Management of the Difficult Airway

Miller, Kelsey A.; Goldman, Marshall I.; Nagler, Joshua

doi:10.1097/pec.0000000000002916

Cited by 3 publications

(11 citation statements)

References 81 publications

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“…Degeneración de tejidos: con el envejecimiento, los tejidos de la vía aérea experimentan degeneración, incrementando la laxitud y el riesgo de obstrucción. La fragilidad de los tejidos demanda precaución durante los procedimientos, con un enfoque específico en la delicadeza y adaptabilidad (1,16). Mayor probabilidad de comorbilidades: los pacientes geriátricos suelen presentar comorbilidades, lo que puede afectar la gestión de la vía aérea.…”

Section: Pacientes Geriátricosunclassified

“…Mayor probabilidad de comorbilidades: los pacientes geriátricos suelen presentar comorbilidades, lo que puede afectar la gestión de la vía aérea. Una evaluación integral de la salud es esencial para un abordaje adecuado, considerando la complejidad de condiciones médicas concurrentes (1,16). Respuestas fisiológicas diferentes: las respuestas fisiológicas pueden variar en la población geriátrica.…”

Section: Pacientes Geriátricosunclassified

“…La gestión efectiva de la vía aérea representa uno de los pilares fundamentales en el ámbito de la atención médica, desempeñando un papel crítico en situaciones que van desde la rutina clínica hasta emergencias médicas graves. La vía aérea, como sistema anatómico y funcional, posibilita el intercambio vital de oxígeno y dióxido de carbono entre el ambiente y los pulmones, asegurando así un suministro adecuado de oxígeno al organismo y la eliminación eficiente de productos de desecho gaseosos (1). El abordaje de la vía aérea implica la implementación de diversas técnicas y estrategias diseñadas para garantizar un flujo de aire óptimo hacia y desde los pulmones.…”

Section: Introductionunclassified

“…Esta tarea adquiere una importancia aún mayor en situaciones donde la función respiratoria se ve comprometida, ya sea debido a patologías médicas, trauma o durante procedimientos quirúrgicos. La habilidad para asegurar una vía aérea permeable y mantener una adecuada oxigenación y ventilación se vuelve esencial para preservar la vida y prevenir complicaciones graves (1).…”

Section: Introductionunclassified

“…KEYWORDS: respiratory system; respiratory physiology; airway management; ventilation; endotracheal intubation; clinical decision-making. 1 Médica general, graduada de la Universidad Autónoma de Centroamérica (UACA). Código médico: MED17473.…”

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confidence: 99%

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Optimizando el abordaje de la vía aérea: estrategias y consideraciones actuales en medicina

Pérez Piedra,

Alvarado Quesada,

Enríquez Barrantes

2024

Rev.méd.sinerg.

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El abordaje de la vía aérea en el campo de la medicina constituye un componente esencial y complejo, el cual involucra la comprensión detallada de la anatomía y fisiología, además de aspectos éticos y legales. Desde la estructura intricada de las vías respiratorias hasta las funciones fisiológicas relacionadas con la respiración y oxigenación, este abordaje se fundamenta en una base anatómica y fisiológica sólida. La atención a la vía aérea no sigue un enfoque uniforme, sino que demanda adaptabilidad y especialización en diversas situaciones. La atención pediátrica, las peculiaridades en pacientes con obesidad, y las respuestas necesarias en situaciones de emergencia requieren estrategias específicas y un conocimiento especializado. En este contexto, la intersección entre ética y legalidad se vuelve destacada. El respeto a la autonomía del paciente, la obtención del consentimiento informado y la adhesión a estándares éticos y legales son pilares fundamentales que definen la integridad y responsabilidad del profesional de la salud.

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Section: Pacientes Geriátricosunclassified

Section: Introductionunclassified

mentioning

confidence: 99%

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Optimizando el abordaje de la vía aérea: estrategias y consideraciones actuales en medicina

Pérez Piedra,

Alvarado Quesada,

Enríquez Barrantes

2024

Rev.méd.sinerg.

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Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers

Pimentel,

Chung,

Ross

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims to understand risks to patient safety in the free-standing ASC setting, compared to HORs. METHODS: Free-standing ASC and HOR closed claims between 2015 and 2022 from The Doctors Company that involved an anesthesia provider responsible for the claim were included. We compared the coded data of 212 free-standing ASC claims with 268 HOR claims in terms of severity of injury, major injuries, allegations, comorbidities, contributing factors, and financial value of the claim. RESULTS: Free-standing ASC claims accounted for almost half of all anesthesia-related cases (44%, 212 of 480). Claims with high severity of injury were less frequent in free-standing ASCs (22%) compared to HORs (34%; P = .004). The most common types of injuries in both free-standing ASCs and HORs were dental injury (17% vs 17%) and nerve damage (14% vs 11%). No difference in frequency was noted for types of injuries between claims from free-standing ASCs versus HORs––except that burns appeared more frequently in free-standing ASC claims than in HORs (6% vs 2%; P = .015). Claims with alleged improper management of anesthesia occurred less frequently among free-standing ASC claims than HOR claims (17% vs 29%; P = .01), as well as positioning-related injury (3% vs 8%; P = .025). No difference was seen in frequency of claims regarding alleged improper performance of anesthesia procedures between free-standing ASCs and HORs (25% vs 19%; P = .072). Technical performance of procedures (ie, intubation and nerve block) was the most common contributing factor among free-standing ASC (74%) and HOR (74%) claims. Free-standing ASC claims also had a higher frequency of communication issues between provider and patient/family versus HOR claims (20% vs 10%; P = .004). Most claims were not associated with major comorbidities; however, cardiovascular disease was less prevalent in free-standing ASC claims versus HOR claims (3% vs 11%; P = .002). The mean ± standard deviation total of expenses and payments was lower among free-standing ASC claims ($167,000 ± $295,000) than HOR claims ($332,000 ± $775,000; P = .002). CONCLUSIONS: This analysis of medical malpractice claims may indicate higher-than-expected patient and procedural complexity in free-standing ASCs, presenting patient safety concerns and opportunities for improvement. Ambulatory anesthesia practices should consider improving safety culture and communication with families while ensuring that providers have up-to-date training and resources to safely perform routine anesthesia procedures.

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State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time

Sbaraglia,

Cuomo,

Della Sala

et al. 2024

JPM

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This review delves into the challenge of pediatric anesthesia, underscoring the necessity for tailored perioperative approaches due to children’s distinctive anatomical and physiological characteristics. Because of the vulnerability of pediatric patients to critical incidents during anesthesia, provider skills are of primary importance. Yet, almost equal importance must be granted to the adoption of a careful preanesthetic mindset toward patients and their families that recognizes the interwoven relationship between children and parents. In this paper, the preoperative evaluation process is thoroughly examined, from the first interaction with the child to the operating day. This evaluation process includes a detailed exploration of the medical history of the patient, physical examination, optimization of preoperative therapy, and adherence to updated fasting management guidelines. This process extends to considering pharmacological or drug-free premedication, focusing on the importance of preanesthesia re-evaluation. Structural resources play a critical role in pediatric anesthesia; components of this role include emphasizing the creation of child-friendly environments and ensuring appropriate support facilities. The results of this paper support the need for standardized protocols and guidelines and encourage the centralization of practices to enhance clinical efficacy.

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Management of the Difficult Airway

Cited by 3 publications

References 81 publications

Optimizando el abordaje de la vía aérea: estrategias y consideraciones actuales en medicina

Optimizando el abordaje de la vía aérea: estrategias y consideraciones actuales en medicina

Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers

State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time

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