Bloqueo de la vía aérea tras la extubación. Revisión bibliográfica
Resumen Introducción y objetivo: El bloqueo de la vía aérea (BVA) tras la extubación en cualquier cirugía es un evento crítico con baja incidencia, potencialmente grave, que puede precisar reintubación o traqueotomía, en el que frecuentemente el otorrinolaringólogo es requerido. Objetivo: Conocer la prevalencia de BVA y sus causas mediante revisión bibliográfica sistemática. Método: Revisión bibliográfica en PubMed, Cochrane y Scopus de ensayos clínicos, metanálisis, revisiones y series de casos y control sobre obstrucción de la vía aérea tras extubación que precisa reintubación en adultos. Resultados: Se seleccionaron 6 estudios y una guía de práctica clínica. La causa más frecuente de fallo de extubación es el bloqueo de la vía aérea por diversas causas (debilidad muscular faríngea —frecuentemente por efecto residual farmacológico—, laringoespasmo, parálisis de cuerdas vocales, edema de vías respiratorias superiores, hematoma cervical postoperatorio, cuerpos extraños o secreciones). La mayoría de los casos de reintubación ocurrieron en las 2 horas tras la extubación. Conclusiones: La causa más frecuente de fallo tras la extubación en anestesia general es el bloqueo de la vía aérea generalmente provocado por efecto de bloqueo neuromuscular residual. El riesgo de BVA se incrementa en la cirugía de la vía aérea y de cabeza y cuello. Las guías de intubación difícil han mejorado la actuación y reducido los eventos adversos y es necesario implementar estrategias similares en la extubación. El procedimiento de extubación y reintubación debe estar documentado. Los grupos de trabajo sobre la vía aérea han de ser multidisciplinares e incluir especialistas en otorrinolaringología.
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Boyd M, Chatterjee A, Chiles C, Chin R. Tracheobronchial foreign body aspiration in adults. South Med J 2009;102(2):171–4. https://doi.org/10.1097/SMJ.0b013e318193c9c8
Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg 2010;111(1):129–40. https://doi.org/10.1213/ane.0b013e3181da8312
Chinachoti T, Chau-in W, Suraseranivongse S, Kitsampanwong W, Kongrit P. Postoperative reintubation after planned extubation in Thai Anesthesia Incidents Study (THAI Study). J Med Assoc Thai. 2005;88 Suppl 7:S84--94.
Chinachoti T, Poopipatpab S, Buranatrevedhya S, Taratarnkoolwatana K, Werawataganon T, Jantorn P. The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of post anesthetic reintubation: an analysis of 184 incident reports. J Med Assoc Thai. 2008;91(11):1706–13.
Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011;106(5):617–31. https://doi.org/10.1093/bja/aer058
Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012;67(3):318–40. https://doi.org/10.1111/j.1365-2044.2012.07075.x
Epstein SK. Decision to extubate. Intensive Care Med 2002 May;28(5):535–46. https://doi.org/10.1007/s00134-002-1268-8
Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT, et al. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012;345:e6329. https://doi.org/10.1136/bmj.e6329
Hines R, Barash PG, Watrous G, O'Connor T. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg 1992 Apr;74(4):503–9. https://doi.org/10.1213/00000539-199204000-00006
Kluger MT, Bullock MFM. Recovery room incidents: a review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002;57(11):1060–6. https://doi.org/10.1046/j.1365-2044.2002.02865.x
Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth 2003;15(8):575–81. https://doi.org/10.1016/j.jclinane.2003.03.006
Lin H-T, Ting P-C, Chang W-Y, Yang M, Chang C-J, Chou A-H. Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: A single-center retrospective case-controlled study in Taiwan from 2005 to 2009. Acta Anaesthesiol Taiwanica 2013;51(1):3–9. https://doi.org/10.1016/j.aat.2013.03.004
Mathew JP, Rosenbaum SH, O'Connor T, Barash PG. Emergency tracheal intubation in the postanesthesia care unit: physician error or patient disease? Anesth Analg 1990;71(6):691–7. https://doi.org/10.1213/00000539-199012000-00020
Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010;111(1):120–8. https://doi.org/10.1213/ane.0b013e3181da832d
Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology 2005;103(1):33–9. https://doi.org/10.1097/00000542-200507000-00009
Rosenthal LHS, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117(10):1864–70. https://doi.org/10.1097/MLG.0b013e3180de4d49
Rubin AD, Sataloff RT. Vocal fold paresis and paralysis. Otolaryngol Clin North Am 2007;40(5):1109–31, viii–ix. https://doi.org/10.1016/j.otc.2007.05.012
Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002 1;27(9):949–53.
Sanapala A, Nagaraju M, Rao LN, Nalluri K. Management of bilateral recurrent laryngeal nerve paresis after thyroidectomy. Anesth essays Res;9(2):251–3.
Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med 2003;24(3):457–71. https://doi.org/10.1016/S0272-5231(03)00048-0
Swanson KL, Edell ES. Tracheobronchial foreign bodies. Chest Surg Clin N Am 2001;11(4):861–72.
Ting PC, Chou AH, Yang MW, Ho AC-Y, Chang CJ, Chang SC. Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan. Acta Anaesthesiol Taiwanica 2010;48(4):167–71. https://doi.org/10.1016/j.aat.2010.12.003
Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care 2005;14(3):e3. https://doi.org/10.1136/qshc.2002.004275
Weber S. Traumatic complications of airway management. Anesthesiol Clin North America 2002;20(3):503–12. https://doi.org/10.1016/S0889-8537(02)00014-7
Wittekamp BHJ, van Mook WNKA, Tjan DHT, Zwaveling JH, Bergmans DCJJ. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 2009;13(6):233. https://doi.org/10.1186/cc8142
Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg 2010;111(1):129–40. https://doi.org/10.1213/ane.0b013e3181da8312
Chinachoti T, Chau-in W, Suraseranivongse S, Kitsampanwong W, Kongrit P. Postoperative reintubation after planned extubation in Thai Anesthesia Incidents Study (THAI Study). J Med Assoc Thai. 2005;88 Suppl 7:S84--94.
Chinachoti T, Poopipatpab S, Buranatrevedhya S, Taratarnkoolwatana K, Werawataganon T, Jantorn P. The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of post anesthetic reintubation: an analysis of 184 incident reports. J Med Assoc Thai. 2008;91(11):1706–13.
Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011;106(5):617–31. https://doi.org/10.1093/bja/aer058
Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012;67(3):318–40. https://doi.org/10.1111/j.1365-2044.2012.07075.x
Epstein SK. Decision to extubate. Intensive Care Med 2002 May;28(5):535–46. https://doi.org/10.1007/s00134-002-1268-8
Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT, et al. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 2012;345:e6329. https://doi.org/10.1136/bmj.e6329
Hines R, Barash PG, Watrous G, O'Connor T. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg 1992 Apr;74(4):503–9. https://doi.org/10.1213/00000539-199204000-00006
Kluger MT, Bullock MFM. Recovery room incidents: a review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002;57(11):1060–6. https://doi.org/10.1046/j.1365-2044.2002.02865.x
Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth 2003;15(8):575–81. https://doi.org/10.1016/j.jclinane.2003.03.006
Lin H-T, Ting P-C, Chang W-Y, Yang M, Chang C-J, Chou A-H. Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: A single-center retrospective case-controlled study in Taiwan from 2005 to 2009. Acta Anaesthesiol Taiwanica 2013;51(1):3–9. https://doi.org/10.1016/j.aat.2013.03.004
Mathew JP, Rosenbaum SH, O'Connor T, Barash PG. Emergency tracheal intubation in the postanesthesia care unit: physician error or patient disease? Anesth Analg 1990;71(6):691–7. https://doi.org/10.1213/00000539-199012000-00020
Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010;111(1):120–8. https://doi.org/10.1213/ane.0b013e3181da832d
Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology 2005;103(1):33–9. https://doi.org/10.1097/00000542-200507000-00009
Rosenthal LHS, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 2007;117(10):1864–70. https://doi.org/10.1097/MLG.0b013e3180de4d49
Rubin AD, Sataloff RT. Vocal fold paresis and paralysis. Otolaryngol Clin North Am 2007;40(5):1109–31, viii–ix. https://doi.org/10.1016/j.otc.2007.05.012
Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002 1;27(9):949–53.
Sanapala A, Nagaraju M, Rao LN, Nalluri K. Management of bilateral recurrent laryngeal nerve paresis after thyroidectomy. Anesth essays Res;9(2):251–3.
Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med 2003;24(3):457–71. https://doi.org/10.1016/S0272-5231(03)00048-0
Swanson KL, Edell ES. Tracheobronchial foreign bodies. Chest Surg Clin N Am 2001;11(4):861–72.
Ting PC, Chou AH, Yang MW, Ho AC-Y, Chang CJ, Chang SC. Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan. Acta Anaesthesiol Taiwanica 2010;48(4):167–71. https://doi.org/10.1016/j.aat.2010.12.003
Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care 2005;14(3):e3. https://doi.org/10.1136/qshc.2002.004275
Weber S. Traumatic complications of airway management. Anesthesiol Clin North America 2002;20(3):503–12. https://doi.org/10.1016/S0889-8537(02)00014-7
Wittekamp BHJ, van Mook WNKA, Tjan DHT, Zwaveling JH, Bergmans DCJJ. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 2009;13(6):233. https://doi.org/10.1186/cc8142
Sánchez-Tabernero, Álvaro, Pardal-Refoyo, J. L., & Cuello-Azcárate, J. J. (2017). Bloqueo de la vía aérea tras la extubación. Revisión bibliográfica. Revista ORL, 8(1), 23–29. https://doi.org/10.14201/orl.15055
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