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Objective@#To compare the effect of gum elastic bougie and laryngoscope on the stress response to endotracheal intubation in critically ill patients.@*Methods@#A total of 110 cases patients admitted to intensive care unit who needed intubaton from January 2015 to December 2017 were randomly divided into 2 groups: gum elastic bougie group (gum elastic bougie was used for intubation) and Macintosh laryngoscope group(laryngoscope intubation was performed) with 55 patients in each group. The mean arterial blood (MAP) and heart rate (HR) were recorded before intubation(T0), 1 min after intubation (T1), 3 min after intubation(T2) and 5 min after intubation(T3). The concentration of norepinephrine(NE) and epinephrine(E) in the vein were measured at T0 and T2.@*Results@#The levels of MAP, HR, NE and E were increased in both groups after intubation (P<0.05). At T1, T2 and T3, the levels of MAP in gum elastic bougie group [(101.5 ± 6.4), (92.1 ± 3.3), (84.4 ± 7.7) mmHg, 1 mmHg=0.133 kPa] were significantly lower than those in Macintosh laryngoscope groupgroup [(116.2 ± 17.8), (110.4 ± 9.7), (97.5 ± 6.4) mmHg](P<0.05). The level of HR in gum elastic bougie group at T1 [(95.4 ± 7.9) times/min] was significantly reduced than that in Macintosh laryngoscope group [(112.7 ± 12.6) times/min](P<0.05). After intubation, the concentration of NE and E in gum elastic bougie group [(161.28 ± 10.45), (105.04 ± 7.31) ng/L] were reduced than those in Macintosh laryngoscope group [(189.32 ± 11.56), (128.61 ± 3.68) ng/L], there were significant differences between two groups (P<0.05).@*Conclusions@#Compared with normal laryngoscope, gum elastic bougie guided intubation is of great significance in terms of better hemodynamics and less stress response.
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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.