Dos soluciones diferentes a la sección del tubo nasotraqueal durante la osteotomía maxilar / Two ways of managing a damaged nasotracheal tube during maxillary osteotomy

Durante las osteotomías que se realizan en la cirugía ortognática, el tubo traqueal corre el riesgo de ser cortado parcial o completamente. Los peligros potenciales ante esta complicación son el compromiso de la ventilación y oxigenación junto con el riesgo de broncoaspiración. Presentamos dos casos en los que, debido al tamaño de la sección del tubo, las características de los pacientes y las expectativas de ventilación postoperatoria requirieron de un manejo diferente. En el primer caso, la simple estabilización del tubo y sellado de la fuga con gasas humedecidas, bastó para asegurar una correcta protección de la vía aérea. En el segundo caso, ideamos un conector que se pudo adaptar a los dos fragmentos seccionados del tubo y, con una aceptable seguridad, permitió incluso la ventilación postoperatoria (AU)

[2 different solutions to a severed nasotracheal tube during maxillary osteotomy]. / Dos soluciones diferentes a la sección del tubo nasotraqueal durante la osteotomía maxilar.

During osteotomy in orthognathic surgery, the tracheal tube is in danger of being partially or completely cut, a complication that can lead to failure of ventilation/oxygenation or bronchial aspiration. We report two cases of tracheal tube damage in which we had to manage the airway differently in relation to the size of the cuts, patient characteristics and the expectation of postoperative ventilation requirements. In the first case, the airway was safeguarded by simply stabilizing the tube and sealing the leak with wet compresses. In the second case, we were able to attach a connector to the two sections of the damaged tube, a system that afforded sufficient safety and even allowed us to provide postoperative ventilation.

[Utility of COPA (cuffed oropharyngeal airway) in anesthesia for colonoscopies]. / Utilidad del COPA (cuffed oropharyngeal airway) en anestesia para colonoscopias.

OBJECTIVE: To assess the usefulness of the cuffed oropharyngeal airway (COPA), a new device for airway control, in 45 patients scheduled for colonoscopy. PATIENTS AND METHODS: The patients were anesthetized with propofol and the COPA was applied following the manufacturer's recommendations. Positive pressure ventilation was provided at first, and later the patients were allowed to breathe spontaneously. RESULTS: The mean dose of propofol needed to place the COPA correctly was 2.3 +/- 0.3 mg.kg-1. "Free hands" anesthesia was possible in 43 procedures (96%). Placement had to be attempted several times in five patients (11%) before adequate ventilation was achieved. Two patients (4%) had to be switched to a smaller or larger size COPA. In two others (4%), the technique was abandoned because of inadequate ventilation. No hemodynamic changes were observed after placement, although systolic blood pressure tended to increase slightly during colonoscopy, while heart rate decreased. Spontaneous ventilation was possible in all cases and respiratory frequency and end-tidal CO2 increased significantly during colonoscopy. No cases of laryngospasm or sore throat were observed, although 10 patients (22%) coughed upon emergence from anesthesia. CONCLUSIONS: The COPA is a new alternative to intubation or other methods for controlling the airway during short procedures, making "free hands" anesthesia possible in most cases. Provided contraindications are respected, the number and seriousness of complications seems to be minimal.

[Anesthesia techniques in epidermolysis bullosa]. / Técnicas anestésicas en la epidermólisis ampollosa.

Epidermolysis bullosa encompasses a group of rare clinical profiles marked by the formation of bullae on the skin and mucosa as the result of slight mechanical trauma. The anesthesiologist must take certain safety measures to monitor the airway and must expect difficult venous access in patients with this disease. We report our experience in providing anesthesia by various techniques for plastic and maxillofacial surgery. Most anesthetic techniques can be considered safe if they are performed with care and attention to detail.

[Inflation of the endotracheal tube cuff as an aid for blind nasotracheal intubation in patients with predicted difficult laryngoscopy]. / El inflado del neumotaponamiento como ayuda para la intubación nasotraqueal a ciegas en pacientes con predicción de laringoscopia difícil.

HYPOTHESIS AND OBJECTIVES: Inflation of the tracheal tube cuff to facilitate blind nasal intubation as described by Gobarck in 1987 has been shown to be effective for increasing the rate of successful intubation from 45 to 95% in patients with no airway alterations. We aimed to assess the usefulness of this technique in patients with anatomical alterations of the airway, in whom difficult intubation was predicted. PATIENTS AND METHODS: We enrolled 25 patients with airway alterations that made laryngoscopy likely to be difficult and who were scheduled for neoplastic maxillofacial surgery. RESULTS: Twelve patients (48%) were intubated on the first try, 5 (20%) on the second try and 6 (24%) on the third try. We were unable to intubate 2 patients (8%) after three tries, and therefore opted to intubate with a fiberoptic endoscope. CONCLUSIONS: Inflation of the tracheal tube cuff is useful for facilitating nasotracheal intubation in the awake patient.