Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.09.016
Brazilian Journal of Anesthesiology
Scientific Article

The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy

A influência das manobras de suporte das vias aéreas sobre a visibilidade da glote em fibrobroncoscopia pediátrica

Tarik Umutoglu; Ahmet Hakan Gedik; Mefkur Bakan; Ufuk Topuz; Hayrettin Daskaya; Erdogan Ozturk; Erkan Cakir; Ziya Salihoglu

http://dx.doi.org/10.1016/j.bjane.2014.09.016 Braz J Anesthesiol, vol.65, n5, p.313-318, 2015
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Abstract

ABSTRACTINTRODUCTION:Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy.MATERIALS AND METHODS:In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I---II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded.RESULTS:Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p < 0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p > 0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p < 0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p > 0.05).

Keywords

Fiberoptic bronchoscopy, Pediatrics, Airway maneuvers, Jaw trust, Glottis view

Resumo

RESUMOINTRODUÇÃO: A broncofibroscopia flexível (BF) é uma valiosa intervenção para o manejo eavaliação de doenças respiratórias em pacientes tanto pediátricos quanto adultos. O obje-tivo deste estudo foi investigar a influência das manobras de apoio das vias aéreas sobre avisibilidade da glote durante a BF pediátrica.MATERIAL E MÉTODO: Estudo cruzado, randômico e controlado, incluindo pacientes com idadesentre 0-15 anos, ASA I-II, que foram submetidos à BF. Pacientes com risco de intubação difí-cil, entubados ou com traqueostomia e aqueles com mobilidade reduzida do pescoço ou queexigissem cuidados para a mobilidade do pescoço foram excluídos do estudo. Depois de obter amelhor visibilidade da glote na posição neutra, os pacientes foram posicionados com elevaçãoda mandíbula e abertura da aberta (EMBA), com elevação da mandíbula e protrusão dos dentes(EMPD), com inclinação da cabeça elevação do queixo (ICEQ) e com a tripla manobra das viasaéreas (TMVA). Os melhores escores da glote foram registrados.RESULTADOS: No total, 121 pacientes pediátricos foram incluídos no estudo: 57 pacientes do sexofeminino e 64 do sexo masculino. Ambos as manobras EMBA e EMPD melhoraram a visibilidadeda glote em comparação com a posição neutra (p < 0,05), mas não observamos diferença entreas manobras EMBA e EMPD (p > 0,05). As manobras ICEQ e TMVA melhoraram a visibilidade daglote em comparação com as manobras EMBA e EMPD e a posição neutra (p < 0,05); porém, nãoencontramos diferenças entre a ICEQ e a TMVA (p > 0,05).CONCLUSÃO: Todas as manobras de acesso às vias aéreas melhoraram a visibilidade da glotedurante a BF pediátrica; porém, a inclinação da cabeça e elevação do queixo e a tripla manobradas vias aéreas foram consideradas as manobras mais eficazes.

Palavras-chave

Fibrobroncoscopia, Pediatria, Manobras das vias aéreas, Elevação da mandíbula, Visibilidade da glote

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