Letter to the Director
Difficult airway management and neuromuscular blockade
Tratamiento de la vía aérea difícil y bloqueo neuromuscular
M.Á. Gómez-Ríos
Departmento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña; Hospital HM Modelo, A Coruña, Spain
Read
3
Timeswas read the article
2
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2341192918301306" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.011" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "929" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:477-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935618300938" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.04.002" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "929" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:477-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 299 "formatos" => array:2 [ "HTML" => 161 "PDF" => 138 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Tratamiento de la vía aérea difícil y bloqueo neuromuscular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "477" "paginaFinal" => "478" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Difficult airway management and neuromuscular blockade" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.Á. Gómez-Ríos" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M.Á." "apellidos" => "Gómez-Ríos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918301306" "doi" => "10.1016/j.redare.2018.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301306?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300938?idApp=UINPBA00004N" "url" => "/00349356/0000006500000008/v2_201812070619/S0034935618300938/v2_201812070619/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918301318" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.08.004" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "931" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:478-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 13 "formatos" => array:2 [ "HTML" => 7 "PDF" => 6 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "BRILMA and PEC blocks: Simpler and more adequate options in radical breast surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "478" "paginaFinal" => "479" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueos BRILMA y PEC: opciones más sencillas y adecuadas en cirugía radical de mama" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 721 "Ancho" => 2000 "Tamanyo" => 123414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Approach and ultrasound image of the BRILMA blockade.C4, 4th rib; AML, mid-axillary line; pl, pleura; sc, subcutaneous cellular tissue; serr, serratus muscle.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.T. Fernández Martín, S. López Álvarez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M.T." "apellidos" => "Fernández Martín" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "López Álvarez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618300951" "doi" => "10.1016/j.redar.2018.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300951?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301318?idApp=UINPBA00004N" "url" => "/23411929/0000006500000008/v1_201810100615/S2341192918301318/v1_201810100615/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918301203" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.07.001" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "925" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:473-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Density spectral array of BIS VISTA™ monitoring system in a functional hemispherectomy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "473" "paginaFinal" => "476" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monitorización con espectrograma del sistema de monitorización BIS VISTA™ en una hemisferectomía funcional" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1755 "Ancho" => 3176 "Tamanyo" => 568826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Color spectrogram during functional hemispherectomy. Part A: an image before frontal disconnection showing an increase in low frequency band (0.1–4<span class="elsevierStyleHsp" style=""></span>Hz) and alpha band (8–12<span class="elsevierStyleHsp" style=""></span>Hz) power in the right hemisphere, where the focus of epilepsy was. Part B: there is a marked decrease in power in the low frequency and alpha bands on the right side after frontal connection.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Luis, E. Vilà, L. Moltó, A. Pardo, J.L. Fernández Candila, S. Pacreu" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Luis" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Vilà" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Moltó" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Pardo" ] 4 => array:2 [ "nombre" => "J.L." "apellidos" => "Fernández Candila" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Pacreu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618300744" "doi" => "10.1016/j.redar.2018.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300744?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301203?idApp=UINPBA00004N" "url" => "/23411929/0000006500000008/v1_201810100615/S2341192918301203/v1_201810100615/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Difficult airway management and neuromuscular blockade" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "477" "paginaFinal" => "478" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M.Á. Gómez-Ríos" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M.Á." "apellidos" => "Gómez-Ríos" "email" => array:1 [ 0 => "magoris@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departmento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña; Hospital HM Modelo, A Coruña, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la vía aérea difícil y bloqueo neuromuscular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the letter submitted by Pérez Fernández-Escandon et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> in which they present a descriptive study to evaluate the influence of neuromuscular blockade (NMB) on difficult airway management. We would like to add a series of comments that might be of interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">NMB overrides the muscle tone of the upper airway and inhibits oropharyngeal reflexes. In doing so, it reduces the incidence of phenomena such as laryngospasm, optimises chest wall distensibility, and reduces the number of intubation attempts and complications by improving the conditions for intubation, and for this reason it is widely used in airway management. However, there is no unanimous consensus regarding its use in a potentially difficult airway, and its role in the progression to “cannot intubate, cannot oxygenate” (CICO) status. Therefore, we need to consider the evidence currently available. A recent systematic review evaluated the effect of using NMB vs. not using NMB on intubation conditions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Avoiding NMB can increase the risk of difficult intubation (RR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>P13.27, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.00001), difficult laryngoscopy (RR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.54; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0003), and upper airway discomfort or injury (RR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.37; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> For this reason, NMB is now becoming standard practice to facilitate face mask ventilation, intubation, or extraglottic device placement in unanticipated difficult airway,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> and is mandatory if front of neck access (FONA) is needed in a CICO situation.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> In this context, rocuronium is a rapid-onset relaxant that can be immediately reversed with sugammadex. The latter, in a CICO situation, is only useful when NMB is contributing or causing the airway obstruction, which is infrequent. It is important to bear in mind sugammadex does not reverse the effect of the other anaesthetic drugs used nor the mechanical obstruction of the airway. It can also cause laryngospasm, and if CICO persists it will be necessary to re-paralyse the patient with a non-aminosteroid NMB before progressing to emergency FONA.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In general terms, the current recommendation is that NMB should only be avoided in the presence of an anticipated difficult airway, where the technique of choice is awake intubation with awake patient, and when neuromuscular relaxants are contraindicated.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> In any event, it must be borne in mind that all recommendations must be personalised; in other words, each case must be judged individually based on the specific characteristics of each patient.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Ríos M. Tratamiento de la vía aérea difícil y bloqueo neuromuscular. Rev Esp Anestesiol Reanimac. 2018;65:477–478.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuromuscular blockade in the management of the difficult airway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Pérez Fernández-Escandon" 1 => "A.I. Fernández Díez" 2 => "R. Pérez Blanco" 3 => "N. Guadalupe Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2017.07.010" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2018" "volumen" => "65" "paginaInicial" => "176" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28947268" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.H. Lundstrom" 1 => "C.H. Duez" 2 => "A.K. Norskov" 3 => "C.V. Rosenstock" 4 => "J.L. Thomsen" 5 => "A.M. Moller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD009237.pub2" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2017" "volumen" => "5" "paginaInicial" => "Cd009237" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28513831" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Frerk" 1 => "V.S. Mitchell" 2 => "A.F. McNarry" 3 => "C. Mendonca" 4 => "R. Bhagrath" 5 => "A. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aev371" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2015" "volumen" => "115" "paginaInicial" => "827" "paginaFinal" => "848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26556848" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of tracheal intubation in critically ill adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Higgs" 1 => "B.A. McGrath" 2 => "C. Goddard" 3 => "J. Rangasami" 4 => "G. Suntharalingam" 5 => "R. Gale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bja.2017.10.021" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2018" "volumen" => "120" "paginaInicial" => "323" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29406182" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategies for the prevention of airway complications - a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.M. Cook" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.14123" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2018" "volumen" => "73" "paginaInicial" => "93" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29210033" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheal intubation without the use of neuromuscular blocking agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.W. Woods" 1 => "S. Allam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aei006" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2005" "volumen" => "94" "paginaInicial" => "150" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15516354" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines and algorithms for managing the difficult airway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Gómez-Ríos" 1 => "L. Gaitini" 2 => "I. Matter" 3 => "M. Somri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2017.07.009" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2018" "volumen" => "65" "paginaInicial" => "41" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29031661" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000008/v1_201810100615/S2341192918301306/v1_201810100615/en/main.assets" "Apartado" => array:4 [ "identificador" => "70434" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000008/v1_201810100615/S2341192918301306/v1_201810100615/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301306?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2019 June | 1 | 2 | 3 |
