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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The breathing circuit is briefly disconnected as the tube is externalized and reconnected to the circuit and then secured to the patient Fig. Pasaje Republica de Honduras interior 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 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. Afterwards retrogtada 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 brought out with controlled rotational movements.
In such cases a tracheostomy is the indicated procedure. The limitation of this technique is for patients who also present a neurological deficit or thoracic trauma and need more than 7 days of postoperative ventilator support Jundt et al. The management of a difficult airway rstrograda one of the biggest challenges of perioperative anesthesia management.
Intubación retrograda modificada
At the end of the surgery the tube was disconnected, pulled back into the oral cavity and reconnected. Guide wire insertion through cricothyroid membrane; B.
Very low rates of complications have been reported.
Endotracheal tube in position fixed to skin. Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig. Guide wire red dotted line passed through larynx to oral cavity; B. There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al.
On initial evaluation the patient was in non-acute distress, alert, awake and oriented, with a Glascow coma score of Submental intubation in oral maxillofacial surgery: Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening. Further clinical examination did not reveal any other traumatic injury. The open reduction and internal fixation of the facial fractures could then be performed as planned and the occlusion checked with intermaxillary fixation.
A skin incision of 2 cm in the submental, paramedian region and with blunt dissection toward the floor of mouth until the mucosa was tented with a hemostat after which another 2 cm incision is made in the mucosa Fig.
The submental route for endo-tracheal intubation. Each technique has its indications with advantages and disadvantages. The anesthesiologist reassures the adequate end tidal carbon dioxide curve and auscultation of the chest for correct position of the tube. The endotracheal tube was secured and adequate end tidal carbon dioxide curve was observed. Then using Seldinger technique the malleable wire Spring-Wire Guide: In addition, the surgical anatomy of the technique is detailed described.
Intracranial malposition of nasopharyngeal airway. Submental intubation versus tracheostomy. A closed Kelly hemostatic forceps was introduced through the incision until the tip of the hemostat tented the mucosa of the floor of the mouth staying close to the lingual surface of mandible and lateral to the sublingual caruncle to avoid injury to the submandibular duct and lingual nerve.
The connector and breathing system were reattached and the cuff reinflated. Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology.
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.
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. 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.
Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the success of the procedure. 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. 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, ineligible for nasotracheal intubation due to the potential risk of creating a false passage to the cranial cavity Jundt et al.
intubacion retrograda tecnica pdf
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. In addition, the surgical anatomy of the technique is described in detail. Technical Note and Case Report. San Juan, Puerto Rico. The mortality rate of tracheostomy has been reported to range from 0.
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.
This technique was first described in by Francisco Intuacion 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 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 ertrograda mouth opening. However, adequate mouth opening is a prerequisite for the technique. In comparing submental intubation and tracheostomy, submental intubation has no significant reported major complications Jundt et al. After preoxygenation and intravenous induction of anesthesia, submental region and anterior neck is disinfected and draped as usual sterile fashion.
The Insertion of the wire inthbacion through the cricothyroid membrane helps to place correctly the endotracheal tube and also counting with the assistance of the direct video intubaicon, where the complete mouth opening is not necessary. There was midface mobility, malocclusion and mouth opening was restricted. Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy.
University of Puerto Rico.