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Martins MP, Ortenzi AV, Perin D, Quintas GCS, Malito ML, Carvalho VH. Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults. Braz J Anesthesiol 2024; 74:744477. [PMID: 38135152 PMCID: PMC10877351 DOI: 10.1016/j.bjane.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.
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Affiliation(s)
| | - Antonio V Ortenzi
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brazil
| | - Daniel Perin
- Universidade de São Paulo (USP), Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil
| | - Guilherme C S Quintas
- Hospital da Restauração, Hospital Universitário Oswaldo Cruz, CET Hospital Getúlio Vargas, Recife, PE, Brazil
| | | | - Vanessa H Carvalho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brazil
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Carvalho VH, Azi LMTA, Carvalho LIMD, Schmidt AP. Obstetric anesthesia: pearls and pitfalls in anesthesia for cesarean delivery. Brazilian Journal of Anesthesiology (English Edition) 2022; 72:441-443. [PMID: 35662608 PMCID: PMC9373631 DOI: 10.1016/j.bjane.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - André P Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
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Schmidt AP, Módolo NSP, de Amorim CG, Simões CM, Kraychete DC, Joaquim EHG, Lineburger EB, Papa FV, Fernandes FC, Mendes FF, Guimarães GMN, Barros GAM, Silva-Jr JM, Navarro E Lima LH, Azi LMTA, Carvalho LIM, Stefani LC, Garcia LV, Malbouisson LMS, Salgado-Filho MF, Nascimento Junior PD, Alves RL, Carvalho VH, Quintão VC, Carmona MJC. Two years of the COVID-19 pandemic: an anesthesiology perspective. Brazilian Journal of Anesthesiology (English Edition) 2022; 72:165-168. [PMID: 35189166 PMCID: PMC8856750 DOI: 10.1016/j.bjane.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Affiliation(s)
- André P Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Norma S P Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | | | | | | | | | | | | | - Fátima C Fernandes
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Florentino F Mendes
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Guilherme A M Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - João M Silva-Jr
- Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | | | | | | | - Luciana C Stefani
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Luis V Garcia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luiz Marcelo S Malbouisson
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | | | - Vinicius C Quintão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maria José C Carmona
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Braga ADFDA, Potério GMB, Braga FSDS, Cremonesi E, Siqueira FP, Carvalho VH. Dose preparatória versus injeção única: estudo comparativo entre diferentes doses de cisatracúrio. Braz J Anesthesiol 2003. [DOI: 10.1590/s0034-70942003000100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Braga ADFDA, Potério GMB, Braga FSDS, Cremonesi E, Siqueira FP, Carvalho VH. [Priming versus bolus: a comparative study with different cisatracurium doses.]. Rev Bras Anestesiol 2003; 53:9-16. [PMID: 19475252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2002] [Accepted: 07/15/2002] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses. METHODS Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated. RESULTS Mean times for maximum neuromuscular block onset were: Group I (3.90 +/- 0.60 min and 3.88 +/- 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 +/- 0.40 min and 2 +/- 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes. CONCLUSIONS Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes.
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