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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Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening. 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 intubbacion out with controlled rotational movements.
Several airway management techniques have been described, including: 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. The endotracheal tube was secured and adequate end tidal carbon dioxide curve was intubacionn. The mortality rate of tracheostomy has been reported to range from 0.
intubacion retrograda tecnica pdf
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 nasotracheal intubation are contraindicated. Guide wire red dotted line passed through larynx to oral cavity; B. Submental intubation in oral maxillofacial surgery: Throat pack was placed. Guide wire insertion through cricothyroid membrane; B. Reinforced endotracheal tube fixed to skin.
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. Mandible border blue lineskin incision yellow linecenter region of geniohyoid and genioglossus muscles red area ; B.
Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the success of the procedure.
The Insertion of the wire guide through the cricothyroid membrane helps to place correctly the endotracheal tube and also counting with the assistance of the direct video laryngoscopy, where the complete mouth opening is not necessary.
Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy. 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 level 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.
At the end of the surgery the tube was disconnected, pulled back into the oral cavity and reconnected.
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. Since the first application of this technique, less than thirty retrograa ago, many authors have studied the clinical use of this procedure.
Intubación retrograda modificada
In a literature review conducted by Jundt et al. The breathing circuit is briefly disconnected as the tube is externalized and reconnected to inthbacion circuit and then secured to the patient Fig.
After preoxygenation and intravenous induction of anesthesia, submental region and anterior neck is disinfected and draped as usual sterile fashion. The original surgical procedure consists in the externalization of the endotracheal tube from the mouth through the floor of the mouth and the submental retrogada.
It was decided to use retrograde intubation technique in the present case due to the restricted mouth retrgrada, and the difficulty to maintain a clear airway with the submandibular incision bleeding or other invasive manipulation. Endotracheal tube in position fixed to skin. 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.
Technical Note and Case Report.
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In choosing a potential modification, the surgeon should inform the anesthesiologist of their intended sequence. Radiologic examination confirmed the presence of Le Fort II fracture, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture.
Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by Arya et al. Intracranial malposition of nasopharyngeal airway. There was midface mobility, malocclusion and mouth opening was restricted. Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology. The patient had suffered trauma to the midface.
The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma ineligibles for nasotracheal intubation.
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 intbuacion scar Jundt et al.
University of Puerto Rico. In such cases a tracheostomy is the indicated procedure. There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al. The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant retdograda of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma, ineligible for nasotracheal intubation due to the potential risk of creating a false passage to the cranial cavity Jundt et al.
Pasaje Republica de Honduras interior A skin incision of 2 cm in the submental, paramedian region and with blunt dissection toward the intubqcion of mouth until the mucosa was tented with a hemostat after which another 2 cm incision is made in the mucosa Fig.