The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are ...defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine.
Cilj ovog osvrta je usporediti stare konvencionalne tehnike i uređaje za obradu poteškoća u disanju i nove sofisticirane tehnike i uređaje. Dosadašnje tehnike i uređaje propisala je ASA (Američko ...udruženje anesteziologa) kao praktične smjernice u obradi poteškoća u disanju, iste su objavljene 1992., revidirane 1993. i ažurirane 2003. godine. Prema ASA tehnike za obradu poteškoća u disanju podijeljene su na tehnike za poteškoće pri intubaciji i poteškoće pri ventilaciji. Budna fiberoptička intubacija kao tehnika izbora u obradi poteškoća u disanju propisana je dokumentom Svjetske zdravstvene organizacije o sigurnosti bolesnika u operacijskoj dvorani. Konvencionalne tehnike intubacije koriste direktnu vizualizaciju. Nova generacija uređaja ne zahtijeva direktnu vizualizaciju glasnih žica pri postavljanju endotrahealnog tubusa. Oni omogućavaju bolju vizualizaciju i uspješnu endotrahealnu intubaciju putem indirektne laringoskopije. Novi uređaji za intubaciju, kao video laringoskop, olakšavaju endotrahealnu intubaciju indirektnom vizualizacijom struktura grla bez premještanja oralne, faringealne i laringealne osi bolesnika s abnormalnostima vratne kralježnice. Video laringoskopi kao V-Mac i C-Mac, Glide skop, McGrath, Airway skop, Aertracq, Bonfils i Bullard lako su dostupni na tržištu. Naprave za disanje su svjetleće sonde i endotrahealni vodiči (ili vodiči endotrahealnog tubusa). Zaključak ovog osvrta je da se primjena ovih uređaja može lako naučiti. Tehnika indirektne laringoskopije već se koristi u obradi poteškoća u disanju, kao i u svakodnevnoj anesteziološkoj praksi.
OZLJEDE DIŠNOG PUTA KOD TRAUME DIŠNOG PUTA SHIRGOSKA, BILJANA; NETKOVSKI, JANE; KIKERKOV, IGOR
Acta medica Croatica,
11/2018, Volume:
72, Issue:
Suplement 1
Journal Article
Open access
Bolesnici s ozljedama gornjeg dišnog puta moraju biti tretirani kao bolesnici s teškim dišnim putem, u predbolničkom i bolničkom okruženju. Upravljanje dišnim putem uključeno je u predbolničku skrb i ...naprednu skrb. Cilj ovog rada je prikazati klinička opažanja koja se odnose na liječenje dišnog puta u bolesnika s ozljedama gornjeg dišnog puta, uključujući klinički pristup traumatiziranim gornjim dišnim putovima, poteškoće u uspostavljanju dišnog puta kod takvih pacijenata, defi niranje neuspjelog dišnog puta, algoritam za neuspjeli dišni put, predviđanje i odlučivanje. Klinički pristup gornjem dišnom putu je prvi korak koji kliničari obično rade. Traumatizirani dišni put zahtijeva istu procjenu predviđanja teškoća pri tretmanu, koji koristimo i za procjenu netraumatiziranog dišnog puta. Teškoće u uspostavljanju dišnog puta kod bolesnika s traumom su: poteškoće u laringoskopiji i intubaciji, otežana ventilacija pomoću maske i poteškoće u upotrebi supraglotičkih uređaja. Kod pacijenata s ozbiljno traumatiziranim gornjim dišnim putem neophodna je jasna defi nicija zatajenja uspostavljanja dišnog puta, kao i akcijski plan koji će nakon toga slijediti. Prema smjernicama Diffi cult Airway Society za upravljanje neočekivanom teškom intubacijom kod odraslih, neuspješnom intubacijom se smatra nakon tri neuspjela pokušaja iskusnog anesteziologa ili nakon jednog neuspjelog pokušaja iskusnog anesteziologa u kombinaciji s nemogućnošću održavanja dovoljne zasićenosti kisikom. Ponovljeni pokušaji intubacije nose rizik od traumatizacije već traumatiziranog gornjeg dišnog puta. Vrijeme i sposobnost jasnog razmišljanja u ovoj situaciji ograničeni su pa se u tim situacijama treba koristiti DAS-ovim algoritmom. S druge strane, postoji puno propalih algoritama dišnog puta koje su propisala nacionalna stručna društva. Ono što je najvažnije u tim algoritmima i u svima isto, jest predviđanje i donošenje odluka. Odluke su vođene s obzirom na to ima li dovoljno vremena za razmatranje alternativa. Ako se u bilo koje vrijeme ne može intubirati i ne može dati kisik, nastaje scenarij CICO (ne može se intubirati, ne može se oksigenirati) i jedino rješenje je otvaranje prednjeg pristupa vratu (FONA). Odgovarajuće je pokušati brzo postaviti laringealnu masku (LMA) istovremeno s pripremanjem za FONA. Pokušaj postavljanja LMA ne smije odgoditi inicijaciju konačnog dišnog puta i mora se učiniti paralelno s pripremama za FONA. Razlozi za tešku FONA mogu biti unutarnje ili otvorene ozljede vrata. Teškoće vezane uz povredu u takvim situacijama su iskrivljeni ili poremećeni dišni put. Krikotireoidna membrana može biti dostupna ili ozlijeđena. U takvoj situaciji rješenje za uspostavu dišnog puta je traheotomija.
: The presence of a functional cochlear nerve is a key issue in the preoperative evaluation of pediatric candidates for cochlear implants. Correlations between cochlear nerve deficiency (CND) and ...bony abnormalities of the labyrinth or bony canal of the cochlear nerve are not yet well understood. The aim of this study was to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND.
: A total of 11 children with a confirmed diagnosis of prelingual, severe sensorineural hearing loss were included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane and images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. Two factors were reviewed retrospectively: the presence of inner ear anomalies and the relationship between BCNC stenosis and the existence of CND.
: From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). The BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR.
: Children with BCNC stenosis have a high incidence of CND. A narrowed BCNC on CT can be an indicator for the selection of children with sensorineural hearing loss who will need to be additionally referred for MRI in order to definitively assess the status of the cochlear nerve.
: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of ...SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample.
: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed.
: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample.
: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.
