Request PDF on ResearchGate | On Jan 1, , Teresa López Correa and others published Intubación retrógrada. Acceso quirúrgico a la vía aérea. May 18, ·. INTUBACIÓN RETROGRADA. Views. 8 Likes15 Shares · Share. English (US) · Español · Português (Brasil) · Français (France) · Deutsch. intubacion retrograda tecnica pdf. Quote. Postby Just» Tue Aug 28, am. Looking for intubacion retrograda tecnica pdf. Will be grateful for any help!.
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In such cases a tracheostomy is the indicated procedure. In addition, the surgical anatomy of the technique is detailed described.
The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity Arya et al. On initial evaluation the patient was in non-acute distress, alert, awake and oriented, with a Glascow coma score of Submental intubation versus tracheostomy.
The main objective of this study is to describe a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening.
In conclusion, submental intubation is a safe and effective technique for establishing a secure airway in patients requiring facial reconstructive surgery where traditional oral and retrogrxda intubation are contraindicated.
intubacion retrograda tecnica pdf
The management retrogdada a difficult airway is one of the biggest challenges of perioperative anesthesia management. Several airway management techniques intubaciom been described, including: Additional research is necessary to validate new modifications reported in the literature.
The open reduction and internal fixation of the facial fractures could then be performed as planned and the occlusion checked with intermaxillary fixation. Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the retrograada of the procedure. Afterwards the pilot balloon was grasped with the hemostat and pulled out gently through the passage, then the hemostat was reinserted through the passage to grasp the proximal end of the endotracheal tube to be brought out with controlled rotational movements.
Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy. After preoxygenation and intravenous induction of anesthesia, submental region detrograda anterior neck is disinfected and draped as usual sterile fashion. Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig.
A skin incision of 2 cm in the submental, paramedian region and with blunt dissection toward the floor of mouth until the mucosa was tented with a hemostat after which another 2 cm incision is made in the mucosa Fig. In addition, the surgical anatomy of the technique is described in detail. The connector and breathing system were retrofrada and the cuff reinflated.
Then using Seldinger technique the malleable wire Spring-Wire Guide: The appropriate reinforced endotracheal tube size was passed which connector was previously removed through with the malleable wire as guidance, when the distal end of the endotracheal tube meets the resistance at the intubacionn of the cricothyroid membrane against the wirethe wire was cut at the puncture site and the endotracheal tube passed, the remaining wire removed through the tube. In our case where the patient only presented midface isolated trauma with need of intraoperative intermaxillary fixation, submental intubation was the correct choice for intraoperative airway.
At the end of the surgery the tube was disconnected, pulled back into the oral cavity and reconnected.
INTUBACION RETROGRADA – VIA AEREA DIFICIL ECARRILLO
The endotracheal tubes now lies on the floor of the mouth between the tongue and the mandible. The submental route for endo-tracheal intubation.
Reinforced endotracheal tube fixed to skin. The anesthesiologist reassures the adequate end tidal carbon dioxide curve and auscultation of the chest for correct position of the tube. A closed Kelly hemostatic forceps was introduced through the incision until the tip of the hemostat tented the mucosa of the floor retrograds the mouth staying close to the lingual surface of mandible and lateral to the sublingual caruncle to avoid injury to the submandibular duct and lingual nerve.
In choosing a potential modification, the surgeon should inform the anesthesiologist of their intended sequence. Extraorally the wound was sutured and the patient was extubated without complications. The patient had suffered trauma to the midface. We described a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening.
The breathing circuit is briefly disconnected as the tube is externalized and reconnected to the circuit and then secured to the patient Fig. The tented oral mucosa retrgrada incised to make a small opening and the blades of the hemostat were opened to allow the entrance of the reinforced endotraqueal tube. Mandible border blue lineskin incision yellow linecenter region of geniohyoid and genioglossus muscles red area ; B.
Intubación retrograda modificada
However, adequate mouth opening is a prerequisite for the technique. Radiologic examination confirmed the presence of Le Fort II ihtubacion, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture.
This technique was first described in by Francisco Hernandez Altemir and since its first description 10 articles have been published outlining modifications to the original technique primarily aimed at reducing complications Altemir, ; Jundt et al. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity. San Juan, Puerto Rico.
There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al. Throat pack was placed.
The original surgical procedure consists in the externalization of the endotracheal tube from the mouth through the floor of the mouth and the submental triangle.