Publication: Evaluación de la dosis efecto de propofol con o sin remifentanilo para insertar la mascarilla laríngea supreme, implicaciones para la seguridad del paciente
Loading...
Official URL
Full text at PDC
Publication Date
2017-09-19
Authors
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
Aunque en todos los tiempos los médicos han intentado aliviar la enfermedad sin causar más daño, sólo recientemente, en virtud de datos objetivos, la seguridad asistencial ha comenzado a considerarse una parte integral del quehacer sanitario. En este sentido, la Anestesiología ha sido la primera especialidad médica en reconocer la seguridad del paciente como un problema independiente. Así los anestesiólogos hemos liderado la seguridad del paciente desde hace años, tal vez porque la anestesia puede ser peligrosa y no conlleva en sí misma un beneficio terapéutico. Los avances tecnológicos han permitido mejorar la monitorización, la dosificación de los fármacos anestésicos y desarrollar nuevos dispositivos para el control de la vía aérea (VA) y sin duda, mejorar la seguridad del paciente. Desde las primeras publicaciones en los comienzos de la Anestesiología, una de las mayores preocupaciones de los anestesiólogos era cómo administrar una suficiente cantidad de anestésico que asegurara la adecuación del estado hipnótico del paciente durante el acto quirúrgico. Uno de los anestesiólogos pioneros de los inicios de la Anestesia, John Snow, manifiestó prontamente sus dudas acerca de cómo evaluaban sus colegas la profundidad anestésica mediante la respuesta del paciente a un “pinchazo”. Así para John Snow esta práctica no era válida porque repetidamente había observado que el paciente podía no responder a una agresión quirúrgica leve como la sutura de una herida, y sin embargo manifestar una respuesta intensa si se realizaba otra maniobra qirúrgica como una incisión de la pared abdominal. Este autor ya concluyó en 1858, que el estímulo que se debe aplicar al paciente debe ser supramáximo, y que la profundidad anestésica se debía evaluar con la ausencia de respuesta a dicho estímulo. Con posterioridad surgieron las ideas de la dosis, el estímulo, y la respuesta en el órgano diana, sentándose las bases para el desarrollo de métodos para medir y comparar la potencia anestésica, surgiendo así el concepto de “Concentración Alveolar Mínima o CAM”...
The LMA-Supreme™ is a new, single-use laryngeal mask airway that was recently introduced and combines some of the features of the LMA-Fastrach™ and the LMA-ProSeal™. The mask utilizes an airway tube with an elliptical cross section, which is intended to facilitate placement without requiring the insertion of fingers into the mouth. The LMA-Supreme™ incorporates a drainage tube to permit drainage from and access to the stomach and to provide confirmatory evidence of correct placement. To minimize accidental rotation, the airway tube of the LMA-Supreme™ is much stiffer than that of the LMA-Classic™ or the LMA-ProSeal™. Recently, there has been a growing interest in this device because of favourable studies obtained in several anaesthetic contexts that have proven its effectiveness and safety. Propofol has been extensively used for insertion of supraglottic devices, generally providing optimal conditions. However, co-induction agents such as opioids are commonly used with propofol to facilitate device insertion and to reduce the dose of propofol along with the adverse effects associated with large propofol doses. When administered with propofol, the ultrashort-acting opioid remifentanil improves clinical conditions for insertion of supraglottic airways and reduces the concentration of propofol required for this purpose. The propofol requirement for insertion of the LMA-Supreme™ is unknown. Most available data on anaesthetic and co-induction agent requirements for insertion of the LMA-Supreme™ originate from research focused on other evaluations of the device, such as the adequacy of ventilation achieved and the incidence of complications. Previous studies have shown that the anaesthetic requirements for insertion of different airway devices are dissimilar; these differences may be related to structural changes associated with these airway devices that exert different pressures and forces in the oral and pharyngeal cavities...
The LMA-Supreme™ is a new, single-use laryngeal mask airway that was recently introduced and combines some of the features of the LMA-Fastrach™ and the LMA-ProSeal™. The mask utilizes an airway tube with an elliptical cross section, which is intended to facilitate placement without requiring the insertion of fingers into the mouth. The LMA-Supreme™ incorporates a drainage tube to permit drainage from and access to the stomach and to provide confirmatory evidence of correct placement. To minimize accidental rotation, the airway tube of the LMA-Supreme™ is much stiffer than that of the LMA-Classic™ or the LMA-ProSeal™. Recently, there has been a growing interest in this device because of favourable studies obtained in several anaesthetic contexts that have proven its effectiveness and safety. Propofol has been extensively used for insertion of supraglottic devices, generally providing optimal conditions. However, co-induction agents such as opioids are commonly used with propofol to facilitate device insertion and to reduce the dose of propofol along with the adverse effects associated with large propofol doses. When administered with propofol, the ultrashort-acting opioid remifentanil improves clinical conditions for insertion of supraglottic airways and reduces the concentration of propofol required for this purpose. The propofol requirement for insertion of the LMA-Supreme™ is unknown. Most available data on anaesthetic and co-induction agent requirements for insertion of the LMA-Supreme™ originate from research focused on other evaluations of the device, such as the adequacy of ventilation achieved and the incidence of complications. Previous studies have shown that the anaesthetic requirements for insertion of different airway devices are dissimilar; these differences may be related to structural changes associated with these airway devices that exert different pressures and forces in the oral and pharyngeal cavities...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Toxicología y Legislación Sanitaria, leída el 21/01/2016