Huffman Prism

Fiber Optic Howland Lock

Laryngoscope Blade – Blechman

Light Intensity Meter

McCoy

A Clinical Comparison of the Flexiblade™ and Macintosh Laryngoscopes for Laryngeal Exposure in

Anesthetized AdultsRochelle 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

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.

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

1954 HOPKINS H. DESARROLLO DEL FIBROSCOPIO

FLEXIBLE

1967 MURPHY P. REPORTO LA PRIMERA INTUBACIÓN

UTILIZANDO EL FIBROBRONCOSCOPIO

1972 TAYLOR P.A. DESCRIBIO LA METODOLOGÍA DEL

USO DEL FIBROBRONCOSCOPIO EN

ANESTESIA

1987 OVASSAPIAN ESCRIBIÓ MONOGRAFÍA SOBRE FIBRO–

LARINGOBRONCOSCOPIO EN EL

MANEJO DE LA VÍA AÉREA

1988 ROBERTS J. INICIO DE TALLERES EN LA REUNIÓN

ANUAL DE LA A.S.A.

HISTORIA:

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

INDICACIONES

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 RIGIDOS DE FIBRA ÓPTICA

Laringoscopios rígidos ópticos

Indicaciones:

Laringoscopios rígidos ópticos

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

Contraindicaciones:

Deformidad exagerada del cuello en flexión

No apertura oral

Complicaciones:

Dolor de garganta

Ruptura dental

Daño en mucosa

Laringoscopios rígidos ópticos

UPSHERSCOPE

TrachView Intubating Videoscope

VETT TM

A clinical assessment of the Glidescope videolaryngoscope in nasotracheal intubation with general anesthesia

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.

Journal of Clinical Anesthesia

Vol 18, Issue 8, Dec 2006

BULLARD

WUSCOPE

UPSHERSCOPE

VIDEO LARINGOSCOPIOSSEMI-RÍGIDOS

VIDEO LARINGOSCOPIOSSEMI-RÍGIDOS

Levitan

Shikani Optical Stylet

Bonfils RetromolarIntubation Fiberscope

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.

Rigid fibreoptic laryngoscopes:

Equipment for airway management

Kathryn Jackson, Tim Cook

ANAESTHESIA AND INTENSIVE CARE MEDICINE 7:10

AIRTRAQAIRTRAQ

Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes

Chrisen H. Maharaj MB

Am J of Emergency Med2006) 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.

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.

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.

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.

The Airtraq to facilitate endotracheal tube exchange in a critically ill, difficult-to-intubate patient

Journal of Clinical Anesthesia (2007) 19, 485-488Adrian A. Matioc MD

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.

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.

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”.

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 performed extremely well

compared to standard laryngoscopy

and an optical stylet.

VISTA DE LA GLOTIS

Clinical comparisons between GlideScope® video laryngoscope and Trachlight® in

simulated cervical spine instabilityJournal 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 UpdateJohn 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.

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.

Comparison of direct and video-assisted viewsof 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

Journal of Clinical Anesthesia (2006) 18, 357–362

ConclusionsVideo- 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.

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 3ra. Ley de Arthur C. Clarke:Cualquier tecnología suficientemente avanzada es indistinguible de la magiaCorolario: 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.

La vida nunca esta libre de riesgos: solo nos toca decidir cual riesgo es aceptable y cual no.