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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On initial evaluation the patient was in non-acute distress, alert, awake and oriented, with a Glascow coma score of 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.
In a literature review conducted by Jundt et al. 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.
Additional research is necessary to validate new modifications reported in the literature. Many trials have shown the submental route to be a simple, quick and safe approach to airway management Caubi et al. There was midface mobility, malocclusion and mouth opening was restricted.
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.
However, adequate mouth opening is a prerequisite for the technique. The connector and breathing system were reattached and the cuff reinflated. San Juan, Puerto Rico.
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Communication between the surgeon and anesthesiologist is extremely important for the safety of the patient and the success of the procedure. The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management.
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 brought out with controlled rotational movements. 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.
The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of refrograda and reduction of facial fractures in patients with craniomaxillofacial trauma ineligibles for rdtrograda intubation. Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy. Endotracheal tube in position fixed to skin. Mandible border blue lineskin incision yellow linecenter region of geniohyoid and genioglossus muscles red area ; B.
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. Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology.
Then using Seldinger technique the malleable wire Spring-Wire Guide: 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. Intracranial malposition of nasopharyngeal airway. Each technique has its indications with advantages and disadvantages. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components intjbacion the upper airway and often with little external evidence of deformity.
Guide ontubacion insertion through cricothyroid membrane; B. The breathing circuit is briefly disconnected as the tube is externalized and reconnected to the circuit and then secured to the patient Fig.
In comparing submental intubation and intybacion, submental intubation has no significant reported major complications Jundt et al. 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.
Finally, the endotracheal tube is retrogrxda to skin with sutures to prevent accidental displacement Fig. Submental intubation in oral maxillofacial surgery: The patient had suffered trauma to the midface.
intubacion retrograda tecnica pdf
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.
Guide wire red dotted line passed through larynx to oral cavity; B. In such cases a tracheostomy is the indicated procedure. 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 mortality rate of tracheostomy has been reported to range from 0.
At the end of the surgery the tube was disconnected, pulled back into the oral cavity and retrogtada.
The endotracheal tube was disconnected from the breathing circuit and the connector removed the anesthesiologist stabilized at this moment the endotracheal tube with Magill’s forceps to avoid extubation. University of Puerto Rico. Technical Note and Case Report. Pasaje Republica de Honduras interior Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening.
Radiologic examination confirmed the presence of Le Fort II fracture, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture. In addition, the surgical anatomy of the technique is described in detail.
It was decided to use retrograde intubation technique in the present case due to the restricted mouth opening, and the difficulty to maintain a clear airway with the submandibular incision bleeding or other invasive manipulation. 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.
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.