No description available.

O uso de antissépticos complementa a higienização bucal reduzindo a microbiota e, consequentemente minimizando a colonização, a formação de biofilme e, assim promovendo a saúde bucal. Diante das opções de antissépticos bucais e produtos naturais, faz-se necessária a análise microbiológica da eficácia desses produtos e suas implicações no controle do biofilme. Neste sentido, têm-se como objetivos: determinar a diluição inibitória máxima (DIMax) de antissépticos bucais (Listerine®, Colgate Plax® Tea Fresh, Periogard®) e o óleo de melaleuca sobre as cepas de Candida albicans e Candida glabrata, clínicas e padrão; quantificar as unidades formadoras de colônias por tubo traqueal (UFC/TT) das leveduras em TTs revestidos com os respectivos produtos e, analisar a formação de biofilme em fragmentos de tubos revestidos ou não com antissépticos e óleo de melaleuca por C. glabrata. Trata-se de um estudo de natureza laboratorial, in vitro, realizado com cepas clinicas e padrão e subsidiado em métodos clássicos da microbiologia para o processamento das avaliações propostas. Para determinar a DIMax, realizou-se a diluição dupla seriada (1/4 a 1/4096) dos antissépticos e óleo de melaleuca respectivamente, sendo as placas incubadas a 37°C por 24 horas. Considerou-se DIMax a maior diluição capaz de inibir o crescimento de todas as cepas avaliadas. Na formação de biofilme foram empregadas duas técnicas: determinação das UFC/TT e microscopia eletrônica de varredura (MEV). Na aleatorização das cepas C. glabrata utilizou-se a análise estatística pelo modelo de regressão logístico multinomial. A partir da análise dos resultados observou-se que o Listerine® apresentou a menor ação inibitória na DIMax de 1/4, óleo de melaleuca (1/16), Colgate Plax® Tea Fresh (1/64) e o Periogard® (1/128). Em termos de formação de biofilme, o tubo revestido com Colgate Plax® Tea Fresh apresentou diferença no teste de comparações múltiplas (p=0,0031), com atividade antibiofilme em todas as cepas de C. glabrata, com exceção de um isolado clínico. As fotomicrografias revelaram reprodução por brotamento presente no TT revestido com óleo de melaleuca, lise celular na ação do Periogard® e, os TTs revestidos com Colgate Plax® Tea Fresh não apresentaram biofilme, exceto na cepa 33. A formação de biofilme por células leveduriformes foi significativa apresentando-se de forma diversificada nos diferentes tubos revestidos. Estudos adicionais sobre Candida spp. em tubos traqueais são recomendáveis em pacientes, com e sem pneumonia, submetidos à ventilação mecânica / Introduction: The use of oral antiseptics is increasingly common, as a complement to the regular oral hygiene by reducing the oral microbiota, biofilm formation and thereby promoting oral health. Facing of several oral antiseptics and natural products, it is necessary microbiological analysis of the effectiveness of these antiseptics and in its implications in the control of biofilm. Objective: The aims of the study were to determine the maximum inhibitory dilution (MID) oral antiseptics (Listerine®, Colgate® Plax, Fresh Tea and Periogard®) and tea tree oil of clinical and standard strains of Candida spp. and Candida glabrata; colony forming units assay (CFU/TT) of yeast in tracheostomy tubes (TT) coated with some products; and analyze the biofilm formed in fragments of tubes coated or not with oral antiseptics and tea tree oil for Candida glabrata. Methods: This is a laboratory investigation, in vitro study performed with clinical and standard strains and subsidized of classical microbiology methods for processing the proposals reviews. To determine the MID, serial dilution was carried out (1/4 a 1/2048) of oral antiseptics and tea tree oil respectively, and the plates were incubated at 37°C for 24h. The MID was considered the highest dilution capable of inhibiting the growth of all strains tested. In biofilm formation two techniques were employed: determination of colony forming units (CFU/TT) and scanning electron microscopy (SEM). The statistical analysis by multinomial logistic regression model was used to randomization strains of C. glabrata. Results: Listerine® showed the worst performance, MID (1/4), tea tree oil (1/16), Colgate Plax® Fresh Tea (1/64) and Periogard® (1/128). In terms of biofilm formation, the multiple comparisons test presented differences (p=0.0031) for tube coated Colgate Plax® Tea Fresh with antibiofilm activity in all strains of C. glabrata, except for one clinical isolate. The photomicrographs revealed reproduction by budding in the TT coated with tea tree oil, cell lysis in action of Periogard®, and the Colgate Plax® Fresh Tea coated tube produced no visible colony, except with strain 33. Conclusion: Biofilm formation by yeast was significant presenting diverse in different coated tubes. Additional studies of Candida spp. in tracheostomy tubes are recommended in patients with and without pneumonia, undergoing mechanical ventilation

O uso de antissépticos complementa a higienização bucal reduzindo a microbiota e, consequentemente minimizando a colonização, a formação de biofilme e, assim promovendo a saúde bucal. Diante das opções de antissépticos bucais e produtos naturais, faz-se necessária a análise microbiológica da eficácia desses produtos e suas implicações no controle do biofilme. Neste sentido, têm-se como objetivos: determinar a diluição inibitória máxima (DIMax) de antissépticos bucais (Listerine®, Colgate Plax® Tea Fresh, Periogard®) e o óleo de melaleuca sobre as cepas de Candida albicans e Candida glabrata, clínicas e padrão; quantificar as unidades formadoras de colônias por tubo traqueal (UFC/TT) das leveduras em TTs revestidos com os respectivos produtos e, analisar a formação de biofilme em fragmentos de tubos revestidos ou não com antissépticos e óleo de melaleuca por C. glabrata. Trata-se de um estudo de natureza laboratorial, in vitro, realizado com cepas clinicas e padrão e subsidiado em métodos clássicos da microbiologia para o processamento das avaliações propostas. Para determinar a DIMax, realizou-se a diluição dupla seriada (1/4 a 1/4096) dos antissépticos e óleo de melaleuca respectivamente, sendo as placas incubadas a 37°C por 24 horas. Considerou-se DIMax a maior diluição capaz de inibir o crescimento de todas as cepas avaliadas. Na formação de biofilme foram empregadas duas técnicas: determinação das UFC/TT e microscopia eletrônica de varredura (MEV). Na aleatorização das cepas C. glabrata utilizou-se a análise estatística pelo modelo de regressão logístico multinomial. A partir da análise dos resultados observou-se que o Listerine® apresentou a menor ação inibitória na DIMax de 1/4, óleo de melaleuca (1/16), Colgate Plax® Tea Fresh (1/64) e o Periogard® (1/128). Em termos de formação de biofilme, o tubo revestido com Colgate Plax® Tea Fresh apresentou diferença no teste de comparações múltiplas (p=0,0031), com atividade antibiofilme em todas as cepas de C. glabrata, com exceção de um isolado clínico. As fotomicrografias revelaram reprodução por brotamento presente no TT revestido com óleo de melaleuca, lise celular na ação do Periogard® e, os TTs revestidos com Colgate Plax® Tea Fresh não apresentaram biofilme, exceto na cepa 33. A formação de biofilme por células leveduriformes foi significativa apresentando-se de forma diversificada nos diferentes tubos revestidos. Estudos adicionais sobre Candida spp. em tubos traqueais são recomendáveis em pacientes, com e sem pneumonia, submetidos à ventilação mecânica / Introduction: The use of oral antiseptics is increasingly common, as a complement to the regular oral hygiene by reducing the oral microbiota, biofilm formation and thereby promoting oral health. Facing of several oral antiseptics and natural products, it is necessary microbiological analysis of the effectiveness of these antiseptics and in its implications in the control of biofilm. Objective: The aims of the study were to determine the maximum inhibitory dilution (MID) oral antiseptics (Listerine®, Colgate® Plax, Fresh Tea and Periogard®) and tea tree oil of clinical and standard strains of Candida spp. and Candida glabrata; colony forming units assay (CFU/TT) of yeast in tracheostomy tubes (TT) coated with some products; and analyze the biofilm formed in fragments of tubes coated or not with oral antiseptics and tea tree oil for Candida glabrata. Methods: This is a laboratory investigation, in vitro study performed with clinical and standard strains and subsidized of classical microbiology methods for processing the proposals reviews. To determine the MID, serial dilution was carried out (1/4 a 1/2048) of oral antiseptics and tea tree oil respectively, and the plates were incubated at 37°C for 24h. The MID was considered the highest dilution capable of inhibiting the growth of all strains tested. In biofilm formation two techniques were employed: determination of colony forming units (CFU/TT) and scanning electron microscopy (SEM). The statistical analysis by multinomial logistic regression model was used to randomization strains of C. glabrata. Results: Listerine® showed the worst performance, MID (1/4), tea tree oil (1/16), Colgate Plax® Fresh Tea (1/64) and Periogard® (1/128). In terms of biofilm formation, the multiple comparisons test presented differences (p=0.0031) for tube coated Colgate Plax® Tea Fresh with antibiofilm activity in all strains of C. glabrata, except for one clinical isolate. The photomicrographs revealed reproduction by budding in the TT coated with tea tree oil, cell lysis in action of Periogard®, and the Colgate Plax® Fresh Tea coated tube produced no visible colony, except with strain 33. Conclusion: Biofilm formation by yeast was significant presenting diverse in different coated tubes. Additional studies of Candida spp. in tracheostomy tubes are recommended in patients with and without pneumonia, undergoing mechanical ventilation

A research report submitted in partial fulfilment of the requirements for the degree Master of Science in Medicine in the Field of Emergency Medicine in the Division of Emergency Medicine, University of the Witwatersrand / Introduction: Control over the patient bears time-critical importance in emergency medicine. In the entrapment situation after a Motor Vehicle Collision (MVC), emergency care including airway management may need to be initiated before extrication and thus with restricted access. Objective: This manikin study aimed at answering the question of which advanced airway device can be inserted the fastest and most reliably by paramedics in the simulated entrapped patient. Methods: Paramedics were asked to insert four airway devices (endotracheal tube with the Macintosh laryngoscope, endotracheal tube with the Airtraq® optical laryngoscope, Laryngeal Mask Airway - SupremeTM, and Laryngeal Tube Suction - DisposableTM) in randomised order into a manikin seated in the driver seat of a light motor vehicle. Time to first successful ventilation and number of attempts required for successful insertion were measured. Following each insertion, participants were asked by means of a questionnaire to rate the degree of insertion difficulty (scale 1 – 10) and provide reasons for this rating. Finally, participants were asked which device they preferred and why. Results: Prospectively collected data from 26 paramedics were analysed. The LMA-SupremeTM had the shortest mean time to first successful ventilation (16.7 seconds (CI [0.95]; 14.9 - 18.6)), followed by the LTS-DTM (19.4 seconds (CI [0.95]; 18.0 - 20.8)), ETI using the Macintosh laryngoscope (37.7 seconds (CI [0.95]; 31.8 - 43.5)) and ETI using the Airtraq® (41.2 seconds (CI [0.95]; 36.7 - 45.6)). Both face-to-face ETI with the Macintosh laryngoscope and the insertion of the LMA-SupremeTM had 100% first-attempt success. Five participants required a second attempt to successfully intubate the manikin using the Airtraq® and one participant had to re-insert the LTS-DTM for correct placement. In terms of insertion difficulty, the LMA-SupremeTM received the lowest mean score (1.7/10 (CI [0.95]; 1.2 - 2.1)) followed by the LTS-DTM (2.5/10 (CI [0.95]; 1.8 – 3.2)), face-to-face ETI using the Macintosh laryngoscope (3.7/10 (CI [0.95]; 2.9 - 4.5)), and ETI with the Airtraq® (4.5/10 (CI [0.95]; 3.7 - 5.3)). Most participants chose the Macintosh laryngoscope for ETI as their preferred device (10/26; 38%) followed closely by the LMA-SupremeTM (9/26; 35%). These participants stated clinical experience and ease of insertion respectively as the primary reasons for their preference. Conclusion: Besides ETI, Supraglottic Airway Devices are beneficial alternative airway devices to be considered by paramedics in the entrapped patient after a MVC. The LMA-SupremeTM was the fastest and least difficult airway device to insert. Face-to-face endotracheal intubation with the Macintosh laryngoscope remains an important definitive airway that was shown to be performed competently by participating paramedics. The Airtraq® can be used for face-to-face ETI and enables improved laryngoscopy.

Os primeiros indícios de tentativas de abordagem e manejo da via aérea (VA) datam de cerca de 4000 anos. A intubação traqueal (IT) consiste na introdução de um tubo na luz da traquéia, e é responsável por salvar muitas vidas. O manejo da VA nos serviços de emergência é um dos principais desafios e seguramente um dos momentos mais críticos do cuidado com o paciente grave. As principais complicações e efeitos adversos da IT decorrem da laringoscopia direta e da introdução do tubo traqueal na VA. A sequência rápida de intubação (SRI) é a realização do procedimento de IT através de uma abordagem organizada que envolve a utilização de agentes sedativos, analgésicos e bloqueador neuromuscular. A SRI tem por objetivo diminuir ou limitar os efeitos adversos do procedimento de IT, em especial da laringoscopia direta. A SRI é o método de escolha na maioria dos procedimentos de IT de emergência em pediatria na literatura internacional. Os registros de dados sobre o manejo da VA em serviços de emergência pediátricos no Brasil são raros e não abordam a SRI como técnica de IT. Dessa forma os objetivos do presente estudo foram descrever a experiência do pronto-socorro de um hospital pediátrico de atendimento terciário com o uso da SRI, e detectar possíveis fatores associados ao sucesso da SRI. Para tanto foi realizado estudo prospectivo observacional tipo \"coorte\" de julho de 2005 a dezembro de 2007, onde foram coletados os dados relacionados a todas as ITs realizadas no pronto-socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP). Foram incluídos no estudo todos os pacientes que foram submetidos a SRI. Foi considerado IT com sucesso aquela realizada na primeira tentativa. O registro dos dados foi realizado pelo profissional que participou diretamente do procedimento em formulário específico. Durante o período de estudo ocorreram 117 ITs, sendo que 84% delas foram realizadas sob SRI; a idade dos pacientes variou de 29 dias a 17 anos (mediana=4,4anos) e 60% eram do sexo masculino; setenta e nove por cento eram portadores de patologias de base, sendo 21% doenças neurológicas, 18% oncológicas e 8% respiratórias; a insuficiência respiratória aguda foi a causa imediata da IT em 40% dos procedimentos e alteração do nível de consciência e choque em 20% e 18% respectivamente; todas as ITs foram realizadas no pronto-socorro e por um dos médicos da equipe; a taxa de sucesso foi de 39%; o residente de pediatria do segundo ano foi o responsável por 74% das ITs, e com taxa de sucesso de 35%; foi realizada ventilação com pressão positiva em 74% dos procedimentos, sendo menor a sua utilização entre os pacientes que foram intubados com sucesso (21 versus 49 p=0,002). O midazolam foi o sedativo de escolha, utilizado em 80% dos procedimentos, e o rocurônio foi o bloqueador neuromuscular em 100% dos procedimentos; complicações decorrentes da SRI foram descritas em 75 (80%) dos procedimentos, sendo queda da saturação de oxigênio relatada em 47% do total, e significativamente menor nos pacientes que foram intubados com sucesso (p<0.001); dificuldades relativas à IT foram menos relatadas nos procedimentos realizados com sucesso (p<0,001). Em conclusão, pode-se afirmar que a SRI foi o método de escolha nas ITs realizadas no pronto-socorro do ICr-HCFMUSP, que a população que necessitou de manejo da via aérea foi composta em sua grande maioria por pacientes portadores de doenças de base com problemas respiratórios e que, complicações do procedimento de SRI são mais frequentes quando há necessidade de maior número de tentativas de laringoscopia direta. / The first signs of attempts to approach and manage airways date from about 4000 years. The tracheal intubation (TI) consists in to introduce a tube in the trachea lumen and it is responsible for saving many lives. The airway management in the emergency services is one of the most challenges and critical moments of care for the critically ill patient. The major complications and adverse effects of TI stem from the direct laryngoscopy and tracheal tube introduction into the airway. The Rapid Sequence Intubation (RSI) is the actual procedure of TI through an organized approach that involves the use of sedative agents, analgesics and neuromuscular blocker. The objective of SRI is to minimize and limit the main adverse effects of the TI procedure and in special of the direct laryngoscopy. SRI is the method of choice in most of TI procedures in emergency pediatrics in the international literature. The data records on airway management in pediatric emergency services are rare and do not address the SRI as a technique to perform TI. The objectives of this study were to describe the experience of a pediatric tertiary care emergency department with the use of RSI, and identify possible factors associated with the success of RSI. For this, a prospective observational study type \"cohort\" was conducted from July 2005 through December 2007, where all data related to TI performed in the emergency room of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP) was collected. The study included all patients who underwent to RSI. Intubation was considered successful when it was performed on the first try. Data registration was done by the professional who directly participated in the procedure in a specific form. During the study period 117 tracheal intubations were performed, and 84% of these events were held under RSI; the patients\' ages ranged from 29 days to 17 years (median = 4.4 years) and 60 % were male; seventy-nine percent of patients had underlying diseases, 21% of them were neurological diseases, 18% cancer and 8% respiratory diseases; the acute respiratory failure was the immediate cause of TI in 40% of the procedures and altered level of consciousness and shock in 20% and 18% respectively; all TIs were performed in the emergency room by emergency physician with success rate of 39%; the pediatric resident\'s from the second year was responsible for 74% of the TIs, and with a success rate of 35%; positive pressure ventilation was performed in 74% of procedures, their use was lower among patients who were successfully intubated (21 vs. 49 p = 0.002); Midazolam was chosen as a sedative in 80% of procedures, and rocuronium as a neuromuscular blocking agent in 100% of procedures; Complications from the procedure of TI have been described in 75 (80%) of procedures, where a decrease in oxygen saturation was reported by 47% and significantly lower in patients who were successfully intubated (p <0.001). Difficulties related to TI were reported less in procedures performed with success (p <0.001). In conclusion, it can be stated that RSI was the method of choice in TI performed in the emergency room of ICr-FMUSP, that the patients who required airway management was composed mostly of patients with underlying diseases with respiratory problems and that complications of the RSI procedure are more frequent when there is need for a higher number of direct laryngoscopy attempts.

No description available.

Os primeiros indícios de tentativas de abordagem e manejo da via aérea (VA) datam de cerca de 4000 anos. A intubação traqueal (IT) consiste na introdução de um tubo na luz da traquéia, e é responsável por salvar muitas vidas. O manejo da VA nos serviços de emergência é um dos principais desafios e seguramente um dos momentos mais críticos do cuidado com o paciente grave. As principais complicações e efeitos adversos da IT decorrem da laringoscopia direta e da introdução do tubo traqueal na VA. A sequência rápida de intubação (SRI) é a realização do procedimento de IT através de uma abordagem organizada que envolve a utilização de agentes sedativos, analgésicos e bloqueador neuromuscular. A SRI tem por objetivo diminuir ou limitar os efeitos adversos do procedimento de IT, em especial da laringoscopia direta. A SRI é o método de escolha na maioria dos procedimentos de IT de emergência em pediatria na literatura internacional. Os registros de dados sobre o manejo da VA em serviços de emergência pediátricos no Brasil são raros e não abordam a SRI como técnica de IT. Dessa forma os objetivos do presente estudo foram descrever a experiência do pronto-socorro de um hospital pediátrico de atendimento terciário com o uso da SRI, e detectar possíveis fatores associados ao sucesso da SRI. Para tanto foi realizado estudo prospectivo observacional tipo \"coorte\" de julho de 2005 a dezembro de 2007, onde foram coletados os dados relacionados a todas as ITs realizadas no pronto-socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP). Foram incluídos no estudo todos os pacientes que foram submetidos a SRI. Foi considerado IT com sucesso aquela realizada na primeira tentativa. O registro dos dados foi realizado pelo profissional que participou diretamente do procedimento em formulário específico. Durante o período de estudo ocorreram 117 ITs, sendo que 84% delas foram realizadas sob SRI; a idade dos pacientes variou de 29 dias a 17 anos (mediana=4,4anos) e 60% eram do sexo masculino; setenta e nove por cento eram portadores de patologias de base, sendo 21% doenças neurológicas, 18% oncológicas e 8% respiratórias; a insuficiência respiratória aguda foi a causa imediata da IT em 40% dos procedimentos e alteração do nível de consciência e choque em 20% e 18% respectivamente; todas as ITs foram realizadas no pronto-socorro e por um dos médicos da equipe; a taxa de sucesso foi de 39%; o residente de pediatria do segundo ano foi o responsável por 74% das ITs, e com taxa de sucesso de 35%; foi realizada ventilação com pressão positiva em 74% dos procedimentos, sendo menor a sua utilização entre os pacientes que foram intubados com sucesso (21 versus 49 p=0,002). O midazolam foi o sedativo de escolha, utilizado em 80% dos procedimentos, e o rocurônio foi o bloqueador neuromuscular em 100% dos procedimentos; complicações decorrentes da SRI foram descritas em 75 (80%) dos procedimentos, sendo queda da saturação de oxigênio relatada em 47% do total, e significativamente menor nos pacientes que foram intubados com sucesso (p<0.001); dificuldades relativas à IT foram menos relatadas nos procedimentos realizados com sucesso (p<0,001). Em conclusão, pode-se afirmar que a SRI foi o método de escolha nas ITs realizadas no pronto-socorro do ICr-HCFMUSP, que a população que necessitou de manejo da via aérea foi composta em sua grande maioria por pacientes portadores de doenças de base com problemas respiratórios e que, complicações do procedimento de SRI são mais frequentes quando há necessidade de maior número de tentativas de laringoscopia direta. / The first signs of attempts to approach and manage airways date from about 4000 years. The tracheal intubation (TI) consists in to introduce a tube in the trachea lumen and it is responsible for saving many lives. The airway management in the emergency services is one of the most challenges and critical moments of care for the critically ill patient. The major complications and adverse effects of TI stem from the direct laryngoscopy and tracheal tube introduction into the airway. The Rapid Sequence Intubation (RSI) is the actual procedure of TI through an organized approach that involves the use of sedative agents, analgesics and neuromuscular blocker. The objective of SRI is to minimize and limit the main adverse effects of the TI procedure and in special of the direct laryngoscopy. SRI is the method of choice in most of TI procedures in emergency pediatrics in the international literature. The data records on airway management in pediatric emergency services are rare and do not address the SRI as a technique to perform TI. The objectives of this study were to describe the experience of a pediatric tertiary care emergency department with the use of RSI, and identify possible factors associated with the success of RSI. For this, a prospective observational study type \"cohort\" was conducted from July 2005 through December 2007, where all data related to TI performed in the emergency room of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP) was collected. The study included all patients who underwent to RSI. Intubation was considered successful when it was performed on the first try. Data registration was done by the professional who directly participated in the procedure in a specific form. During the study period 117 tracheal intubations were performed, and 84% of these events were held under RSI; the patients\' ages ranged from 29 days to 17 years (median = 4.4 years) and 60 % were male; seventy-nine percent of patients had underlying diseases, 21% of them were neurological diseases, 18% cancer and 8% respiratory diseases; the acute respiratory failure was the immediate cause of TI in 40% of the procedures and altered level of consciousness and shock in 20% and 18% respectively; all TIs were performed in the emergency room by emergency physician with success rate of 39%; the pediatric resident\'s from the second year was responsible for 74% of the TIs, and with a success rate of 35%; positive pressure ventilation was performed in 74% of procedures, their use was lower among patients who were successfully intubated (21 vs. 49 p = 0.002); Midazolam was chosen as a sedative in 80% of procedures, and rocuronium as a neuromuscular blocking agent in 100% of procedures; Complications from the procedure of TI have been described in 75 (80%) of procedures, where a decrease in oxygen saturation was reported by 47% and significantly lower in patients who were successfully intubated (p <0.001). Difficulties related to TI were reported less in procedures performed with success (p <0.001). In conclusion, it can be stated that RSI was the method of choice in TI performed in the emergency room of ICr-FMUSP, that the patients who required airway management was composed mostly of patients with underlying diseases with respiratory problems and that complications of the RSI procedure are more frequent when there is need for a higher number of direct laryngoscopy attempts.

<p>Uvod: Adenoidektomija sa tonzilektomijom je najče&scaron;će indikovana hirur&scaron;ka intervencija u dečjem uzrastu. Intervencija se izvodi u op&scaron;toj anesteziji. Endotrahealni tubus predstavlja &bdquo;zlatni standard&ldquo; za obezbeđenje disajnog puta u dečjoj otorinolaringolo&scaron;koj hirurgiji. Upotreba endotrahealnog tubusa nosi rizike od nastanka komplikacija koje se mogu javiti pri uvodu u op&scaron;tu anesteziju, u toku hirur&scaron;ke intervencije i nakon ekstubacije deteta. Učestalost komplikacija se može smanjiti upotrebom supraglotičnih sredstava. Fleksibilna laringealna maska spada u prvu generaciju supraglotičnih sredstava, koja omogućava zadovoljavajuću oksigenaciju i ventilaciju bolesnika u ORL hirurgiji. Cilj istraživanja: Utvrditi: efikasnost fleksibilne laringealne maske u za&scaron;titi disajnog puta od aspiracije krvi i sekreta gornjih disajnih puteva u odnosu na endotrahealni tubus u toku adenotonzilektomije; da li primena fleksibilne laringealne maske u zbrinjavanju disajnog puta u toku adenotonzilektomije utiče na učestalost postekstubacionih komplikacija u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom; da li zbrinjavanje disajnog puta fleksibilnom laringealnom maskom u toku adenotonzilektomije ima uticaj na intenzitet postoperativnog bola u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom; da li zbrinjavanje disajnog puta fleksibilnom laringealnom maskom u toku adenotonzilektomije ima uticaj na pojavu postoperativne mučnine i povraćanja u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom. Metodologija: Prospektivnom, randomizovanom, studijom bilo je obuhvaćeno 160 dečaka i devojčica uzrasta od 3 do 8 godina planiranih za elektivnu hirur&scaron;ku intervenciju adenotonzilektomiju u op&scaron;toj anesteziji. Bolesnici su bili podeljeni u dve grupe: 80 bolesnika kod kojih je disajni put bio obezbeđen endotrahealnim tubusum (ET grupa) i 80 bolesnika kod kojih je disajni put bio obezbeđen laringealnom maskom (LMA grupa). Na kraju hirur&scaron;ke intervencije, u obe grupe bolesnika, izvr&scaron;ena je provera prisustva krvi na larinksu i u traheji pomoću fiberoptičkog bronhoskopa. Postekstubacione respiratorne komplikacije vezane za upotrebu fleksibilne laringealne maske odnosno endotrahealnog tubusa (ka&scaron;alj, opstrukcija disajnog puta i laringospazam) bile su praćene neposredno nakon ekstubacije bolesnika. Procena postoperativnog bola bila je vr&scaron;ena pomoću Face, Legs, Activity, Cry, Consolability Scale 2 i 4 sata nakon hirur&scaron;ke intervencije kao i prvog postoperativnog dana u 7 sati ujutro. Postojanje postoperativne mučnine i povraćanja bilo je utvrđivano heteroanamnestički, anketom roditelja, dan nakon hirur&scaron;ke intervencije u 7 sati ujutro. Statistička analiza izvr&scaron;ena je pomoću statističkog paketa Statistical Package for Social Sciences &ndash; SPSS 21. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost je određivana na nivou p&lt;0.05. Rezultati: Ni kod jednog deteta iz ET odnosno LMA grupe bolesnika nakon hirur&scaron;ke intervencije fiberoptičkim bronhoskopom nije uočeno prisustvo krvi, sekreta niti regurgitiranog želudačnog sadržaja na larinksu odnosno u traheji. Bolesnici iz ET grupe su imali statistički značajno vi&scaron;e komplikacija u odnosu na bolesnike iz LMA grupe (&chi;2=4.254; p=0.039; p &lt; 0.05). Ne postoji statistički značajna razlika u distribuciji bolesnika sa i bez respiratornih komplikacija izmeĊu ET i LMA grupe (&chi;2=3.413; p=0.065; p &gt; 0.05). U proceni postoperativnog bola FLACC skalom 2 sata nakon hirur&scaron;ke intervencije postoji statistički značajna razlika u intenzitetu postoperativnog bola kod bolesnika iz ET u odnosu na bolesnike iz LMA grupe (&chi;2=31.316; p=0.000; p&lt;0.05). Četiri sata nakon hirur&scaron;ke intervencije, statistički je značajno vi&scaron;e bolesnika sa umerenim bolom u ET grupi u odnosu na LMA grupu (&chi;2=40.705; p=0.000; p&lt;0.05). Na dan otpusta, statistički je značajno vi&scaron;e bolesnika sa blagim diskomforom u ET grupi bolesnika u odnosu na LMA grupu (&chi;2=8,012; p=0,005; p &lt; 0.05). U LMA grupi bolesnika jedan ili 1.49% bolesnika je imao postoperativnu mučninu i povraćanje, dok je u ET grupi troje ili 3.56% bolesnika imalo postoperativnu mučninu i povraćanje. Zaključak: Fleksibilna laringealna maska pruža podjednaku za&scaron;titu distalnih delova disajnog puta od krvi i sekreta tokom adenotonzilektomije kao i endotrahealni tubus. Učestalost postoperativnih komplikacija i intenzitet postoperativnog bola su manji kada se za obezbeđenje disajnog puta u toku adenotonzilektomije koristi fleksibilna laringealna maska. Primenom fleksibilne laringealne maske smanjuje se učestalost postoperativne mučnine i povraćanja u toku adenotonzilektomije.</p> / <p>Introduction: Adenoidectomy with tonsillectomy is the most indicated surgery in childhood. The intervention is performed under general anesthesia. Endotracheal tube represents the &bdquo;gold standard&ldquo; for airway management in paediatric ENT surgery. The use of endotracheal tube carries the risk of complications that may occur during the induction of general anesthesia, during the surgery and after extubation of the child. The frequency of complications may be reduced by the use of supraglottic airway devices. Flexible laryngeal mask is first generation of supraglottic airway devices, which allows sufficient oxygenation and ventilation of patients in ENT surgery. Aims: To determine the effectiveness of the flexible laryngeal mask which protectes the airway from aspiration of blood and secretions of the upper airways compared to the airway management with endotracheal tube during adenotonsillectomy; to determine does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy affects the frequency of post extubation complications compared to the airway management with endotracheal tube, as wll as does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy has an impact on the intensity of postoperative pain compared to the airway management with endotracheal tube, and does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy has an impact on the incidence of postoperative nausea and vomiting compared to the airway management with endotracheal tube. Methodology: One hundred and sixty boys and girls aged from 3 to 8 years scheduled for elective surgical intervention adenotnosillectomy in general anaesthesia were included in this prospective, randomized study. Patients were divided into two groups: 80 patients in whom the airway was managed with a cuffed endotracheal tube (ET group) and 80 patients in whom airway was managed with a laryngeal mask (LMA group). At the end of surgical procedure, in both groups of patients, fiberoptic bronchoscopy was performed to verify the presence of blood in the larynx and trachea. Immediate respiratory complications associated with the use of flexible laryngeal mask or endotracheal tube (cough, airway obstruction and laryngospasm) were monitored following extubation of patients. Postoperative pain assessment was performed using Face, Legs, Activity, Cry, Consolability Scale 2 and 4 hours following surgery as well as the first postoperative day at 7 o&#39;clock a.m. The presence of postoperative nausea and vomiting was confirmed heteroanamnestically by polling the parents the day after surgery at 7 o&#39;clock a.m. The statistical analysis was performed using Statistical Package for Social Sciences - SPSS version 21. The data were presented in tables and graphs, statystical significance was set at p value of less than 0.05. Results: Following surgery there were no any patient in ET or LMA group in which the presence of blood, secretion or regurgitated stomach contents on larynx or in the trachea could be observed by using the fiberoptic bronchoscope. Patients in the ET group had statistically more significant complications compared to patients in the LMA group (&chi;2 = 4.254; p = 0.039; p &lt;0.05). There is no statistically significant difference in the distribution of patients with and without respiratory complications between ET and LMA groups (&chi;2 = 3.413; p = 0.065; p&gt; 0.05). In the assessment of postoperative pain using FLACC scale 2 hours following surgical intervention, there is a statistically significant difference in the intensity of postoperative pain in ET patients compared to patients in the LMA group (&chi;2 = 31.316, p = 0.000, p &lt;0.05). Four hours following surgical intervention, a statistically significant number of patients had mild pain in the ET group compared to the LMA group (&chi;2 = 40.705; p = 0.000; p &lt;0.05). On the day of release, statistically significant numbers of patients with mild discomfort in the ET group were compared to the LMA group (&chi;2 = 8,012; p = 0,005; p &lt;0.05). In the LMA group, one or 1.49% of the patients had postoperative nausea and vomiting, while in the ET group, three or 3.56% of the patients had postoperative nausea and vomiting. Conclusion: Flexible laryngeal mask provides equal protection of the distal parts of airway from the blood and secretions during adenotonsillectomy as the endotracheal tube. The frequency of postoperative complications and the intensity of postoperative pain are smaller when a flexible laryngeal mask is used for airway management during adenotonsillectomy. The usage of the flexible laryngeal mask reduces the frequency of postoperative nausea and vomiting during adenotonsillectomy.</p>