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Orthognathic surgery is performed in subjects with some type of skeletal alteration. Maxillomandibular movements have an impact on the airway (AW) and this aspect must be included into surgical planning. The aim of this research is to determine the changes in the AW after orthognathic surgery. A pilot study was conducted including 51 subjects with class II and class III facial deformity; they were included using the ANB angle and the type of dental occlusion. Cone beam computed tomography were performed showing the maximum volume in the airway and the minimum and maximum areas; in addition, the position of the hyoid bone and the angle of the mandibular plane were included to relate it to the morphology of the AW; to define statistical significance, a value of p<0.05 was established, including the student's t-test and the t-test. The results showed that class II subjects significantly increased the volume and maximum and minimum areas of the AW; skeletal class III subjects did not presented significant differences between the pre- and post-surgical stage; the hyoid bone was in an anterior position in both class II and class III cases. It is possible to conclude that AW improves substantially in subjects with facial class II and remains unchanged in subjects with facial class III. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Congenital tracheal stenosis (CTE) is a serious and rare malformation due to the absence of most or all of the tracheal pars membranosa with the presence of a variable number of complete tracheal rings, which determine a fixed narrowing of the tracheal lumen; produce life-threatening respiratory failure, requires prompt diagnosis and treatment; there are few series and case reports and even fewer reports regarding anesthetic management. The objective of this clinical case is a review of the current bibliography in order to establish a protocol and recommendations for anesthetic and perioperative management. CLINICAL CASE: 6-month-old male; with Down syndrome, congenital hypothyroidism, congenital stenosis of the middle and lower third of the trachea and left bronchus diagnosed by rigid laryngobronchoscopy, scheduled for sliding tracheobronchial plasty managed under balanced general anesthesia, fluid control and intercommunication during perioperative critical moments and near postanesthetic surveillance. Extubated 10 days later, discharge to the floor 6 days later and hospital discharge 40 days postoperatively. CONCLUSIONS: Timely and effective treatment of CTE is challenging and requires multidisciplinary treatment. Beyond the discussion about the ideal drug and type of anesthesia, management should be based on protocols with clear objectives and goals and focus on the critical moments of the procedure, airway pressure, adequate oxygen, and strict perioperative care. It is important to consolidate the experience in the country in order to obtain better results in these patients. [ABSTRACT FROM AUTHOR]

The approach to the airway in the neurosurgical patient presents great challenges due to the complex scenario we face; we must consider the patient's own characteristics, the co-morbidities present and the neurological pathology for which it is going to be intervened. Knowing the neurological pathology and the implications or repercussions that this may have over the management of the airway will help decision making and manage the challenges and scenarios that could arise during the anesthetic surgical event. [ABSTRACT FROM AUTHOR]

Ultrasonography is an active part of the clinical tools that we have in our arsenal for the evaluation of patients, and in the management of the airway, it can allow us to locate and mark the cricothyroid membrane prior to the management of a patient with a possible Difficult Airway. In trained hands allows the anatomy to be identified so that a cricothyroidotomy can be performed quickly and accurately in just 24.3 seconds. In this article, we show a rapid and visual systematic ultrasound localization of the cricothyroid membrane with an estimated time less than one minute. A linear high-frequency probe (5-14 MHz) should be used for exploration, as it is probably the most suitable for evaluating surface structures (within 0-5 cm below the skin surface). The positioning of the operator and the ultrasound scanner will depend on the patient's position, so in seated patients the operator is placed behind him and the ultrasound scanner in front of both, and in patients in a supine position, the operator is placed at the bedside of the patient and the ultrasound at the level of the right elbow. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has spread rapidly around the world. Its main transmission mechanisms are through saliva droplets or bronchial secretions, and by contact with surfaces contaminated with the virus. The formation of aerosols when speaking, coughing and sneezing are the main airborne transmission mechanism; performing in-hospital diagnostic and therapeutic procedures represent the greatest risk of contagion. The arrival of the new SARS-CoV-2 virus and the consequent declaration of a pandemic by the World Health Organization --with a very rapid and silent spread among the world population-- has caused great interest in knowing its form of transmission to be able to contain it, combat it and, thus, protect the population. Being a new and unknown virus, many aspects were ignored and, at the beginning of the pandemic, its behavior was compared with that of other closer and similar coronaviruses (such as SARS-CoV-1), for which the same prevention measures. It has long been known that humans continually produce natural aerosols through normal breathing, increasing with deep breathing and by talking, coughing, sneezing or singing. A fraction of the aerosols generated naturally can be inhaled by one or more people, thus becoming one of the main transmission mechanisms of respiratory diseases. [ABSTRACT FROM AUTHOR]

Currently, there is an undetermined number of surgical patients infected with coronavirus 2019 (COVID-19) due to the fact that its spread has been carried out at an unprecedented speed, for which reason the surgical areas have had to be reinforced. In the context of viral transmission risk procedures, the surgical team does not escape the high risk of contagion due to infection with the SARS-CoV-2 virus. The epidemiology of surgical pathologies will always have their prevalence, even in times of pandemic. A non-systematic review of the recommendations for the perioperative management of the COVID-19 patient published to date was carried out in order to organize and integrate the information regarding the perioperative management of the COVID-19 surgical patient in order to systematize the same language. adapted to the individual needs of each institution with the particularity of basing the management of this type of patients in 10 steps and thus safeguarding the integrity and protection of both health personnel and the patient himself. [ABSTRACT FROM AUTHOR]

In recent days, various protocols have been published for the prevention of transmission of the COVID-19 virus during manipulation of the airway. The article describes a form for airway management that is used in some hospitals in the Boyacá Colombia and Mexico City. This consists of nine phases that describe from the preparation of the medical equipment to be used, as well as the medical personnel that will perform the procedure, to the removal of the endotracheal tube. These phases are: placement of personal protective equipment, preparation, pre-oxygenation, induction, intubation, confirmation, aspiration tube, extubation and removal and disposal of material. [ABSTRACT FROM AUTHOR]

Biological risks are currently of great interest and concern due to the COVID-19 pandemic. In this setting, the exposure of anesthetists and healthcare personnel to patients infected with SARS-CoV-2 causing COVID-19 in their professional practice makes an update in the knowledge of the subject essential. The aim is prevention and protection during procedures entailing a higher risk, as is the case of the so-called aerosol generators (by inhalation of droplets). Therefore, we recommend extreme standard precautions focused on hand washing and barrier protection through the use of personal protective equipment (PPE) in accordance with comprehensive prevention and protection protocols for anesthetists, patients and operating rooms. [ABSTRACT FROM AUTHOR]

Introduction: Complications related to airway management represent from 1 to 18%. Totaltrack® is a laryngeal video-mask device with, that allows intubate and ventilate patients with indirect vision through a camera, also have a port to introduce an esophagogastric aspiration probe. Material and methods: The device was evaluated in 57 ASA I-III patients from 18 to 65 years of age undergoing balanced general anesthesia, with and without predictors of difficult airway, without neuromuscular block, it has been made the difficult intubation predictor index before each procedure. During the direct laryngoscopy due to incidental extubation, the Cormack-Lehane assessment was performed. Once the results were obtained, an analysis was made of the use of Totaltrack® in the sealing pressures of the laryngeal mask and the success of tracheal intubation through the device. Results: Of the total number of patients analyzed. The insertion and ventilation were successful in all cases, the static leak and the maximum inflation pressures of the laryngeal mask component were 30 cm of air respectively. The tracheal intubation through the device was successful in all cases, with a mean intubation time of 4.5 ± 0.58 seconds. Gastric insufflation was not observed. The hemodynamic variability was not clinically significant. No significant side effects were reported, the Cormack-Lehane of the two patients incidentally extubated was III in both cases. Conclusions: Yes, the use of Totaltrack® was found useful in all cases. The use of Totaltrack® allows an optimal visualization of the airway, the intubation is not complicated and can be performed with rapid sequence, independently of the difficult intubation predictor index and the Cormack Lehane. [ABSTRACT FROM AUTHOR]

The trachea's morphological study can be performed by different methods, including scopic examination during autopsies, endoscopy and diagnostic imaging. Multislice computed tomography (MSCT) is the reference method in medical imaging. Knowledge and analysis of the trachea's morphology is not only relevant to basic science, it is also important to applied science. It has been suggested that it is the most relevant variable in intubation injuries. Therefore, our goal is to determine Mackenzie's tracheal morphology distribution in Instituto Oncológico "Ángel Roffo" (oncological institute-UBA) by MSCT. Tracheal morphology was reviewed in 68 patients to determine prevalence according to morphological variables defined by Mackenzie and other authors, finding a mode in the U category, place that the C category occupies in other studies. Furthermore, our results were analyzed through a comparison of proportions statistic test with a signification of 0,05 or less. Statistically significant differences were found between the authors of reference and the obtained results, except for a few categories. In conclusion, Mackenzie's tracheal morphology distribution in Instituto Oncológico "Ángel Roffo" can be determined by computed tomography, finding out statistically significant differences with other authors. [ABSTRACT FROM AUTHOR]

To understand, diagnose and treat airway own child pathological conditions requires adequate knowledge of anatomy and physiology. Airway adult is completely different from that of the child, making pediatric patients not only more susceptible to originate disorders airway but of greater severity, coupled with low exposure to health care providers in pre and intrahospital environments can get to have. In this review the anatomical description of the pediatric airway, the physiological process of breathing, behavior of the respiratory system against disease processes and addressing the airway in pediatric patients is included. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The management of the airway requires adequate training, information to carry out this procedure in microgravity environments add a new problem to the existing ones in the advance airway management. The main problem in microgravity environments is the positioning of the patient for proper alignment and airway approach because without the help of Earth's gravity the body of patient and the staff who perform the procedure is unsupported. The purpose of this paper is to document the evidence on the management of the airway in microgravity environments. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Skeletal Class II (CII) combined with a clockwise growth pattern can anatomically predispose to a narrow upper airway. Purpose: To establish if according to the skeletal CII etiology (mandibular, maxillary, mixed, or backwards mixed position) in cases with a clockwise growth tendency is possible to observe special characteristics on the airway diameter. Methods: This cross-sectional study used 301 lateral tele-cephalograms of growing skeletal CII with clockwise tendency patients of both sexes. Analysis included pharyngeal diameter in three levels (VAP-A VAP-Mx1, VAP-B), soft palate length, and hyoid-mandibular plane distance. Patients also responded a questionnaire about quality of life. Data were analyzed through ANOVA, post-Hok Tukey, T, Square Chi, and the Fisher's tests. Results: Significant differences were found for the laryngeal-pharyngeal diameter (VAP-B) in the 4 etiologies (p=0.001) according to the standard; male children showed a longer soft palate when compared with females (p=0.018); and 22% with mandibular etiology presented apnea. Conclusions: No special characteristics were observed in the airway of the different groups of the study. All groups had a deficit at the laryngeal-pharyngeal level as well as a quality of life deficiency. The group with mandibular etiology is the only one that reported sleep apnea. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge and development of skills in the management of the airway is one of important competencies in the training of the anesthesiologist, "knowledge" and "know how well and fast" are decisive in some critical situations during the anesthetic management. Bronchoscopy is a useful both diagnostic and therapeutic procedure. Knowledge of technique and the anatomy of the airway is the key of bronchoscopy, finding different anatomic variations and classifications of the airway. Objective: Describe the airway anatomy through diagrams, evaluate anatomic variations and characteristics of procedure. Methodology: With the keywords "Bronchoscopy" and "Anatomy", "Airway", "Anesthesia" held a non-systematic review databases (PUBMED/MEDLINE, OVID, Science Direct, SciElo). Results and conclusions: The bronchoscopy is a useful procedure in the surgical level and diagnosis, being used in various procedures. Airway anatomical variations occur in a small percentage of the population. Anatomical classifications are different both anatomic as numerically, but what is important is developing a spatial relation. Bronchoscopy is a technique that goes in parallel development of other advances in biomedical technology, is a procedure whereby the anesthesiologist should be investigated in order to generate better effects in the field of the anesthesiology. [ABSTRACT FROM AUTHOR]

The trauma patient should be handled immediately, there are various systems of care based on the A (Airway), B (Breathing) and C (Circulation); any of these systems have the same goal which is to reduce morbidity and mortality. All physicians must be trained to treat the patient with trauma, regardless of the specialty to have. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The incidence of deep neck life-threatening infections has been significantly reduced by widespread use of antimicrobial and surgical treatment, however these infections can compromise the life of our patients; or by lost of the airway control, or to generate sepsis and septic shock that can culminate in death. The appropriate diagnosis, airway control, the antibiotherapy and eventually aggressive the surgical handling are essential to improve the evolution of the patient. The etiology of these infections is variable, the commonest is odontogenic origin, also the infections of airway, post surgical infections and trauma. The anatomical knowledge of the neck is needed to understand and improve the results. We describe a clinical case of a patient with deep abscess complicated with descending mediastinitis, pleural empyema and death. [ABSTRACT FROM AUTHOR]

Background. Emergency management of airway in victims of maxillofacial trauma (MFT) is challenging; there are not local series reporting factors to lead to this strategy. Material and methods. 70 months-retrospective study; MFT victims admitted by General Surgery at our trauma center. Main object of study: adoption of emergency management of airway. Statistical analysis: univariate and stepwise logistic regression. Results. 84 patients were studied, 74 (88%) males, 10 (11%) females; mechanism: motor vehicle accidents 75% (n = 63), assault 11% (n = 9), falls 7% (n = 6), gunshot wound 6% (n = 4), explosion 2% (n = 2). Admission data: systolic pressure 126.2 ± 23.2 mmHg, cardiac rate 97.48±19.9 beats/min, respiratory rate 21.4±4.9 breaths/min, RTS 7.57±0.7, ISS 11.1±7.2. Factors associated to the emergency management of the airway: gunshot wound (p = 0.0003), systolic pressure < 90 mmHg (p = 0.0001), respiratory rate > 29 breaths/min (p = 0.0001), maxillofacial bleeding (p = 0.0003), Glasgow score < 8 (p = 0.0001), mandibular fracture (p = 0.0001), crystalloids in Emergency Department (p = 0.0001), non-facial injuries (p = 0.001). Stepwise logistic regression analysis identified to gunshot wound (p = 0.013, ARR 1.25; 95% CI 1.08-1.43) and mandibular fracture (p = 0.257, ARR 1.19, 95% CI 1.01-1.34) to be independent predictive factors for mandatory emergency management of airway. [ABSTRACT FROM AUTHOR]

Brachiocephalic trunk (BCT) aneurysms are rare but very important since they pose a significant threat to life and limbs due to the risk of rupture, embolization, or compression of the adjacent structures. We now present a case of a BCT aneurysm with tracheal compression leading to difficult ventilator weaning. [ABSTRACT FROM AUTHOR]

Proper head and neck position is critical in airway management. Positioning that facilitates jaw distraction, mouth opening and appropriate observation of the epiglottis, vocal cords and glottis are important in all patients specially in morbidly obese patients. In these patients the ideal laryngoscopy position is with the external auditory meatus and sternal notch horizontally aligned. This is the called ramped position. The aim of this paper is to review current concepts related to this position and its importance in obese patients. [ABSTRACT FROM AUTHOR]