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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INTUBACION RETROGRADA – VIA AEREA DIFICIL ECARRILLO
Submental intubation versus tracheostomy. Reinforced endotracheal tube fixed to skin. The patient had suffered trauma to the midface. The appropriate reinforced endotracheal tube size was passed which connector was previously removed through with the inubacion wire as guidance, when the distal end of the endotracheal tube meets the resistance at the level of the cricothyroid membrane against the wirethe wire was cut at the retrgorada site and the endotracheal tube passed, the remaining wire removed through the tube.
Many trials have shown the submental route to be a simple, quick and safe approach to airway management Caubi et al.
Further clinical examination did not reveal any other traumatic injury. Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig.
Then using Seldinger technique the malleable wire Spring-Wire Guide: The endotracheal tube was secured and adequate end tidal carbon dioxide curve was observed. In choosing a potential modification, the surgeon should inform the anesthesiologist of their intended sequence. At the end of the surgery the tube was disconnected, pulled back into the oral cavity and reconnected.
intubacion retrograda tecnica pdf
In conclusion, submental intubation is a safe and effective technique itubacion establishing a secure airway in patients requiring facial reconstructive surgery where traditional oral and nasotracheal intubation are contraindicated.
The connector and breathing system were reattached and the cuff reinflated.
In addition, the surgical anatomy of the technique is detailed described. It was decided to use retrograde intubation technique in the present case due to the restricted mouth opening, and the difficulty to maintain a clear airway with the submandibular incision intubaciln or other invasive manipulation. After preoxygenation and intravenous induction of anesthesia, submental region and anterior neck is disinfected and draped as usual sterile fashion.
The endotracheal tubes now lies on the floor of the mouth between the tongue and the mandible. Each technique has its indications with advantages and disadvantages.
In comparing submental intubation and tracheostomy, submental intubation has no significant reported major complications Jundt et al. Extraorally the wound was sutured and the patient was extubated without complications. 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.
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. Technical Note and Case Report. Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening.
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. Guide wire red dotted line passed through larynx to oral cavity; B. Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the success of the procedure. In addition, the surgical anatomy of the technique is described in detail. Since the first application of this technique, less than thirty years ago, many authors have studied the clinical use of this procedure.
Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by Arya et al.
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 breathing circuit is briefly disconnected as the tube is externalized and reconnected to the circuit and then secured to the patient Fig.
In such cases a tracheostomy is the indicated procedure. Mandible border blue lineskin incision yellow linecenter region of geniohyoid and genioglossus muscles red area ; B. Endotracheal tube in position fixed to skin. There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al.
The submental route for endo-tracheal intubation. Submental intubation combines the advantages of nasotracheal intubation, which allows the mobilization of the dental occlusion, and those of orotracheal intubation, which allows access to naso-orbito-ethmoidal fractures Caubi et al.
The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. Pasaje Republica de Honduras interior In addition to fewer reported minor complications infection, fistula, hypertrophic scarring, mucocelesubmental intubation requires less time than a tracheostomy, costs less and results in an aesthetically well tolerated scar 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.
University of Puerto Rico. Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology. 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.
Examination of the face revealed periorbital and nasal swelling, traumatic telecanthus, nasal deformity, epistaxis and bilateral subconjuntival hemorrhage. The open reduction and internal fixation of the facial fractures could then be performed as planned and the occlusion checked with intermaxillary fixation. Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy.