Publication: Ensayo clínico para evaluar la concentración de sevoflurano asociada a remifentanilo requerida para la inserción de la mascarilla laríngea supreme vs. La mascarilla laríngea pro-seal: implicaciones para la seguridad del paciente
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2019-01-28
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Universidad Complutense de Madrid
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Abstract
La mascarilla laríngea (ML) representa una auténtica innovación para el manejo de la vía aérea (VA) en general y, en especial, para los pacientes intervenidos en régimen de cirugía mayor ambulatoria (CMA). De forma específica, los diseños de ML de segunda generación han mejorado la seguridad del paciente. La ML-ProSeal ha sido ampliamente estudiada, habiendo quedado demostrada su efectividad para proveer una ventilación adecuada, incluso en situaciones complejas. La ML-Supreme es un dispositivo para un único uso, más fácil de insertar y cuyos resultados preliminares han mostrado resultados favorables. Ambos tipos de ML son dispositivos ampliamente utilizados en la ráctica clínica de la CMA.La utilización de la ML se asocia a una mayor estabilidad hemodinámica y respiratoria en comparación con la intubación orotraqueal, así como a unos requerimientos anestésicos menores, incluyendo la posibilidad de instrumentarla VA sin utilizar relajantes neuromusculares. La estrategia anestésica habitual para la inserción de una ML consiste en la administración de un agente inductor intravenoso o inhalatorio, asociado o no a un agente co-inductor como los opiáceos. El sevoflurano representa el prototipo de agente inductor inhalatorio y estudios previos han mostrado que las necesidades de este fármaco son superiores para la inserción de la ML-ProSeal en comparación con la MLClásica. La asociación de un opiáceo en la inducción anestésica tiene un efecto sinérgico y, en el contexto de la CMA, el remifentanilo por sus propiedades farmacocinéticas podría considerarse el opiáceo ideal...
The Laryngeal Mask Airway (LMA) represents an authentic innovationin the field of airway management in general and, concretely, for outpatients. Specifically, second-generation LMA devices have improved patient safety. The LMA-ProSeal has been widely evaluated, showing its effectiveness for providing adequate ventilation, even in advanced situations. The LMASupreme is a single-use device, easier to insert and whose preliminary results have shown positive results. Both types of LMA are devices widely used for the clinical practice of ambulatory surgery.The use of LMA devices is associated with a major haemodynamic and respiratory stability as compared with orotracheal intubation, along with minor anaesthetic requirements, including the possibility of airway instrumentation without using neuromuscular blocking agents. The common anaesthetic strategy for LMA device´s insertion consists in the administration of an intravenous or an inhalational induction agent, with or without a co-induction agent like opioids. Sevoflurane represents the prototype of inhalational induction agent and previous studies have concluded that its requirements are higher for the insertion of the LMA-ProSeal than for the LMA-Classic. The association of an opioid to the anaesthetic induction has a synergic effect and, in the field of ambulatory anaesthesia, remifentanil due to its pharmacokineticproperties might be the ideal opioid...
The Laryngeal Mask Airway (LMA) represents an authentic innovationin the field of airway management in general and, concretely, for outpatients. Specifically, second-generation LMA devices have improved patient safety. The LMA-ProSeal has been widely evaluated, showing its effectiveness for providing adequate ventilation, even in advanced situations. The LMASupreme is a single-use device, easier to insert and whose preliminary results have shown positive results. Both types of LMA are devices widely used for the clinical practice of ambulatory surgery.The use of LMA devices is associated with a major haemodynamic and respiratory stability as compared with orotracheal intubation, along with minor anaesthetic requirements, including the possibility of airway instrumentation without using neuromuscular blocking agents. The common anaesthetic strategy for LMA device´s insertion consists in the administration of an intravenous or an inhalational induction agent, with or without a co-induction agent like opioids. Sevoflurane represents the prototype of inhalational induction agent and previous studies have concluded that its requirements are higher for the insertion of the LMA-ProSeal than for the LMA-Classic. The association of an opioid to the anaesthetic induction has a synergic effect and, in the field of ambulatory anaesthesia, remifentanil due to its pharmacokineticproperties might be the ideal opioid...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Legal, Psiquiatría y Anatomía Patológica, leída el 08-10-2018