difíciles, Es insuficiente la evidencia para respaldar el uso de un determinado dispositivo por encima de otro

Introduction: The laryngeal mask is the equipment with the aim of increasing quality, safety, care, however, despite having universal use and high efficacy for ventilation, it is not without complications. The objective of this research was to identify the frequency of complications with the use of a laryngeal mask in the Vicente Corral Moscoso and José Carrasco public hospitals in the city of Cuenca. Methods: It is an observational, descriptive, prospective study in 220 pediatric patients, ASA I, II and III who underwent elective and emergent surgeries under general anesthesia in a time interval of 30 to 240 minutes, of all surgical medical specialties of the year 2018, the different types of mask were used. The sample was obtained by applying the formula for unknown population (n = (Z2 x p x q) / e2), confidence level (Z): 95%. (1.96) Margin of error (e): 5% Probability of occurrence of the event (p): 15% Probability of non-occurrence of the event (q): 85%. Results: 220 cases entered the study. The rate of laryngeal complications is 5.9%, frequently cough and bloody discharge, associating factors such as classic mask, age (2-5 years), time greater than 60 minutes, greater number of attempts, ASA> I, nutritional status, overweight, and insert in formation. Conclusion: The laryngeal mask is validated as a device in pediatric anesthesia due to rapid learning, low failure rate, fewer complications and usefulness in difficult airways. The evidence is insufficient to support the use of a certain device over another.

Comparison of two supraglottic airway devices on postoperative sore throat in children: a prospective randomized controlled trial / Comparação entre dois dispositivos supraglóticos de vias aéreas na dor de garganta pós-operatória em crianças: estudo controlado prospectivo randomizado

Abstract Background and objective: Sore throat is well recognized complaint after receiving general anesthesia. This study is conducted to compare the severity and frequency of postoperative sore throat in children undergoing elective surgery, following the use of Ambu laryngeal mask airway or I-gel®, who are able to self-report postoperative sore throat. Method: Seventy children, 6 to 16 years-old, undergoing elective surgery randomly allocated to either Ambu laryngeal mask (Ambu Group) or I-gel® (I-gel Group). After the procedure, patients were interviewed in the recovery room immediately, after one hour, 6 and 24 hours postoperatively by an independent observer blinded to the device used intra-operatively. Results: On arrival in the recovery room 17.1% (n = 6) of children of the Ambu Group complained of postoperative sore throat, against 5.7% in I-gel Group (n = 2). After one hour, the results were similar. After 6 hours, postoperative sore throat was found in 8.6% (n = 3) of the children in Ambu group vs. 2.9% (n = 1) in I-gel Group. After 24 hours, 2.9% (n = 1) of the children in Ambu Group complained of postoperative sore throat compared to none in I-gel Group. There was no significant difference found in the incidence of postoperative sore throat in both devices on arrival (p = 0.28); after 1 hour (p = 0.28); after 6 hours (p = 0.30); and after 24 hours (p = 0.31). The duration of the insertion of Ambu laryngeal mask was shorter and it was easier to insert than I-gel® (p = 0.029). Oropharyngeal seal pressure of I-gel® was higher than that of Ambu laryngeal mask (p = 0.001). Conclusion: The severity and frequency of postoperative sore throat in children is not statistically significant in the I-gel Group compared to Ambu Group.

Resumo Justificativa e objetivo: Dor de garganta é uma queixa bem conhecida após anestesia geral. O presente estudo comparou a gravidade e a frequência da queixa de dor de garganta pós-operatória associada ao uso de máscara laríngea Ambu ou máscara laríngea I-gel® durante cirurgia eletiva, em crianças capazes de autoreferir a queixa no pós-operatória. Método: Setenta crianças, de 6 a 16 anos submetidas à cirurgia eletiva foram alocadas aleatoriamente para o emprego da máscara laríngea Ambu (Grupo Ambu) ou para o emprego da máscara laríngea I-gel® (Grupo I-gel). Após o procedimento, os pacientes foram entrevistados imediatamente após admissão na sala de recuperação pós-anestésica-SRPA, uma hora, 6 e 24 horas após a cirurgia por um observador independente e cego ao dispositivo de vias aéreas utilizado no intraoperatório. Resultados: Na admissão à SRPA, 17,1% das crianças no Grupo Ambu (n = 6) se queixaram de dor de garganta pós-operatória, contra 5,7% no Grupo I-gel (n = 2). Após uma hora, os resultados foram similares. Após 6 horas, houve dor de garganta pós-operatória em 8,6% (n = 3) das crianças no Grupo Ambu vs. 2,9% (n = 1) no Grupo I-gel. Após 24 horas, 2,9% (n = 1) das crianças no Grupo Ambu versus nenhuma criança no Grupo I-gel. Não houve diferença significante na incidência de dor de garganta pós-operatória nos dois dispositivos na admissão na SRPA (p = 0,28); após 1 hora (p = 0,28); após 6 horas (p = 0,30); e após 24 horas (p = 0,31). A duração da inserção foi menor no grupo da máscara laríngea Ambu, e a I-gel® foi mais fácil de inserir (p = 0,029). A pressão de selagem orofaríngea do I-gel® foi maior do que a da máscara laríngea Ambu (p = 0,001). Conclusão: A gravidade e a frequência da dor de garganta pós-operatória em crianças não foram estatisticamente significantes no grupo com máscara laríngea I-gel® em comparação ao grupo com máscara laríngea Ambu.

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.

Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies / Revisão sistemática e metanálise comparando técnicas de suporte ventilatório em emergências químicas, biológicas e radiológicas / Comparación de técnicas de soporte ventilatorio en situaciones de emergencia química, biológica y radiológica: revisión sistemática y meta-análisis

Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the "reduction of the time of the procedures" outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The "laryngeal mask as a guide for orotracheal intubation" subgroup showed moderate heterogeneity (I2= 74%). The "2ndgeneration supraglottic devices" subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the "success in the first attempt" outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).

Objetivo: comparar o tempo médio do desenvolvimento das técnicas de laringoscopia direta e de inserção de dispositivos supraglóticos e avaliar a taxa de sucesso na primeira tentativa dessas técnicas, considerando a utilização de equipamentos de proteção individual específicos (macacão impermeável; luvas; botas; proteção ocular; máscara) pelos profissionais de saúde. Método: metanálise com estudos das bases LILACS, MEDLINE, CINAHL, Cochrane, Scopus e Web of Science. As palavras-chave foram: personal protective equipment; airway management; intubation; laryngeal masks. Resultados: no desfecho redução "do tempo dos procedimentos" a análise geral dos dispositivos supraglóticos em comparação com o tubo orotraqueal apresentou inicialmente alta heterogeneidade dos dados (I2 = 97%). A análise por subgrupos impactou na redução da heterogeneidade entre os dados. O subgrupo "máscara laríngea como guia para intubação orotraqueal" demonstrou heterogeneidade moderada (I2 = 74%). O subgrupo "dispositivos supraglóticos de 2ª geração" evidenciou homogeneidade (I2 = 0%). Todas as metanálises foram favoráveis aos dispositivos supraglóticos. No desfecho "êxito na primeira tentativa" foi encontrada homogeneidade moderada (I2 = 52%), demonstrando maior proporção de acerto para dispositivos supraglóticos. Conclusão: no contexto do desastre químico, biológico ou radiológico, a inserção do dispositivo supraglótico revelou ser mais rápida e apresentar maior chance de acerto por profissionais de saúde. Registro PROSPERO (CRD42019136139).

Objetivo: comparar el tiempo medio de desarrollo de las técnicas de laringoscopia directa y de inserción de dispositivos supraglóticos y evaluar la tasa de éxito obtenida en el primer intento de dichas técnicas con profesionales sanitarios provistos de equipos de protección individual específicos (mono impermeable, guantes, botas, protección ocular, mascarilla). Método: meta-análisis con estudio de las bases de datos LILACS, MEDLINE, CINAHL, Cochrane, Scopus y Web of Science. Las palabras clave fueron las siguientes: personal protective equipment; airway management; intubation; laryngeal masks. Resultados: en el resultado "reducción del tiempo de los procedimientos", el análisis general de los dispositivos supraglóticos en comparación con el tubo orotraqueal presentó, inicialmente, una alta heterogeneidad de los datos (I2= 97%). El análisis por subgrupos dio como resultado una reducción de la heterogeneidad entre los datos. El subgrupo "mascarilla laríngea como guía para la intubación orotraqueal" mostró una heterogeneidad moderada (I2= 74%). El subgrupo "dispositivos supraglóticos de 2ª generación" mostró homogeneidad (I2= 0%). Todos los meta-análisis fueron favorables a los dispositivos supraglóticos. En el resultado "éxito en el primer intento" se halló una homogeneidad moderada (I2= 52%), obteniendo una mayor proporción de aciertos con el uso de dispositivos supraglóticos. Conclusión: en el contexto de un desastre químico, biológico o radiológico, se ha demostrado que la inserción del dispositivo supraglótico es más rápida y que los profesionales sanitarios obtienen una mayor probabilidad de acierto. Registro PROSPERO (CRD42019136139).

Efectividad de la máscara laríngea Ambu® Aura40TM para anestesia general en cirugía ortopédica pediátrica / Effectiveness of Ambu® Aura40TM laryngeal mask for general anesthetic in pediatric orthopedic surgery

RESUMEN Introducción: las máscaras laríngeas son dispositivos supraglóticos utilizadas ampliamente en anestesia para el abordaje y mantenimiento de la vía respiratoria. Una de ellas, la Ambu® Aura 40TM, tiene un diseño que le permite ajustarse al entorno de la hipofaringe con su lumen dirigido a la apertura laríngea. Ha demostrado ser adecuada para procedimientos quirúrgicos donde no es necesaria la intubación endotraqueal. Objetivo: determinar la efectividad dicha máscara laríngea para anestesia general en cirugía ortopédica pediátrica. Materiales y métodos: se realizó un estudio descriptivo, prospectivo, transversal, en 135 pacientes intervenidos quirúrgicamente de forma electiva en el Hospital Pediátrico Eliseo Noel Caamaño, de Matanzas, en el periodo enero de 2015- junio 2017. Se tuvo en cuenta el número de intentos y el tiempo para insertar la máscara laríngea, la necesidad de reemplazarla por un tubo endotraqueal y las complicaciones relacionadas con su uso. Resultados: la ML Ambu® Aura 40TM fue efectiva en la mayoría de los pacientes ya que permitió realizar la cirugía sin necesidad de sustituirla por el tubo endotraqueal y la aparición de complicaciones relacionada con su uso fue baja. Conclusiones: la ML Ambu® Aura 40TM fue efectiva ya que en la mayoría de los pacientes fue insertada correctamente en el primer intento y un tiempo inferior a los 20 segundos. Solo una minoría necesitó que fuera reemplazada por el tubo endotraqueal, y la aparición de complicaciones relacionada con su uso fue baja (AU).

ABSTRACT Introduction: laryngeal mask are supra glottal devices widely used in anesthetics for approaching and maintaining the airway. One of them, the Ambu® Aura 40TM, has a design allowing to adjust to the surroundings of hypo-pharynx with its lumen directed to the pharyngeal opening. It has demonstrated to be adequate for surgical procedures when there is no need of endotracheal intubation. Objective: to determine the effectiveness of that laryngeal mask for general anesthetic in pediatric orthopedic surgery. Materials and methods: a cross-sectional, prospective, descriptive study was carried out in 135 patients who underwent elective surgical intervention in the Pediatric Hospital ?Eliseo Noel Caamaño?, of Matanzas, in the period January 2015- June 2017. The number of attempts and the time needed to insert laryngeal mask, the necessity of changing it for an endotracheal tube, and complications related to its usage were taking into account. Results: Ambu® Aura 40TM laryngeal mask was effective in most patients, due to it allowed to perform the surgery without need of changing it for an endotracheal tube, and the low appearance of complications related to its use. Conclusions: Ambu® Aura 40TM laryngeal mask was effective because it was inserted correctly at the first attempt, in a time less than 20 seconds. Only a minority needed to replace it by endotracheal tube, and the appearance of complications related to its use were low (AU).

Máscara laríngea vs tubo orotraqueal no atendimento pré-hospitalar - desfechos hospitalares / Laringeal mask vs orotraqueal tube in pre-hospital care - hospital outcomes

INTRODUÇÃO: Em situações emergenciais, se torna crucial o manejo adequado das vias aéreas, pois falhas neste processo contribuem consideravelmente para piores desfechos clínicos. OBJETIVO: comparar a utilização do tubo endotraqueal e da máscara laríngea no atendimento pré- -hospitalar em relação aos desfechos hospitalares tais como tempo de ventilação mecânica, tempo de permanência na UTI e taxa de óbito. MATERIAIS E MÉTODOS: estudo observacional retrospectivo, desenvolvido no Hospital Santa Cruz, Rio Grande do Sul. Foram incluídos pacientes maiores de 18 anos, de ambos os sexos, que foram atendidos pelo SAMU durante o atendimento pré-hospitalar, e após o encaminhados para o Pronto Atendimento ou Ambulatório do Hospital Santa Cruz. As variáveis analisadas foram extraídas dos prontuários médicos dos indivíduos selecionados. RESULTADOS: foram analisados 27 indivíduos, maioria do sexo masculino, com média de idade de 46,5±22 anos, sendo a causa predominante do atendimento pré-hospitalar o politraumatismo. Ao compararmos os pacientes que utilizaram tubo endotraqueal com os que utilizaram máscara laríngea, não foram observadas diferenças significativas em relação ao tempo de atendimento pré-hospitalar. Na fase intra-hospitalar, observamos diferença significativa em relação ao tempo de ventilação mecânica e tempode internação na UTI, não sendo o mesmo observado em relação a taxa de óbito. CONCLUSÃO: Os pacientes submetidos a utilização da máscara laríngea no atendimento pré-hospitalar apresentaram menor tempo de ventilação mecânica e menor tempo de internação na UTI, em relação aos pacientes intubados com tubo endotraqueal.

INTRODUCTION: In emergency situations, proper management of the airways becomes crucial, because flaws in this process contribute considerably to worse clinical outcomes. OBJECTIVE: To compare the use of the endotracheal tube and laryngeal mask in prehospital care in relation to hospital outcomes such as mechanical ventilation time, length of stay in the ICU and death rate. MATERIALS AND METHODS: a retrospective observational study, developed in a Hospital Santa Cruz, Rio Grande do Sul. Patient records were used from the Emergency Mobile Service (SAMU) of Santa Cruz do Sul, sent to the Emergency Department or Ambulatory of Santa Cruz Hospital. RESULTS: 27 individuals, mostly males, with an average age of 46.5 ± 22 years, were analyzed, being the predominant cause of pre-hospital care the polytrauma. When comparing the patients who used the endotracheal tube with those who used laryngeal mask, no significant differences were observed in relation to the time of prehospital care. In the in-hospital phase, we observed a significant difference in relation to the time of mechanical ventilation and length of stay in the ICU, and the same was not observed in relation to the death rate. CONCLUSION: The patients submitted to the use of the laryngeal mask in the pre-hospital care presented a shorter time of mechanical ventilation and a shorter time of hospitalization in the ICU than the patients intubated with an endotracheal tube.

Máscara laríngea, alternativa en la oxigenación apneica durante simpatectomía torácica. Presentación de un caso / Laryngeal mask, alternative in the oxygenation apneica during simpatectomía thoracic. Case Presentation

RESUMEN Se presenta el caso de una paciente femenina de 15 años, la que acude a consulta en el Hospital Pediátrico de Cienfuegos, la cual refirió que desde la niñez presenta diaforesis (sudoración profusa) en cuerpo y muy notorio en manos y axilas, que le impide el adecuado desenvolvimiento en público y la imposibilita para escribir en papel sin que este se humedezca. Se le diagnosticó hiperhidrosis y se decidió realizar cirugía video-laparoscópica para simpatectomía torácica. Proceder que se realiza por cirugía mínimamente invasiva y requiere de anestesia general endotraqueal como regularidad en la mayoría de los casos, en este caso se utilizó anestesia general; para permeabilizar la vía aérea se usó la máscara laríngea y oxigenación apneica, con lo que se logró estabilidad hemodinámica. La paciente no presentó complicaciones y se logró la solución definitiva de la hiperhidrosis.

ABSTRACT The case of a 15 year-year-old female patient is presented, attended at the Children's Hospital of Cienfuegos, who reported that since childhood has diaphoresis (profuse sweating) on her body and very noticeable hands and armpits, which prevents proper perfomance in public and the inability to write on paper without it getting wet. He was diagnosed with hyperhidrosis and it was decided to perform video-laparoscopic surgery for thoracic sympathectomy. General anesthesia was used; a laryngeal mask and apneic oxygenation were used to permeabilize the airway, with which hemodynamic stability was achieved. The patient did not present complications and a definitive solution of hyperhidrosis was achieved.

A Comparative Study of Airway Management and Hemodynamic Response During Insertion of I-Gel Airway, Laryngeal Mask Airway, Cuffed Endo-Tracheal Tube

Securing a safe airway is essential for oxygenation and ventilation in management of critical patients in all specialities and during conduction of anaesthesia. Endotracheal tubes has been the mainstay for airway control. Hence need for various devices to secure airway was realized, leading to development of many supraglottic devices. Methods: This prospective, randomized study was conducted in a tertiary care teaching hospital. It included 90 American Society of Anesthesiologists (ASA) grade I-II patients, randomly allocated into 3 groups, undergoing elective surgical procedures under general anaesthesia. It was designed to compare cETT, cLMA and i-gel LMA. Primary outcome measure was number of insertion attempts. We also compared ease of insertion, insertion time, haemodynamic changes and incidences of airway trauma and complications. For statistical comparison pearson's chi-square test for nominal data, ANOVA test for comparison between multiple variables within the study and control groups and unpaired t-test to compare numerical variables were used. Results: The First attempt insertion success and ease of insertion for the three devices were comparable, with i-gel scoring the highest among all. Mean time of insertion was lowest for i-gel (16.83s±3.49s) followed by cLMA (25.23±5.46s) and cuffed ETT (27.6±4.3s), which was statistically significant. The basal vitals with respect to heart rate, systolic, diastolic and mean blood pressure were comparable in all the three groups. Conclusion: It may be concluded that use of i-gel airway offers more favourable hemodynamic stability as compared to endotracheal tube and cLMA and is associated with less postoperative complication.

Comparison of clinical performance of i-gelⓇ and Baska MaskⓇ during laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: The supraglottic airway device is an appropriate alternative to tracheal intubation in laparoscopic surgery. We compared the Baska MaskⓇ with i-gelⓇ by measuring the oropharyngeal leak pressure (OLP) and hemodynamic and respiratory parameters during laparoscopic cholecystectomy.METHODS: A total of 97 patients were randomly allocated to either i-gel group (n = 49) or Baska Mask group (n = 48). Insertion time, number of insertion attempts, fiber-optic view of the glottis, and OLP were recorded. Heart rate, mean arterial pressure, peak airway pressure (PAP), lung compliance, and perioperative complications were assessed before, during, and after pneumoperitoneum.RESULTS: There were no significant differences between the two groups regarding demographic data, insertion time, fiber-optic view of the glottis, and the use of airway manipulation. The OLP was higher in the Baska Mask group than in the i-gel group (29.6 ± 6.8 cmH₂O and 26.7 ± 4.5 cmH₂O, respectively; P = 0.014). Heart rate, mean arterial pressure, PAP, and lung compliance were not significantly different between the groups. The incidence of perioperative complications was small and not statistically significant.CONCLUSIONS: Both the i-gel and Baska Mask provided a satisfactory airway during laparoscopic cholecystectomy. Compared with the i-gel, the Baska Mask demonstrated a higher OLP.

Effect of facemask ventilation with different pressures on perioperative complications in patients un-dergoing gynecological laparoscopic surgery / 中华麻醉学杂志

Objective To evaluate the effect of facemask ventilation with different pressures on perioperative complications in the patients undergoing gynecological laparoscopic surgery. Methods Seven-ty-five American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-60 yr, with body mass index of 18-24 kg∕m2 , scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 3 groups ( n=25 each) using a random number table method: 10 cmH2 O group ( group P10) , 15 cmH2 O group ( group P15) and 20 cmH2 O group ( group P20) . The pres-sure for facemask ventilation was 10, 15 and 20 cmH2 O during induction of anesthesia in group P10, group P15 and group P20, respectively. Before facemask ventilation ( T0 ) and at 180 s of facemask ventilation ( T1 ) , longitudinal and anteroposterior diameters of the antral area in the supine position were measured u-sing ultrasonography, the antral cross-sectional area was calculated, and the development of serious flatu-lence was recorded. The development of hypoxemia, tidal volume and end-tidal pressure of carbon dioxide in each group were recorded at T1 . The operation time and occurrence of postoperative flatulence and nausea and vomiting were recorded. Results Compared with group P10, the incidence of serious flatulence and postoperative flatulence and nausea and vomiting was significantly increased, and the incidence of hypox-emia was decreased in group P15 and group P20, and tidal volume was increased at T1 in group P20 ( P<0. 05) . Compared with group P15, the incidence of serious flatulence was significantly increased ( P<0. 05) , and no significant change was found in the incidence of hypoxemia and postoperative flatulence and nausea and vomiting in group P20 ( P>0. 05) . There was no significant difference in the end-tidal pressure of carbon dioxide at T1 or antral cross-sectional area at T0 and T1 among the three groups ( P>0. 05) . Con-clusion Pressure of 10-15 cmH2 O for facemask ventilation is optimal during induction of general anesthe-sia and can ensure adequate oxygen supply and reduce perioperative complications in the patients undergoing gynecological laparoscopic surgery.

Revisión bibliográfica sobre síndrome de Treacher Collins / Treacher Collins síndrome: A review

INTRODUCTION: Treacher Collins syndrome is a rare disorder of the craniofacial development that constitutes a challenge for anesthesiologists, since it represents a difficult airway in the majority of cases. The main objective of this article is to provide a bibliographic review about how the airway management of patients with Treacher Collins syndrome has been managed. MATERIALS AND METHODS: A literature review was carried out in the following databases: PubMed, EMBASE and ScienceDirect. DISCUSSION: The factors that increase the risk of difficult airway in these patients are presented as well as the strategies to handle it. CONCLUSION: The Treacher Collins syndrome presents a high risk of difficult airway, therefore careful planning of airway management is mandatory and there are different strategies to handle it.

INTRODUCCIÓN: El síndrome de Treacher Collins (STC) es un trastorno inusual del desarrollo craneofacial que constituye un reto para el anestesiólogo, ya que éste condiciona la condición de vía aérea difícil en la mayoría de los casos. El objetivo principal de este artículo es realizar una revisión bibliográfica de cómo se han manejado casos de vía aérea difícil ligados al síndrome de Treacher Collins. MATERIALES Y MÉTODOS: Se realizó una revisión de la literatura disponible en las siguientes bases de datos: PubMed, EMBASE y ScienceDirect. DISCUSIÓN: Se presentan los factores que aumentan el riesgo de vía aérea difícil en estos pacientes, así como las estrategias para manejarla. CONCLUSIÓN: El síndrome de Treacher Collins presenta un alto riesgo de vía aérea difícil, por lo tanto, es obligatoria la planificación cuidadosa de la misma, contando con diferentes estrategias para manejarla.