Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.
r e v c o l o m b a n e s t e s i o l . 2 0 1 4;4 2(4):295301
www.revcolanest.com.co
Revisin
Historia del artculo: Existe un volumen importante de literatura dedicada al tema del manejo de la va area
Recibido el 2 de julio de 2013 difcil, y se han desarrollado una serie de algoritmos y recomendaciones para el manejo
Aceptado el 28 de mayo de 2014 seguro de pacientes en riesgo de una intubacin difcil. Sin embargo, solo recientemente se
On-line el 23 de julio de 2014 ha despertado una mayor conciencia acerca de la extubacin de la va area difcil, pues
aun cuando sea un procedimiento programado, suele estar plagado de complicaciones. La
Palabras clave: importancia de desarrollar estrategias pre-programadas para la extubacin de la va area
Manejo de la va area difcil a fin de aumentar la seguridad del paciente y sus desenlaces se hace evidente a
Extubacin traqueal partir de los datos del ASA Closed Claims Analysis y del reciente Cuarto Proyecto Nacional
Periodo perioperatorio de Auditora del Reino Unido sobre complicaciones mayores en el manejo de la va area.
Intubacin intraraqueal La clave para un manejo exitoso de los pacientes en riesgo de extubacin difcil es efectuar
Anestesia una evaluacin precisa de riesgo, aplicar estrategias apropiadas y la preparacin tanto del
mdico como de la institucin.
2013 Publicado por Elsevier Espaa, S.L.U. en nombre de Sociedad Colombiana de
Anestesiologa y Reanimacin.
a b s t r a c t
Keywords: A considerable amount of literature has been dedicated to the topic of difficult airway
Airway management management and a number of algorithms and recommendations have been established
Airway extubation to safely manage patients at risk for difficult intubation. Only recently, however, has extu-
Perioperative period bation of the difficult airway gained more awareness since this procedure, although elective,
Intubation, intratracheal is often fraught with complications. The importance of developing pre-planned strategies
Anesthesia for extubation of the difficult airway to improve patient safety and outcomes is appa-
rent from data from both the ASA Closed Claims Analysis and the UKs recent Fourth
Autor para correspondencia. Joseph C. Gabel Profesor y Decano, Departamento de Anestesiologa, Facultad de Medicina de la Universidad
de Texas en Houston, 6431 Fannin, MSB 5.020, Houston, Texas 77030-1501.
Correos electrnicos: Carin.A.Hagberg@uth.tmc.edu, Carin.Hagberg@gmail.com (C.A. Hagberg).
http://dx.doi.org/10.1016/j.rca.2014.05.005
0120-3347/ 2013 Publicado por Elsevier Espaa, S.L.U. en nombre de Sociedad Colombiana de Anestesiologa y Reanimacin.
Documento descargado de http://www.revcolanest.com.co el 22/12/2015. Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.
National Audit Project of major complications of airway management. The key to successful
management of patients at risk for difficult extubation is accurate risk assessment, appli-
cation of appropriate strategies, and preparedness by both the individual practitioner and
the institution.
2013 Published by Elsevier Espaa, S.L.U. on behalf of Sociedad Colombiana de
Anestesiologa y Reanimacin.
Tabla 1 Factores de riesgo de la va area segn las Tabla 2 Condiciones mdicas asociadas a un mayor
Guas de la Sociedad para la Va Area Difcil, para el riesgo de extubacin fallida
Manejo de la Extubacin de la Trquea Obesidad y apnea obstructiva del sueno
Dificultades preexistentes de la va area Trastornos de hipoventilacin
Dificultad para la ventilacin con mscara al momento de la Sndrome de hipoventilacin por obesidad
induccin EPOC
Dificultad para la intubacin de la trquea al momento de la Enfermedades neuromusculares
induccin Patologa de cabeza y cuello
Historia del manejo de la va area difcil Neoplasia de cabeza/cuello
Obesidad/apnea obstructiva del sueno Historia de radiacin de cabeza/cuello
Mayor riesgo de aspiracin del contenido gstrico
Embarazo
Deterioro perioperatorio de la va area Artritis reumatoide
Factores quirrgicos (distorsin anatmica, hemorragia, Movilidad reducida del cuello
hematoma, edema) Desviacin de la laringe
Factores no quirrgicos (edema dependiente debido a la Artritis de la articulacin cricoaritenoidea
posicin, a trauma de la va area por manejo previo de esta, Ndulos reumatoides larngeos
manejo agresivo de fluidos) Niveles de conciencia deprimidos
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