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Huffman Prism

Fiber Optic Howland Lock

Laryngoscope Blade –
Blechman
McCoy

Light Intensity Meter


A Clinical Comparison of the Flexiblade™ and
Macintosh Laryngoscopes for Laryngeal Exposure in
Anesthetized Adults
Rochelle W. Cheun, Anesth Analg 2006;102:626–30

The Flexiblade™, after lever activation, is signi-


ficantly better than the Macintosh laryngoscope
for laryngeal visualization in paralyzed adults

Laryngoscopy using the McCoy laryngoscope after


application of a cervical collar
GABBOTT, D. A. Vol 51(9) Sep 1996
Dep. of Anaesthesia, Gloucestershire Royal NHS Trust, Gloucester

The McCoy laryngoscope significantly improves


identification of glottic structures in patients
wearing a rigid, cervical neck collar.
Permiten la visualización directa

de la vía aérea desde la laringe hasta los

bronquios de segunda y tercera generación

 Laringoscopios Flexibles

 Laringoscopios Rígidos

 Fibrolaringoscopios de distintos calibres


HISTORIA:
1 HOPKINS H. DESARROLLO DEL FIBROSCOPIO
FLEXIBLE
3 MURPHY P. REPORTO LA PRIMERA INTUBACIÓN
UTILIZANDO EL FIBROBRONCOSCOPIO
5 TAYLOR P.A. DESCRIBIO LA METODOLOGÍA DEL
USO DEL FIBROBRONCOSCOPIO EN
ANESTESIA
6 OVASSAPIAN ESCRIBIÓ MONOGRAFÍA SOBRE FIBRO–
LARINGOBRONCOSCOPIO EN EL
MANEJO DE LA VÍA AÉREA
9 ROBERTS J. INICIO DE TALLERES EN LA REUNIÓN
ANUAL DE LA A.S.A.
INDICACIONES
 Intubación de rutina
 Intubación en vía aérea difícil
 Intubación en vía aérea traumatizada y quemada
 Intubación en pacientes con estomago lleno
 Intubación en pacientes con lesiones cervicales
 Intubación en pacientes con patología traqueal
 Colocación de tubos para ventilación de un solo
pulmón
 Diagnóstico y manejo de broncoaspiración
LARINGOSCOPIOS RIGIDOS DE FIBRA ÓPTICA

Laringoscopios rígidos ópticos


Permiten verificar posición antes de retirar laringoscopio

Tienen forma de la curva anatómica de la vía aérea

 Evitan la necesidad de mover la cabeza/cuello

 Permiten succionar y administrar 02

 Visualización del paso del tubo E - T


Laringoscopios rígidos ópticos
Indicaciones:

 Patología de tejidos blandos de cavidad oral y oro-faringe

 Apertura oral limitada

 Incisivos de gran tamaño

 Patología columna cervical

 Revisión de laringe

 Intubación despierto con estomago lleno

 Intubación en pacientes con fácil desaturación


Laringoscopios rígidos ópticos

Contraindicaciones:

 Deformidad exagerada del cuello en flexión

 No apertura oral

Complicaciones:
 Dolor de garganta

 Ruptura dental

 Daño en mucosa
UPSHERSCOPE
TrachView Intubating
Videoscope
VETT TM
A clinical assessment of the Glidescope videolaryngoscope
in nasotracheal intubation with general anesthesia

Journal of Clinical
Anesthesia
Vol 18, Issue 8, Dec 2006

Conclusions
The GSVL is an effective device for nasotracheal intubation and
may be incorporated easily into routine clinical practice.
Compared with the Macintosh laryngoscope, the GSVL can
provide an improved laryngeal view in the patient with difficult
airway.
WUSCOPE

BULLARD
UPSHERSCOPE
VIDEO LARINGOSCOPIOS
SEMI-RÍGIDOS
Shikani Optical Stylet

Bonfils Retromolar
Intubation Fiberscope

Levitan
Equipment for airway
management
Kathryn Jackson, Tim Cook

ANAESTHESIA AND INTENSIVE CARE MEDICINE 7:10

Rigid fibreoptic laryngoscopes:

Some devices are designed to be inserted within the TT (Shikani


stylet, Bonfils), others are bladed devices (Wuscope, Bullard,
Upsherscope, Glidescope, McGrath 5, Airtraq) and these provide
a better facility for manipulating the soft tissues. The c-Trach, an
ILMA with built in fibreoptic camera and digital screen fulfils a
similar role.
AI RTRAQ
Tracheal intubation by inexperienced medical residents using
the Airtraq and Macintosh laryngoscopes
Chrisen H. Maharaj MB

Am J of Emergency Med
2006) 24, 769–774

In all scenarios tested, the Airtraq decreased the duration of intubation


attempts, reduced the number of optimization maneuvers required, and reduced
the potential for dental trauma. The residents found the Airtraq easier to use in
all scenarios compared with the Macintosh laryngoscope. The Airtraq may
constitute a superior device for use by personnel infrequently required to
perform tracheal intubation.
A comparison of tracheal intubation using the Airtraq or
the Macintosh laryngoscope in routine airway
management: A randomised, controlled clinical trial

Maharaj CH - Anaesthesia - 01-NOV-2006; 61(11): 1093-9

Dep. of Anaesthesia, Un. College Hospital, Galway, Ireland.

Abstract:
The Airtraq laryngoscope is a novel single use tracheal intubation device. We
compared the Airtraq with the Macintosh laryngoscope.

All but one patient, in the Macintosh group, was successfully intubated on the
first attempt. There was no difference between groups in the duration of
intubation attempts.

In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest


improvements in the intubation difficulty score, and in ease of use. Tracheal
intubation with the Airtraq resulted in less alterations in heart rate.

These findings demonstrate the utility of the Airtraq laryngoscope for tracheal
intubation in low risk patients.
Tracheal Intubation Using the Airtraq in Morbid Obese
Patients Undergoing Emergency Cesarean Delivery
Gilles Dhonneur, M.D., Ph.D.
Anesthesiology 2007; 106:629–30

We decided that after 2 min of failed tracheal intubation using direct


laryngoscopy, rescue AT tracheal intubation should be attempted. After 6
months, this algorithm has been applied by the obstetric anesthesia team; 69
parturient underwent emergency cesarean delivery during general anesthesia,
and 2 required the AT.

We are now considering placing the AT as a


primary airway management device in the case
of emergency cesarean delivery in women
showing predictive difficult airway factors at
labor or operating room clinical evaluation.
Journal of Clinical Anesthesia (2007) 19, 485-488
Adrian A. Matioc MD
The Airtraq to facilitate endotracheal tube exchange
in a critically ill, difficult-to-intubate patient

A comparison of tracheal intubation using the Airtraq or the


Macintosh laryngoscope in routine airway management: A
randomised, controlled clinical trial

Maharaj CH - Anaesthesia - 01-NOV-2006; 61(11)

Dep. of Anaesthesia, Un. College Hospital, Galway, Ireland.

Abstract:
In comparison to the Macintosh laryngoscope, the Airtraq
resulted in modest improvements in the intubation
difficulty score, and in ease of use. Tracheal intubation
with the Airtraq resulted in less alterations in heart rate.
Laryngoscopy vs. Optical Stylet vs. Optical
Laryngoscope (Airtraq) for Extubation Evaluation
Thomas C. Mort, M.D.
Anesthesiology, Hartford Hospital, Connecticut
Anesthesiology 2006; 105: A823

The Airtraq, a disposable optical scope, with its specially designed lenses
and mirrors, offered a wide angle (panoramic) view of the periglottic
structure regardless of the extent of swelling or edema or any limitation of a
restricted “line of sight”.

VISTA DE LA GLOTIS

The Airtraq performed extremely well


compared to standard laryngoscopy
and an optical stylet.
Clinical comparisons between GlideScope®
video laryngoscope and Trachlight® in
simulated cervical spine instability
Journal of Clinical Anesthesia
Vol 19, Issue 2 (March 2007)

Conclusions.-
Trachlight® offers a faster intubation and a
milder hemodynamic response compared
than with GS in patients with MILS.
Nonetheless, both devices are comparable
in success rate of tracheal intubation and
airway complications.
 Todo anestesiólogo debe estar entrenado en su uso
 Todo quirófano debería contar con estos instrumentos
 Las residencias deben tener programas de entrenamiento
 Deben organizarse programas de capacitación a aneste-

siológos formados
 Se deben establecer los requisitos para certificar la compe-

tencia en su empleo
Airway Management in
Trauma:
An Update
John McGill, MD
Emerg Med Clin N Am 25 Aug (2007) 603–622
Tracheal intubation by inexperienced medical residents using
the Airtraq and Macintosh laryngoscopes
Chrisen H. Maharaj MB

American Journal of Emergency


Medicine
2006) 24, 769–774

1. The Airtraq decreased the duration of intubation attempts, reduced the


number of optimization maneuvers required, and reduced the potential for
dental trauma.
2. The residents found the Airtraq easier to use in all scenarios compared with
the Macintosh laryngoscope.
3. The Airtraq may constitute a superior device for use by personnel
infrequently required to perform tracheal intubation.
Journal of Clinical Anesthesia (2006) 18, 357–362

Comparison of direct and video-assisted views


of the larynx during routine intubation
Marshal B. Kaplan MD, Carin A. Hagberg MD, Denham S. Ward MD, PhD, Ansgar Brambrink MD, Ashwani
K. Chhibber MD, Thomas Heidegger MD, Leonardo Lozada MD, Andranik Ovassapian M, David Parsons
MDh, James Ramsay MD, Wolfram Wilhelm MD, Bernhard Zwissler MD, Haus J. Gerig MD, Christian
Hofstetter MD, Suzanne Karan MD, Nevin Kreisler MD, Robert M. Pousman M, Andreas Thierbach MD,
Marc Wrobel MD, George Berci MD

Conclusions
Video- assisted laryngoscopy provides an improved view of the larynx, as
compared with direct visualization. This technique may be useful for cases of
difficult intubation and reintubation as well as for teaching laryngoscopy and
intubation.

Aunque este estudio demuestra la mejoría de la visión


de las estructuras glóticas con el video laringoscopio,
no provee evidencia de una disminución en la
incidencia de intubaciones fallidas.
La vida nunca esta libre de riesgos: solo nos
toca decidir cual riesgo es aceptable y cual no.

La 3ra. Ley de Arthur C. Clarke:


Cualquier tecnología suficientemente avanzada es indistinguible
de la magia
Corolario:
 Cualquier tecnología distinguible de la magia, no esta
suficientemente avanzada.
 Cualquier tecnología, no importa cuan primitiva sea, es magia
para quienes no lo entienden.
 A mayor empleo de técnicas anestésicas con no intubación, la
experiencia de los Anestesiologos, en ella, irá disminuyendo.
 El éxito de un procedimiento depende de una buena técnica y
una práctica regular, a pesar de la excelencia del instrumento
empleado.
 En ciertas circunstancias cuentan más las habilidades que los
instrumentos.