2255

MANEJO MÉDICO
0DQHMRGHOD9®D$ªUHD'LI®FLO
3DUWH,,$OJRULWPR\'LVSRVLWLYRV
)UDQFLVFR5DP´Q3DPS®Q+XHUWD
)DFXOWDWLYR(VSHFLDOLVWDGH‚UHDGH0HGLFLQD,QWHQVLYD
8QLGDGGH&XLGDGRV,QWHQVLYRV+RVSLWDO+00RGHOR$&RUX²D(VSD²D
e-mail: IUDQSDPSLQ#\DKRRHV

+NR@KFNQHSLNRRNMQDBNLDMC@BHNMDRCDFQTON DLDQFDMBH@ @KFTM@R CD K@R OQHMBHO@KDR LDCH-

CDDWODQSNRQD@KHY@C@RONQBNMRDMRNA@R@CNR C@RPTDQDBNLHDMC@MK@L@XNQO@QSDCDDKKNR
DMK@DWODQHDMBH@MNRNMCDNAKHF@CNBTLOKH- son:
miento y deben adaptarse siempre a las par- +HLHS@QDKMµLDQNCDHMSDMSNRCDHMSDQUDM-
SHBTK@QHC@CDRCDB@C@GNROHS@K@R¨BNLN@K@R BH®MBNMDKƥMCDLHMHLHY@QDKSQ@TL@XK@R
G@AHKHC@CDRXCHRONRHSHUNRPTDSDMF@B@C@RDQ- complicaciones.
vicio. "NKNB@Q TM CHRONRHSHUN RTOQ@FK®SHBN #2&
+NROQHMBHO@KDRE@BSNQDRPTDBNMSQHATXDM@QD- BT@MCN @µM DR ONRHAKD K@ UDMSHK@BH®M BNM
RTKS@CNRMDF@SHUNRCTQ@MSDDKL@MDINCDK@U¨@ L@RB@QHKK@E@BH@K,%

@¤QD@ RNM K@R CDƥBHDMBH@R QDK@SHU@R @K ITHBHN NL@QTMLNLDMSNO@Q@K@QDƦDWH®MCDB®LN
BNLTMHB@BH®M OK@MHƥB@BH®M DPTHON X B@O@BH- proceder.
S@BH®MCDKODQRNM@K
$RS@QE@LHKH@QHY@CNBNMKNRDPTHONRXS¤BMH-
3NCNR KNR @KFNQHSLNR OQNONQBHNM@M TM@ RDQHD cas.
RDBTDMBH@K CD OK@MDR CD @BST@BH®M RH K@ HMST- +@L@XNQ¨@CDKNR@KFNQHSLNRBNMSDLOK@M@TM
A@BH®MSQ@PTD@KEQ@B@R@
1DBNMNBHDMCNK@CHƥ- O@BHDMSD BNM TM@ U¨@ @¤QD@ CHE¨BHK OQDUHRS@ N
cultad para la toma de decisiones durante una HLOQDUHRS@DMDKPTHQ®E@MN
4SHKHY@MCNCDQDED-

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,,
QDMBH@DRSNR@KFNQHSLNROQNONMDLNRTMNO@Q@
DKL@MDINCDK@U¨@@¤QD@CHE¨BHK5 #ETDQ@CDK

PTHQ®E@MNœLAHSNCDK@R4QFDMBH@R'NROHS@K@-
QH@RX$WSQ@GNROHS@K@QH@RX4MHC@CDRCD"THC@-
CNR"Q¨SHBNR4MHC@CDRCD"THC@CNR(MSDMRHUNR
X CD 1D@MHL@BH®M /NRSNODQ@SNQH@ BNM CHRON-
%HFTQ@
 KFNQHSLNCDL@MDINCD5 #
2266
MANEJO MÉDICO
RHSHUNR@RDPTHAKDRXCDCDLNRSQ@C@TSHKHC@CX
DƥB@BH@%HFTQ@
$MOQHLDQKTF@QCDADUHFHK@QRDK@BNQQDBS@ON-
RHBH®M CD K@ B@ADY@ ONRHBH®M řCD NKE@SDNŚ K@
ONRHBH®M řDM Q@LO@Ś QDRTKS@ UDMS@INR@ DM DK
paciente obeso.
 27

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

$K L@MSDMHLHDMSN CD K@ NWHFDM@BH®M DR OQHN- paciente.
QHS@QHN SNCNR KNR O@BHDMSDR CDADM RDQ OQDNWH- #TQ@MSDK@K@QHMFNRBNOH@CHQDBS@CDADLNRQD@-
FDM@CNR @MSDR CD K@ HMCTBBH®M  $K EœQL@BN KHY@QTM@DU@KT@BH®MQœOHC@CDK@UHRT@KHY@BH®M
HMCTBSNQ CDAD RDKDBBHNM@QRD RDFµM K@ BNMCH- CD K@ FKNSHR BNM K@ BK@RHƥB@BH®M CD "NQL@BJ
BH®M BK¨MHB@ CDK O@BHDMSD MN G@X PTD NKUHC@Q +DG@MDRHDMCN@BNMRDI@AKDDMKNRFQ@CNR((((5
K@ HLONQS@MBH@ CDK AKNPTDN MDTQNLTRBTK@Q TSHKHY@Q DK ƥ@CNQ DM DK STAN X K@ L@MHNAQ@ CD
DMTM@HMSTA@BH®MCHE¨BHKMNRDCDADMQD@KHY@Q !41/ @CDLœR CD KK@L@Q @ TM BNLO@¬DQN BNM
LœR HMSDMSNR RHM TM AKNPTDN MDTQNLTRBTK@Q LœR DWODQHDMBH@  $M LTBGNR BDMSQNR X RDFµM
BNLOKDSN 3NCNRKNRL¤CHBNRHLOKHB@CNRDMDK K@DWODQHDMBH@DMDRNRFQ@CNRDLOKD@MCHQDB-
L@MDIN CD TM@ 5 # CDADM DRS@Q B@O@BHS@CNR S@LDMSD TM CHRONRHSHUN ®OSHBN  HQSQ@Pl *HMF
DMDKTRNCDTMCHRONRHSHUN®OSHBNBNM@BBDRN 5HRHNMlDSB  
HMLDCH@SN@KLHRLN +@L@MHOTK@BH®MK@Q¨MFD@
DWSDQM@!41/QDRTKS@ADMDƥBHNR@ $KL¤SNCN 2. INTUBACIÓN CON INTRODUCTORES
CD DKDBBH®M O@Q@ BNMƥQL@Q K@ HMSTA@BH®M RDQœ ,DMBHNM@QDLNRCNRCDKNRLœRHLONQS@MSDRDK
K@BNLOQNA@BH®MCDTM@NMC@CDB@OMNFQ@E¨@ &TL$K@RSHB!NTFHDNHMSQNCTBSNQCD$RBGL@MM
BNMSHMT@DRDKFNKCRS@MC@QCO@Q@BNMƥQL@QK@ XDKHMSQNCTBSNQCD%QNU@%HFTQ@
UDMSHK@BH®M

1. LARINGOSCOPIA DIRECTA
LœWHLN
HMSDMSNR
1DBNLDMC@LNRTMLœWHLN
CDHMSDMSNRCDHMSTA@BH®M
@TMPTD RD ONCQ¨@ @BDOS@Q
una tercera tentativa si la
QD@KHY@ TM BNLO@¬DQN LœR
experimentado valorando
la tolerancia a la misma se-
FµM K@ RHST@BH®M BK¨MHB@ CDK %HFTQ@ (MSQNCTBSNQDRCD$RBGL@MMHYPTHDQC@X%QNU@CDQDBG@
 28

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

GUM ELASTIC BOUGIE O INTRODUCTOR DE ES-
CHMANN:
&T¨@RDLHQQ¨FHC@X@K@QF@C@CDBLCDKNM-
FHSTC X TM B@KHAQD CD  %Q QDUDRSHC@ ONQ TM@
QDRHM@ PTD KD BNMƥDQD TM@ RTODQƥBHD CDRKHY@-
@ITRS@QRD@K@ROQDEDQDMBH@RXMDBDRHC@CDRHM-
dividuales. Indicado para tubos de 6 mm de
CHœLDSQNHMSDQMNNRTODQHNQ
TÉCNICA:
AKDBNMOTMS@QNL@BTQU@C@KNRBLCHRS@-  +TAQHB@QDK3$3XK@O@QSDCHRS@KCDKHMSQNCTB-
KDRENQL@MTM@@MFTK@BH®MCDnPTDODQLHSD tor.
CHQHFHQK@O@Q@R@KU@QNARSœBTKNRBNMLNUHLHDM-  2D OTDCD řOQDB@QF@QŚ DK 3$3 RNAQD K@ O@QSD
SNRCDQNS@BH®M
$KL@SDQH@KCDKB@S¤SDQODQLHSD OQNWHL@KCDKHMSQNCTBSNQNHMSQNCTBHQDK3$3
LNKCD@QKN O@Q@ @ITRS@QRD @ K@R OQDEDQDMBH@R X OQNWHL@KLDMSD TM@ UDY BNKNB@CN DK HMSQN-
necesidades individuales. Indicado para tubos CTBSNQDMK@SQœPTD@

CDLLCDCHœLDSQNHMSDQMNNRTODQHNQ
 1D@KHY@QK@K@QHMFNRBNOH@CHQDBS@

 $M DK FQ@CN (( CD "NQL@BJ+DG@MD CDRKHY@Q
INTRODUCTOR DE FROVA: directamente la punta del introductor a tra-
&T¨@RDLHQQ¨FHC@X@K@QF@C@CDBLCDKNM- U¤RCDKNQHƥBHNFK®SHBNDMDKFQ@CN(((HMSQN-
FHSTC X  %Q BNM OTMS@ QNL@ BTQU@C@ PTD ducir la punta del introductor por debajo de
ODQLHSD CHQHFHQK@ O@Q@ R@KU@Q NARSœBTKNR BNM K@DOHFKNSHRDMRDMSHCN@MSDQHNQG@RS@ODQBHAHQ
LNUHLHDMSNRCDQNS@BH®M
2TDWSQDLNCHRS@KDR KNR řBKHBRŚ SQ@PTD@KDR N DMBNMSQ@Q TM řRSNOŚ
BDQQ@CN QNLN X BNM CNR NQHƥBHNR K@SDQ@KDR
 K @KKKDF@Q@K@U¨@@¤QD@RDBTMC@QH@

RDQ GTDBN ODQLHSD K@ NOBH®M LDCH@MSD TMNR  U@MY@QDKHMSQNCTBSNQCDMSQNCDK@SQœPTD@

@C@OS@CNQDR1@OH%HSBNMDWH®MCDLLO@Q@  "NM @XTC@ CD TM RDFTMCN NODQ@CNQ CDRKH-
UDMSHK@BH®M BNMUDMBHNM@K N @C@OS@CNQ +TDQ Y@QDK3$3RNAQDDKHMSQNCTBSNQG@RS@PTDDK
+NBJO@Q@UDMSHK@BH®MBNMIDSCDQD@KHY@QTM@ A@K®MCDMDTLNS@ONM@LHDMSNRNAQDO@RDK@
UDMSHK@BH®MO@QBH@KN@CLHMHRSQ@QNW¨FDMN@RT FKNSHR
$MDKB@RNCDK@%QNU@SDMDQK@OQDB@T-
SQ@U¤R
BH®MCDQDSHQ@QDKDRSHKDSDLDSœKHBNSQ@RG@ADQ
+@R L@QB@R BDMSHLDSQ@C@R E@BHKHS@M K@ BNKN- RNAQDO@R@CNBLK@FKNSHR%HFTQ@ 

B@BH®M CD KNR STANR DMCNSQ@PTD@KDR 3$3
 $K  /@Q@E@BHKHS@QDKCDRKHY@LHDMSNCDK3$3L@M-
L@SDQH@K CDK B@S¤SDQ ODQLHSD LNKCD@QKN O@Q@ SDMDQK@K@QHMFNRBNOH@

 29

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

 2HDMBTDMSQ@TMRSNODMDKO@RN@K@K@QHMFD S@MSN ONQ DK DMSNQMN DWSQ@GNROHS@K@QHN BNLN
QNS@QDK3$3xDMRDMSHCN@MSHGNQ@QHN%HFT- ONQDKO@BHDMSDBTDKKNƦTHCNRDSB OTCHDMCN
Q@! KKDF@Q@DUHS@QDK@BBDRNPTHQµQFHBNCDDR@U¨@
 ,@MSDMDQK@ONRHBH®MCDK3$3XQDSHQ@QDKHM- @¤QD@
SQNCTBSNQXDKK@QHMFNRBNOHN /DQLHSD RT HMRDQBH®M BNM TM@ RNK@ L@MN DM
BT@KPTHDQONRHBH®MRHMLNUDQK@B@ADY@XBNM
3. MASCARILLA LARÍNGEA DE INTUBACIÓN DKBTDKKNDMONRHBH®MMDTSQ@ /QDBHR@TM@@ODQ-
FASTRACH ™ (MLF) STQ@ATB@KL¨MHL@CDBL
#HRONRHSHUNCHRD¬@CNONQ!Q@HMDM 2DG@ +@,+%%HFTQ@DRSœBNLOTDRS@ONQ
CDLNRSQ@CNRTTSHKHC@CXDƥB@BH@DMLTKSHSTC  3TANCDU¨@@¤QD@BNML@MFNQ¨FHCNBTQU@CN
CDDRBDM@QHNRDMKNRPTDBNLNh@KSDQM@SHU@@ @M@S®LHB@LDMSDXBNMTMBNMDBSNQDRSœMC@Q
K@HMSTA@BH®MBNMUDMBHNM@KODQLHSDTMBNMSQNK CDLL /DQLHSDO@R@Q@RTSQ@U¤RTM3$3
CD K@ U¨@ @¤QD@ DM BNMCHBHNMDR CDRE@UNQ@AKDR CDG@RS@LL K@QDTSHKHY@AKDXCDLL K@

%HFTQ@ (L@FDMNASDMHC@DMVVV MDRSDRH@1 NQFX!LNCHƥB@CNCD,B&HKK) $LDQF,DC"KHM- L 

3¤BMHB@CDHMSTA@BH®MBNMHMSQNCTBSNQ
 30

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ "NLONMDMSDRCDK@,+%(L@FDMNASDMHC@XLNCHƥB@C@CD  3TAN DMCNSQ@PTD@K DR
VVV MDRSDRH@1 NQF TM STAN QDBSN CD RHKHBNM@
QDENQY@CN CD SHON ƦDWN
LDSœKHBN L@QB@CN SQ@MR-
UDQR@KLDMSDBNMTM@K¨MD@
MDFQ@O@Q@HMCHB@QDKOTM-
SNCDR@KHC@CDK3$3ONQK@
!$$ 3HDMDL@QB@RCDOQN-
ETMCHC@C DM BDMS¨LDSQNR
TM A@K®M ODPTD¬N PTD KD
ODQLHSD O@R@Q @ SQ@U¤R CD
la MLF y una punta atrau-
LœSHB@  2D OTDCDM TR@Q
3$3 BNMUDMBHNM@KDR ODQN
DWHRSDL@XNQQHDRFNCDKD-
RH®MXCDDWSTA@BH®M@KQD-
tirar a MLF.
 /QNKNMF@CNQ RD HMSQN-
duce en la MLF para pro-
KNMF@Q N @K@QF@Q DK 3$3 @K
CDTRNµMHBN $RSœTMHCN@TML@MFNQ¨FHCN retirar la MLF evitando la
O@Q@E@BHKHS@QK@HMRDQBH®MBNMTM@RNK@L@MN  DWSTA@BH®MCDKO@BHDMSD 
 ,@MFTHSN HMƦ@AKD OTDCD O@R@Q ONQ TM@ +@,+%RDBNLDQBH@KHY@DMCNRUDQRHNMDRQDTSH-
@ODQSTQ@ATB@KCDBL KHY@AKDXCDTRNµMHBN"T@CQN +@QDTSHKHY@-
 !@QQ@DKDU@CNQ@CDK@DOHFKNSHR!$$RHST@C@ AKDODQLHSDTSHKHY@Q3$3CDTMS@L@¬NDMSQD
en la apertura de la mascarilla. La termina- XLLLHDMSQ@RPTDK@CDTRNµMHBNDMSQDX
BH®MCDDRS@A@QQ@MNDRSœƥI@ODQLHSHDMCN 7 mm.
DKDU@QK@DOHFKNSHRBT@MCNO@R@DK3$3
 31

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

"T@CQN 3HONRCD,+%XDRODBHƥB@BHNMDRBNLDQBH@KDR

Reutilizable $RODBHƥB@BHNMDRCDKOQNCTBSN
Tamaño Código Peso Volumen máximo
Tamaño TET (mm)
mascarilla producto paciente manguito (aire)
3 130030 30-50 kg 20 ml 6 6.5 7 7.5 8
4 130040 50-70 kg 30 ml 6 6.5 7 7.5 8
5 130050 70-100 kg 40 ml 6 6.5 7 7.5 8

Uso único $RODBHƥB@BHNMDRCDKOQNCTBSN

Tamaño Código Peso Volumen máximo
Tamaño TET (mm)
mascarilla producto paciente manguito (aire)
3 135130 30-50 kg 20 ml 6 6.5 7 - -
4 135140 50-70 kg 30 ml 6 6.5 7 - -
5 135150 70-100 kg 40 ml 6 6.5 7 - -

TÉCNICA DE INSERCIÓN, INTUBACIÓN Y RETI- K@C@Q @U@MY@MCN G@RS@ DMBNMSQ@Q QDRHRSDMBH@ 

RADA DE LA MLF:
+NB@KHY@QXBNKNB@QDKL@SDQH@KMDBDR@QHN,+%
 1D@KHY@Q K@ h
STANDMCNSQ@PTD@KOQNKNMF@CNQIDQHMF@CD
LKXKTAQHB@MSDGHCQNRNKTAKD
 UDDMDKOK@MNR@FHS@KU@KNQ@MCNPTDMNG@X@
/@Q@(-2$13 1K@,+%%HFTQ@G@XPTDCDRHM-
Ʀ@QK@SNS@KLDMSDBNMK@IDQHMF@X@OKHB@QKTAQH-
B@MSDGHCQNRNKTAKDDMK@O@QSDONRSDQHNQCDK@
OTMS@
"NMK@B@ADY@CDKO@BHDMSDDMONRHBH®M
MDTSQ@CDRKHY@QK@OTMS@CDK@,+%BNMSQ@DKO@-
(MƦ@QDKL@MFTHSNBNMDKUNKTLDMQDBNLDMC@-
CN RDFµM DK S@L@¬N CD K@ ,+%
O@QSDCDK@L@MHNAQ@CD"G@MCXQNS@BH®MRT@-
ETF@CD@HQD@KUDMSHK@Q
/@Q@ (-34! 1 %HFTQ@  RTIDS@Q K@ ,+% ONQ DK
@R@ X QD@KHY@Q K@ h O@QSD CD K@ L@MHNAQ@ CD
"G@MCXDKDU@QCDRCDK@O@QDCE@Q¨MFD@ONRSD-
QHNQ TR@MCN DK L@MFN LDSœKHBN O@Q@ OQDUDMHQ
 32

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ 3¤BMHB@CDHMRDQBH®MDHMSTA@BH®MBNMK@,+%"NQSDR@M@S®LHBNRCDK@RL@MHNAQ@RCD"G@MCXLNCHƥB@CNRCD%DQRNM
#9DS@K  MDRSGDRHNKNFX

DKBGNPTDCDK3$3BNMKNR@QHSDMNHCDRXE@BHKH- para mantener abiertas las cuerdas vocales

S@QRTHMRDQBH®M@K@ANB@QK@B@YNKDS@@K@FKNSHR  BT@MCNO@R@DK3$3 2DHMSQNCTBDDK3$3KTAQH-
2D @BNMRDI@ DLOKD@Q AKNPTDN MDTQNLTRBTK@Q B@CN BNM K@ K¨MD@ MDFQ@ KNMFHSTCHM@K G@BH@ K@
 33

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

M@QHYCDKO@BHDMSD  U@MY@QDK3$3G@RS@O@R@Q OTDCDE@BHKHS@QRTNARSQTBBH®MBNMRDBQDBHNMDR 
K@ L@QB@ GNQHYNMS@K GHMBG@Q DK A@K®M CD MDT- Por ello se debe cambiar el tubo por otro de
LNS@ONM@LHDMSNXBNMƥQL@QK@BNQQDBS@HMST- A@I@OQDRH®MBT@MCNRD@ONRHAKDXBNMRDFTQH-
A@BH®M C@CƥAQNAQNMBNRBNOHNHMSDQB@LAH@CNQş
$K 3$3 CHRD¬@CN O@Q@ TR@Q BNM K@ ,+% %HFTQ@ 2D OTDCDM DLOKD@Q 3$3 BNMUDMBHNM@KDR O@Q@
DRTMSTANQDBSNBNMOTMS@B®MHB@@SQ@TLœ- HMSTA@Q@SQ@U¤RCDK@,+%ODQNBNML@XNQQHDR-
FNCDKDRH®MXDWSTA@BH®M@KQDSHQ@QK@L@RB@QH-
%HFTQ@ 3$3CDK@,+% KK@ $K3$3BNMUDMBHNM@KRDCDADHMSQNCTBHQBNM
K@BTQU@STQ@@KQDU¤R@R¨DKœMFTKNCDR@KHC@DR
LDMNQBNMTM@@KS@OQNA@AHKHC@CCDHMSTA@BH®M
%HFTQ@
/@Q@1$3(1 1K@,+%SQ@RK@HMSTA@BH®M%HFTQ@
G@XPTDCDRHMƦ@QK@L@RB@QHKK@L@MSDMDQDK
3$3DMRTKTF@QBNM@XTC@CDKOQNKNMF@CNQXRT-
IDS@QBNMƥQLDY@DK3$3BNMKNRCDCNRDMBT@M-
SN@O@QDYB@@SQ@U¤RCDK@@ODQSTQ@CDK@,+%
SHB@ @CDBT@C@ O@Q@ K@ HMSTA@BH®M @
BHDF@R  $R HLONQS@MSD L@MSDMDQ K@
NQHDMS@BH®M CD K@ K¨MD@ MDFQ@ KNMFH- %HFTQ@ 3$3BNMUDMBHNM@K@SQ@U¤RCDK@,+%HL@FDMNASDMHC@XLNCH-
STCHM@K G@BH@ K@ M@QHY CDK O@BHDMSD ƥB@C@CDVVV MDRSDRH@1 NQF
O@Q@ @RDFTQ@Q K@ NQHDMS@BH®M @CD-
BT@C@CDKAHRDK +NROQNAKDL@RPTD
puede presentar este tipo de tubo
RNM PTD RT A@K®M CD MDTLNS@ON-
M@LHDMSN ONQ RDQ CD @KS@ OQDRH®M
y bajo volumen puede lesionar la
LTBNR@SQ@PTD@K@CDLœRRTNQHƥBHN
CHRS@KQDCNMCNXCDLDMNQCHœLDSQN
 34

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ 3¤BMHB@CDQDSHQ@C@CDK@,+%SQ@RK@HMSTA@BH®M

DMK@ANB@TML¤SNCN@KSDQM@SHUNDRTSHKHY@QTM DMODQRNM@RONBNDWODQHLDMS@C@RNU¨@@¤QD@
3$3CDB@KHAQDHMEDQHNQ@LNCNCDOQNKNMF@CNQ BNLOKDI@ONCQ¨@CDI@QRDBNMDKL@MFTHSNBNL-
HMRDQSœMCNKNDMDK3$3CDƥMHSHUNPTDSDMDLNR OKDS@NO@QBH@KLDMSDCDRGHMBG@CN
HMSQNCTBHCN DM K@ ,+%  +@ QDSHQ@C@ CD K@ ,+%
debe ser muy cuidadosa manteniendo la cur- DIFICULTAD AL PASO DEL TET (MALPOSICIO-
U@STQ@CDKSTANDMK@U¨@@¤QD@ +@BNMDWH®MCD NES), CAUSAS Y SOLUCIONES:
LL CDK 3$3 RD CDAD QDSHQ@Q OQDUH@LDMSD @ - Si presenta resistencia al paso a 3 cm de la
DRS@L@MHNAQ@BNMDBSœMCNK@ONRSDQHNQLDMSD L@QB@GNQHYNMS@KTM@ONRHAKDB@TR@DRPTD
2HDLOQDPTDRD@ONRHAKDRDCDADQDSHQ@QK@,+% K@,+%RD@CDL@RH@CNODPTD¬@ +@RNKTBH®M
SQ@RK@HMSTA@BH®MO@Q@DUHS@QDCDL@E@Q¨MFDN cambiarla por otra mayor.
NKDRHNMDRCDO@QSDRAK@MC@RONQOQDRH®MODQN  2HOQDRDMS@QDRHRSDMBH@@KO@RN@BLCD
 35

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

K@L@QB@GNQHYNMS@KTM@ONRHAKDB@TR@DRK@ /QDRDMS@TM@QœOHC@BTQU@CD@OQDMCHY@IDOQN-
DOHFKNSHRCNAK@C@G@BH@@A@INNK@HLO@BS@- A@AKDLDMSD RD@M MDBDR@QH@R LœR CD  HMST-
BH®MCDK3$3 +@RNKTBH®MQDSHQ@QO@QBH@KLDM- A@BHNMDR O@Q@ CNLHM@QKN X R@B@Q DK LœWHLN
SD K@ ,+% X QDHMRDQS@QK@ RHM CDRGHMBG@Q K@ ADMDƥBHNONRHAKDRNAQDSNCNDMHMSTA@BHNMDR
L@RB@QHKK@ řL@MHNAQ@  BL @QQHA@@A@INŚ N CHE¨BHKDR •SHKO@Q@DKODQRNM@KPTDQD@KHY@HMST-
řL@MHNAQ@TOCNVMŚ  A@BHNMDRBNMLDMNQEQDBTDMBH@
- Si presenta resistencia al paso a 1 cm de la "NLO@Q@CNBNMDKK@QHMFNRBNOHN,@BHMSNRGG@
L@QB@GNQHYNMS@KTM@ONRHAKDB@TR@DRPTD QDRTKS@CNRTODQHNQDMK@UHRH®MK@Q¨MFD@DMU¨@R
K@ ,+% RD@ CDL@RH@CN FQ@MCD  +@ RNKTBH®M @¤QD@RCHE¨BHKDR +NRL@XNQDRADMDƥBHNRRDG@M
B@LAH@QK@ ONQ NSQ@ LDMNQ  4M@ ,+% CDL@- UHRSNDMO@BHDMSDRBNML@QB@C@KHLHS@BH®MCD
RH@CN FQ@MCD OTDCD C@Q KTF@Q @ HMSTA@BH®M K@LNUHKHC@CBDQUHB@KDLA@Q@Y@C@RXNADRNR
DRNEœFHB@DMDKCDK@RNB@RHNMDR $KCHRONRHSHUNBNMRS@CD%HFTQ@
 "@M@KFT¨@O@Q@K@BNKNB@BH®MDHMRDQBH®MCDK
4. DISPOSITIVOS ÓPTICOS CON PALA CON CA- STANDMCNSQ@PTD@K
NAL: Airtraq®, King Vision®  "@M@K®OSHBNPTDSDQLHM@DMTM@KDMSDCHRS@K 
4M@KTYEQ¨@PTDETMBHNM@BNMA@SDQ¨@RDDM-
HQSQ@Pl BTDMSQ@RHST@C@DMK@OTMS@CDK@O@K@DRS@
$RTMK@QHMFNRBNOHN®OSHBNQ¨FHCNCDRDBG@AKD KTY+$#HMSDFQ@C@B@KHDMS@K@KDMSDCHRS@K@K@
BNLDQBH@KHY@CNCDRCDDK@¬N/QNCNK,D- temperatura corporal para evitar el empaña-
CHSDB5HYB@X@ miento.
/DQLHSDK@UHRT@KHY@BH®MCDK@RBTDQC@RUNB@KDR  5HRNQOQNWHL@KK@HL@FDMRDSQ@MRLHSD@DRSD
RHMK@MDBDRHC@CCD@KHMD@QKNRDIDRNQ@KE@Q¨M- UHRNQ @ SQ@U¤R CD TM RHRSDL@ ®OSHBN CD @KS@
FDNXSQ@PTD@K 2DG@MOTAKHB@CNB@RNRBK¨MHBNR CDƥMHBH®M BNLOTDRSN ONQ KDMSDR DRODINR X
CDTRNDWHSNRNDMRHST@BHNMDROQDGNROHS@K@QH@R OQHRL@R $KUHRNQODQLHSDK@UHRT@KHY@BH®MCD
XDMDRBDM@QHNRETDQ@CDPTHQ®E@MNODQLHSDK@ K@ FKNSHR DRSQTBSTQ@R BHQBTMC@MSDR X OTMS@
HMSTA@BH®MDMBT@KPTHDQONRHBH®M /QDBHR@TM@ CDKSTANDMCNSQ@PTD@K
@ODQSTQ@ ATB@K L¨MHL@ CD  LL  HQSQ@P 2/ 4M@ BNMRHCDQ@BH®M HLONQS@MSD @ SDMDQ DM
O@Q@@CTKSNDRSœMC@Q3$3  BTDMS@@KDLOKD@QKNDRPTDDKDID®OSHBN@OTM-
 36

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

S@@KBDMSQNCDK HQSQ@Pl y el %HFTQ@ "NLONMDMSDRCDK HQSQ@Pl.
B@M@K CD FTH@CN CDRU¨@ DK
3$3 G@BH@ DRD BDMSQN  '@X
PTD QDBNQC@Q PTD CDAHCN
@ PTD DK B@M@K ®OSHBN DRSœ
RHST@CN @ K@ HYPTHDQC@ CDK
dispositivo el usuario vi-
RT@KHY@ K@ O@QSD HYPTHDQC@
CDK 3$3 X CDAHCN @K AHRDK
K@O@QSDCDQDBG@DRK@LœR
@U@MY@C@%HFTQ@ 
$KœMFTKNCDR@KHC@CDK3$3
%HFTQ@!CDODMCDQœCDK
S@L@¬N CDK HQSQ@Pl y del %HFTQ@  HL@FDMX@KHMD@BH®MCDK3$3 !R@KHC@CDK3$3 
S@L@¬N X SHON CD 3$3  +NR
STANR ODPTD¬NR X KNR ST-
ANRQDENQY@CNRR@KCQœMONQ
TM@YNM@LœRONRSDQHNQ $R
muy importante seleccio-
M@Q DK S@L@¬N CD HQSQ@Pl
adecuado para el tamaño
CD 3$3 PTD RDQœ DLOKD@-
do; puede emplearse cual-
PTHDQSHONCD3$3 
2DBNLDQBH@KHY@DMCNRUDQ-
RHNMDR%HFTQ@ HQSQ@Pl
RO SNS@KLDMSD CDRDBG@-
AKD X HQSQ@Pl U@MS O@K@
 37

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

CDRDBG@AKD X ®OSHB@ QDTSHKHY@-
AKD $WHRSDM@CDLœRLµKSHOKDR
@BBDRNQHNR PTD RD BNMDBS@M
con el dispositivo: adaptador
CDSDK¤ENMNL®UHKBœL@Q@6H
%HX@C@OS@CNQO@Q@B@ADY@KCD
BœL@Q@ PTD ODQLHSD OQNXDBS@Q
K@HL@FDMDMK@SNQQDCDƥAQN-
broncoscopia.
En el Cuadro 2 se describen los
%HFTQ@ 5DQRHNMDRBNLDQBH@KHY@C@RCD HQSQ@Pl. S@L@¬NRCDKCHRONRHSHUNS@L@-
¬N CD 3$3 HMCHB@CN O@Q@ B@C@
SHON@ODQSTQ@ATB@KL¨MHL@QD-
PTDQHC@ X DRODBHƥB@BHNMDR BN-
LDQBH@KDR $K U@MSR®KNRDBN-
LDQBH@KHY@ DM KNR CNR S@L@¬NR
para adultos.

TÉCNICA DE INTUBACIÓN:
2DFTHQDLNR KNR RHFTHDMSDR O@-
RNRO@Q@RTOQDO@Q@BH®M
$MBDMCDQK@KTYOQDRHNM@MCN
DKHMSDQQTOSNQ%HFTQ@ 
 +@ KTY O@QO@CD@ CTQ@MSD 
RDFTMCNR LHDMSQ@R K@ KDMSD
es calentada a la tempera-
tura corporal para evitar la
"T@CQN 3@L@¬NRXDRODBHƥB@BHNMDRBNLDQBH@KDRCDK HQSQ@Pl sp. @O@QHBH®MCDU@GN 
 38

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

 ,HDMSQ@RO@QO@CD@K@KTYKTAQHB@QDK3$3XK@ Sujetaremos el dispositivo usando los dedos
O@K@CDK HQSQ@PRHMSNB@QK@KDMSD%HFTQ@ -. K@ L@MN BNLOKDS@ %HFTQ@   @F@QQœM-
! CNKNONQK@YNM@BDQB@M@@K@ANB@-.ONQK@
 #DRKHY@QDK3$3ONQDKB@M@KK@SDQ@KCDK HQSQ@P YNM@RTODQHNQXMTMB@BNLNRHETDRDTMK@QHM-
@KHMD@MCN K@ OTMS@ CDK 3$3 BNM DK ƥM@K CDK FNRBNOHNMNQL@K%HFTQ@!
B@M@KCDFTH@CN%HFTQ@"

%HFTQ@ !" /QDO@Q@BH®MCDK HQSQ@Pl.

%HFTQ@ ! 2TIDBH®MCDK HQSQ@Pl.

 39

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

+NHMRDQS@QDLNRDMK@K¨MD@LDCH@CDK@ANB@  2HMN@SQ@UHDR@K@RBTDQC@RUNB@KDREœBHKLDM-
G@RS@PTDK@O@QSDOK@M@CDK@OTMS@CDK@O@K@ SDMNKNHMSDMS@QDLNRMTDU@LDMSDG@RS@BN-
DRS¤BNLOKDS@LDMSDCDMSQNCDK@B@UHC@CNQ@K QQDFHQK@ONRHBH®M
DUHS@MCNRHDLOQDG@BDQOQDRH®MRNAQDKNRCHDM-  2H RD CHQHFD CDL@RH@CN ONRSDQHNQ RDO@Q@QD-
SDR RTODQHNQDR  #DRKHY@QDLNR K@ O@K@ RNAQD K@
KDMFT@RHMDKDU@QDK HQSQ@PlG@RS@PTDK@OTMS@
%HFTQ@ (MRDQBH®MCDK HQSQ@Pl.
@KB@MBDK@A@RDCDK@KDMFT@OQDUDMHLNROQD-
RHNM@QK@KDMFT@%HFTQ@
Existe la posibilidad de intubar estilo Macin-
SNRG N DRSHKN ,HKKDQ RHDMCN CD DKDBBH®M K@ OQH-
LDQ@@KQDPTDQHQLDMNQSQ@BBH®MG@BH@@QQHA@X
RDQ@R¨LDMNR@FQDRHU@%HFTQ@
2HMNUHRT@KHY@LNRK@RBTDQC@RUNB@KDRDROQN-
A@AKD PTD G@X@LNR QD@KHY@CN TM@ HMRDQBH®M %HFTQ@ 5HRT@KHY@BH®MCDK@FKNSHR
CDL@RH@CNOQNETMC@CDK HQSQ@PlDMDRSDB@RN
CDADQDLNR BNQQDFHQK@ BNM K@ L@MHNAQ@ ř@SQœR
@QQHA@Ś %HFTQ@    4M KHFDQN @KY@CN CDK HQ-
SQ@Pl C@Qœ KTF@Q @ K@ @ODQSTQ@ CD K@ FKNSHR X
B@¨C@CDK@LTDRB@HMSDQ@QHSDMNHCD@ONRHBH®M
®OSHL@O@Q@K@HMSTA@BH®MDWHSNR@%HFTQ@!
$MK@%HFTQ@RDDMTLDQ@MDQQNQDRBNLTMDR
DMK@S¤BMHB@CDHMRDQBH®MCDKCHRONRHSHUNXUH-
RT@KHY@BH®MCDK@FKNSHR
/@Q@ HMRDQS@Q DK 3$3 KN RTIDS@QDLNR BNLN RD
LTDRSQ@DMK@%HFTQ@ XRDFTHQDLNRKNRRH-
FTHDMSDRO@RNR
 U@MY@QDLNRDK3$3ONBN@ONBNCDMSQNCDK
canal.
 40

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ A,@MHNAQ@ř@SQœR@QQHA@ŚB ODQSTQ@CDK@FKNSHRSQ@R@K- LNRDK HQSQ@PlCDK@FKNSHRXKNDKDU@QD-
Y@CNCDK HQSQ@P .
l
LNRKHFDQ@LDMSDBNLNRDHKTRSQ@DMK@
%HFTQ@!
4M@UDY@KB@MY@C@K@@ADQSTQ@FK®SHB@
@ƦNI@QDLNR K@ SQ@BBH®M G@BH@ @QQHA@
antes de pasar el tubo por las cuerdas
UNB@KDRDRSNE@BHKHS@RTHMRDQBH®M
'@X PTD QDBNQC@Q PTD CDAHCN @K DID
%HFTQ@ $QQNQDRBNLTMDR
®OSHBN X @K B@M@K CDK FTH@CN DK TRT@-
QHNUHRT@KHY@K@O@QSDHYPTHDQC@CDK3$3
L@QB@C@ DM QNIN DM K@ %HFTQ@   X
CDAHCN@KAHRDKK@O@QSDCDQDBG@PTDDR
K@LœR@U@MY@C@L@QB@C@DM@YTKDMK@
%HFTQ@ MNRDUD /NQDRSNK@O@QSD
CDK 3$3 UHRHAKD L@QB@C@ DM QNIN DM K@
%HFTQ@ CDAD@OTMS@Q@K@HYPTHDQ-
da de las cuerdas vocales.
2HDK3$3BGNB@DMKNR@QHSDMNHCDRNDM
K@DOHFKNSHRDMK@L@XNQO@QSDCDKNRB@-
RNR TM KHFDQN FHQN @MSHGNQ@QHN CDK HQ-
%HFTQ@ ! (MRDQBH®MCDK3$3
SQ@Pl@XTC@Qœ@HMRDQS@QKN%HFTQ@  
2HBGNB@DMDK@QHSDMNHCDRCDQDBGNNDK
OKHDFTD @QHDOHFK®SHBN RD OTDCD @OKHB@Q
TMLNUHLHDMSNDMDROHQ@K@K3$3CDM-
SQNCDKB@M@KCDFTH@CNO@Q@NQHDMS@QKN
G@BH@K@RBTDQC@RUNB@KDR%HFTQ@!
$M @PTDKKNR B@RNR BNM TM@ @M@SNL¨@
@MNQL@K PTD CHƥBTKSD K@ HMSQNCTBBH®M
 41

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@  &HQN@MSHGNQ@QHNCDK HQSQ@Pl!,NUHLHDMSNDMDROHQ@KCDK3$3

CDK3$3DRQDBNLDMC@AKDDLOKD@QTMHMSQNCTB- TM@DWSTA@BH®M@BBHCDMS@K
SNQ%QNU@$RBGL@MM%HFTQ@  1DSHQ@QDK HQSQ@PlCDK@U¨@@¤QD@CDKO@BHDM-
+NRO@RNRO@Q@QDSHQ@QDK HQSQ@PlCDK@U¨@@¤- SDL@MSDMH¤MCNKNDMK@K¨MD@LDCH@
QD@TM@UDYQD@KHY@C@K@HMSTA@BH®MRNMKNRRH- $QQNQDR BNLTMDR DM K@ S¤BMHB@ CD HMSTA@BH®M
FTHDMSDR%HFTQ@ son:
 "NLOQNA@QK@OQNETMCHC@CCDHMRDQBH®MCDK  (MSDMS@Q HMRDQS@Q DK 3$3 @MSDR CD BNMRDFTHQ
3$3DHMƦ@QDKA@K®M TM@ATDM@UHRH®MCDK@RBTDQC@RUNB@KDR
 1DSHQ@QK@SDQ@KLDMSDDK3$3CDKB@M@KCDFTH@-  U@MBDBNMSHMTNCDK3$3RHMQDONRHBHNM@QDK
CN RTIDSœMCNKN DM RT ONRHBH®M O@Q@ DUHS@Q HQSQ@Pl.
 42

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ 4SHKHY@BH®MCDHMSQNCTBSNQBNLN@XTC@O@Q@K@HM- %HFTQ@ 1DBHBK@IDCDK HSQ@Pl

STA@BH®M

 #DL@RH@C@DKDU@BH®MCDK HQSQ@PlK@QDFH®M
interaritenoidea se ve muy baja en la ima-
FDM
 /NB@DKDU@BH®MCDK HQSQ@PlK@QDFH®MHMSDQ@-
QHSDMNHCD@RDUDLTX@KS@DMK@HL@FDM
 2@B@QDK3$3CDKB@M@KCDFTH@CNRHMBNLOQN-
barlo previamente.
$K QDBHBK@ID CDK CHRONRHSHUN RD QD@KHY@ DM OQH-
LDQ KTF@Q QDSHQ@MCN DK UHRNQ X DM RDFTMCN KT-
F@Q@AQHDMCNK@S@O@QDSHQ@MCNXCDRDBG@MCN@
BNMSHMT@BH®MK@ROHK@RRDFµMK@ONK¨SHB@CDQDBH-
BK@IDCDB@C@GNROHS@K%HFTQ@

GRUPOS DE POBLACIÓN ESPECIALES:

$K HQSQ@Pl RD G@ LNRSQ@CN RTODQHNQ @K K@QHM-
FNRBNOHN,@BHMSNRGDMFQTONRDMKNRPTDONQ
%HFTQ@ 1DSHQ@C@CDK HQSQ@PlCDK@U¨@@¤QD@ E@BSNQDR@M@S®LHBNRK@HMBHCDMBH@CDU¨@@¤QD@
 43

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

CHE¨BHKDRLœRDKDU@C@ King Vision® y King Vision® aBlade™
 .ADRNRL®QAHCNR $K*HMF5HRHNMl%HFTQ@ DRTMUHCDNK@QHM-
 $LA@Q@Y@C@R@S¤QLHMN FNRBNOHN CHRSQHATHCN DM $RO@¬@ ONQ K@ ƥQL@
 /@BHDMSDRBNMHMLNUHKHY@BH®MBDQUHB@K Ambul @RDPTHAKD QDRHRSDMSD X ONQSœSHK  $RSœ
$MNADRNRL®QAHCNRRDQDBNLHDMC@HMSQNCTBHQ CHRD¬@CNO@Q@K@K@QHMFNRBNOH@HMCHQDBS@S@MSN
DKCHRONRHSHUN@KQDU¤RCDKNG@AHST@KBNLNRH O@Q@K@RHMSTA@BHNMDRDMCNSQ@PTD@KDRCHE¨BHKDR
ETDQ@ TM@ BœMTK@ CD &TDCDK CHQHFH¤MCNKN G@- como para las intubaciones rutinarias.
BH@DKO@K@C@QO@Q@FHQ@QKN@BNMSHMT@BH®MDMDK 2DBNLDQBH@KHY@BNMSHONRCDO@K@RCDRDBG@-
HMSDQHNQ CD K@ ANB@ %HFTQ@   $RS@ L@MHNAQ@ AKDRTM@2(-B@M@KXNSQ@".-B@M@KO@Q@FTH@Q
DUHS@PTDK@YNM@CDKUHRNQBGNPTDBNMDKS®Q@W K@BNKNB@BH®MCDKSTANDMCNSQ@PTD@K +@RO@K@R
CDKO@BHDMSDDUHS@DKSQ@TL@SHRLNDMK@U¨@@¤- ".- B@M@K ODQLHSDM K@ HMRDQBH®M CD STANR CD
QD@RTODQHNQODQLHSDTM@HMSTA@BH®MLœREœBHK S@L@¬NRBNLOQDMCHCNRDMSQDXLLCD
XRDFTQ@ CHœLDSQNXQDPTHDQDMTM@@ODQSTQ@ATB@KL¨MH-
$MO@BHDMSDRBNMHMLNUHKHY@BH®MBDQUHB@KK@TSH- ma de 18 mm.
KHY@BH®MCDK HQSQ@PlQDCTBDDKQHDRFNCDE@KKN La desventaja de emplear las palas sin canal
DR PTD BNLN DM NSQNR
UHCDNK@QHMFNRBNOHNR BNM
%HFTQ@ (MRDQBH®MDMNADRHC@CL®QAHC@(L@FDMNASDMHC@DMVVV MDRSDRH@1 NQF DRSD SHON CD O@K@R RD
OQDBHR@ OQœBSHB@ X OQD-
ENQL@Q DK STAN DMCNSQ@-
PTD@K BNM TM DRSHKDSD N
ƥ@CNQ N DLOKD@Q TM HM-
troductor. En esta revi-
RH®M MNR QDEDQHQDLNR @K
DLOKDNCDK*HMF5HRHNMl
BNMO@K@".-B@M@K
$K *HMF 5HRHNMl @!K@CDŷ
%HFTQ@ ! RD CHEDQDM-
 44

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

%HFTQ@ ! "@Q@BSDQ¨RSHB@RCDK*HMF5HRHNMlX*HMF5HRHNMl@!K@CDŷ

BH@CDKMNQL@KDMPTDDKRHRSDL@CDUHCDNDRSœ @CTKSNRXODCHœSQHBNR
HMSDFQ@CNDMDKL@MFNXK@RO@K@RCDRDBG@AKDR
RD @BNOK@M @KQDCDCNQ CD DRSD  (FT@KLDMSD RD TÉCNICA DE INTUBACIÓN:
BNLDQBH@KHY@BNMSHONRCDO@K@RCDRDBG@AKDR 2DFTHQDLNR KNR RHFTHDMSDR O@RNR O@Q@ RT OQD-
".- X 2(- B@M@K DM S@L@¬NR O@Q@ O@BHDMSDR O@Q@BH®M
 45

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

- Conectar la pala y encender el dispositivo; el CDKSTANBNMDKƥM@KCDKB@M@KRHMRNAQDO@-
HMCHB@CNQCDKDRS@CNCDK@A@SDQ¨@CDADDRS@Q R@QKN%HFTQ@!

CDBNKNQUDQCD%HFTQ@ RHO@QO@CD@DM 2TIDS@QDLNRDKCHRONRHSHUNBNMDKOTKF@QDMK@
rojo deben sustituirse las pilas. O@QSD@MSDQHNQXDKRDFTMCNSDQBDQXBT@QSNCD-
 +TAQHB@Q @CDBT@C@LDMSD DK B@M@K %HFTQ@ CNRDMK@ONRSDQHNQ%HFTQ@ 

!X@R¨DUHS@QQNSTQ@RCDKA@K®MCDKSTAN +NHMRDQS@QDLNRDMK@K¨MD@LDCH@CDK@ANB@

Debemos obtener una vi-
RH®M CD K@ FKNSHR BDMSQ@C@
%HFTQ@ !
/QDO@Q@BH®MCDK*HMF5HRHNMl.
pero sin acercarnos de-
L@RH@CN @ DKK@ ONQ DKKN
es muy importante no in-
troducir en exceso el dis-
positivo para obtener una
UHRH®M O@MNQœLHB@ CD K@
DOHFKNSHRXK@RBTDQC@RUN-
B@KDR
"NLNDMDK HQSQ@Pl
DRONRHAKDPTDRDMDBDRHSD
TM@ KHFDQ@ DKDU@BH®M @M-
SDQHNQ O@Q@ UHRT@KHY@Q K@R
BTDQC@R UNB@KDR %HFTQ@
!

En pacientes obesos se re-
comienda insertar lateral-
mente el dispositivo para
DMCNSQ@PTD@K
$RQDBNLDMC@AKDMNQD@KHY@QK@ DUHS@Q DK BGNPTD BNM DK ODBGN
 $M DK B@RN CD
BNMFDKO@Q@DUHS@QPTDOTDC@DLO@¬@QRDK@ K@O@K@".-B@M@K%HFTQ@QDBNLHDMC@MHM-
lente. SQNCTBHQK@CDRCDDKK@CNHYPTHDQCNDMK@RO@K@R
 #DRKHY@QDK3$3ONQDKB@M@K@KHMD@MCNDKƥM@K 2(-B@M@KQDBNLHDMC@MCDRCDDKK@CNCDQDBGN


0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,
0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,,
%HFTQ@
A2TIDBH®MB(MRDQBH®MCDK*HMF5HRHNMl.
(MRDQBH®MDMO@BHDMSDNADRN
/@Q@HMRDQS@QDK3$3CDAD@U@MY@QRDKDMS@LDM-
SDBNQQHFHDMCNK@ONRHBH®MRHDLOQDPTDRD@MD-
cesario.
#TQ@MSD K@ HMRDQBH®M ONCDLNR DMBNMSQ@QMNR
BNMKNRRHFTHDMSDROQNAKDL@RXQDBTQQHQ@K@RRH-
FTHDMSDRRNKTBHNMDR
46
MANEJO MÉDICO
%HFTQ@
OKHDFTD@QHDOHFK®SHBNBNLNRDQDBNLDMC@A@
BNMDK HQSQ@PlRDOTDCDQD@KHY@QTMFHQN@M-
SHGNQ@QHNBNMDKSTAN%HFTQ@CDL@MDQ@
PTDPTDCDDKAHRDK@K@HYPTHDQC@NAHDMQD@-
KHY@QDKFHQN@MSHGNQ@QHNBNMDK*HMF5HRHNMl.
.SQNRQDBTQRNRO@Q@QDRNKUDQOQNAKDL@RCTQ@M-
 $K 3$3 RD CDROK@Y@ G@BH@ K@ O@QSD ONRSDQHNQ SDK@HMRDQBH®MCDK3$3RNM
ONCDLNR BNQQDFHQ K@ ONRHBH®M @KDIœMCNMNR  "NKNB@QDK3$3DMDKB@M@KHMUHQSHDMCNK@BTQ-
CDK@FKNSHRXDKDU@MCNKHFDQ@LDMSDDKCHRON- vatura normal del mismo.
RHSHUNBNLNRDDWOKHB®OQDUH@LDMSD
 $LOKD@QTMHMSQNCTBSNQPTDMNRODQLHS@CHQH-
 $K 3$3 BGNB@ BNM DK@QHSDMNHCDR CDQDBGN N FHQDK3$3G@BH@K@FKNSHR%HFTQ@

 47

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

4SHKHY@Q DK CHRONRHSHUN
BNLNTM@O@K@CD,HKKDQ
esto es especialmente
recomendable en: epi-
FKNSHR FQ@MCDR PTD NAR-
SQTXDM K@ UHRH®M X MN RD
KDU@MS@M BNM E@BHKHC@C X
DMFQ@CNR@KSNRCDK@BK@-
RHƥB@BH®M CD "NQL@BJ
%HFTQ@ &HQN@MSHGNQ@QHNBNMDK3$3
+DG@MD PTD MN LDINQ@M
BNMK@L@MHNAQ@CD!41/
$K *HMF 5HRHNMl no debe
QDSHQ@QRD CD K@ U¨@ @¤QD@
G@RS@ G@ADQ GHMBG@CN DK
A@K®M X BNLOQNA@CN K@
BNQQDBS@ BNKNB@BH®M CDK
3$3  1DSHQ@QDLNR K@ O@K@
sujetando el tubo y com-
OQNA@MCNPTDMNRDG@M
producido daños en las
DRSQTBSTQ@R CD K@ NQNE@-
QHMFD
El dispositivo emplea 3
OHK@R@KB@KHM@R DKQD-
cambio de las mismas se
HKTRSQ@DMK@%HFTQ@

%HFTQ@ $LOKDNCDHMSQNCTBSNQ%QNU@CTQ@MSDK@HMSTA@BH®MBNM*HMF5HRHNMl.
 48

0DQHMRGHOD9®D$ªUHD'LI®FLO3DUWH,, MANEJO MÉDICO

&DQRSDHM -2 !Q@TCD #  'TMF . DS @K  3GD
%@RSQ@BG (MSTA@SHMF +@QXMFD@K ,@RJ HQV@X
an overview and update. "@M ) M@DRSG 
2010;57:588-601.

,B&HKK)  HQV@XL@M@FDLDMSHMSQ@TL@@MTO-
date.$LDQF,DC"KHM-NQSG L
2007;25:603-22.
%HFTQ@ 1DDLOK@YNCDK@ROHK@RDMDK*HMF5HRHNMl.
/@Y # KH@¬N , 2DQM@ ,! DS @K  Dispositivos
OTROS DISPOSITIVOS CON PALA CON CANAL: 3Q@MRFK®SHBNR $M,@QHRB@K,+,@QS¨MDY$#DC 
Pentax-AWS®. ,@MT@KCDL@MDINCDK@U¨@@¤QD@CHE¨BHK/TDR-
S@@KC¨@  MDRSDRH@1 O 
71.

Más información: ,@QS¨MDY $# ,@QHRB@K ,+ DS @K  Dispositivos

®OSHBNR  $M ,@QHRB@K ,+ ,@QS¨MDY $# DC  B-
'HFFR  ,B&Q@SG !  &NCC@QC " DS @K  &TH- ST@KHY@BHNMDRDMU¨@@¤QD@CHE¨BHK/TDRS@@KC¨@
CDKHMDR ENQ SGD L@M@FDLDMS NE SQ@BGD@K HM- 2014-2015. AnestesiaR; 2015. p. 51-143.
tubation in critically ill adults  !Q ) M@DRSG 
2018;120:323-52.

%QDQJ " ,HSBGDKK 52 ,B-@QQX % DS @K  #HƧ-

BTKS HQV@X 2NBHDSX HMSTA@SHNM FTHCDKHMDR
VNQJHMF FQNTO  #HƧBTKS HQV@X 2NBHDSX 
FTHCDKHMDR ENQ L@M@FDLDMS NE TM@MSHBHO@-
SDCCHƧBTKSHMSTA@SHNMHM@CTKSR !Q) M@DRSG 
2015;115:827-48. +NR@TSNQDRCDDRSD@QS¨BTKNCDBK@Q@MMNSDMDQBNMƦHBSNCDHMSDQDRDR