Estudo com objetivo de avaliar e comparar o desempenho teórico e prático de estudantes de enfermagem submetidos a estratégias de ensino-aprendizagem, aula expositivo-dialogada e atividade prática em laboratório de habilidades ou aula simulada, no manejo da via aérea em emergências por meio da máscara laríngea (ML). Estudo com delineamento experimental, abordagem quantitativa, de intervenção tipo Ensaio Clínico Randomizado Controlado. A população consistiu dos estudantes do oitavo período, bacharelado, da Escola de Enfermagem de Ribeirão Preto e a amostra de 17 estudantes, randomizados para grupo controle (GC) e grupo intervenção (GI). O GC foi submetido à aula expositivo-dialogada seguida de atividade prática em laboratório de habilidades com manequim de baixa fidelidade e o GI à aula simulada em laboratório utilizando o mesmo manequim. Elaboraram-se os instrumentos de avaliação escrita, cenário de simulação e avaliação clínica objetiva e estruturada no cenário de simulação (checklist), validados em aparência e conteúdo por comitê de juízes. A estratégia de coleta de dados foi Workshop intitulado \"Manejo da via aérea em emergências: uso da ML\". Foram avaliados teste escrito e OSCE (Exame Clínico Objetivo Estruturado) - avaliação clínica estruturada em Laboratório de Simulação, este último empregando como ferramenta o manequim de média-fidelidade. A atividade foi filmada e analisada por três avaliadores. Analisaram-se os desfechos: desempenho teórico no teste escrito e prático no OSCE, tempo de execução do OSCE, tempo para obtenção da primeira ventilação eficaz, número de tentativas para inserção da ML até obtenção de ventilação efetiva. Resultados: 16 estudantes eram do sexo feminino e um do sexo masculino, a idade média 24,4±4,2 anos. No pré-teste a nota média do GC de 6,6±1,0 e do GI de 6,5±0,5 e a mediana para ambos 6,5. No pós-teste a nota média do GC foi 8,4±0,8 (mediana 8,5), do GI de 8,6±1,1 (mediana 8,6). Comparando-se as médias obtidas no pré-teste por ambos os grupos, não há diferença estatisticamente significante (p=07427). Tal fato também pôde ser constatado no pós-teste (p=0,7117). Comparando as notas pré e pós-teste do GC evidenciou diferença estatisticamente significante (p=0,0025) o que também ocorreu para o GI (p=0,0002). A média no OSCE do GC foi 7,8±0,52 e GI 8,4±0,89; comparou-se tais notas verificando-se que não há diferença estatisticamente significante (p=0,0822). A média obtida pelo GC no pós-teste foi maior que a média obtida no OSCE e, para o GI, são equivalentes. O tempo médio de execução do OSCE pelo GC foi 479,8±183,3s (mediana 468,5s) e no GI 520,3±157s (mediana 506s), não havendo diferença estatisticamente significante (p=0,6311) e também para obtenção da primeira ventilação eficaz (p=0,9835). A média do nº tentativas para inserção da ML pelo GC 1,63±0,74 e GI 1,56±0,63. Embora os resultados não apontem diferença estatisticamente significante entre as médias dos grupos no pós-teste, para o GI os escores foram superiores. No presente estudo, apesar de diferentes estratégias de ensino abordarem o manejo da via aérea em emergências com a ML, os resultados demonstram que as mesmas foram eficazes e os objetivos de aprendizagem foram alcançados, pois houve incremento nas notas obtidas no pós-teste e no OSCE em ambos os grupos. / Study aimed to evaluate and compare the theoretical and practical performance of nursing students subjected to teaching and learning strategies, exhibition-dialogued class, and practical activity in skill lab or simulated class in airway management in emergencies through laryngeal mask (LM). This is a study of experimental design, quantitative approach, intervention type, Controlled Randomized Trials. The population consisted of students in the eighth semester from the Bachelor\'s Degree of the University of São Paulo at Ribeirão Preto College of Nursing and the sample consisted of 17 students, randomly assigned to the control group (CG) and the intervention group (IG). The CG was subjected to exhibition-dialogued class followed by practical activity in skill lab with low-fidelity mannequin and the IG to simulated class in the lab using the same mannequin. Written evaluation instruments, simulation scenario and objective structured clinical evaluation in simulation scenario (checklist) were developed and validated in appearance and content by a committee of judges. The strategy for data collection was the workshop entitled \"Airway management in emergencies: use of LM\". They were evaluates through written test and the OSCE (Objective Structured Clinical Examination) - structured clinical evaluation in Simulation Laboratory, the latter employing the medium-fidelity mannequin as tool. The activity was filmed and analyzed by three evaluators. The outcomes were analyzed: theoretical performance in written and practical test in the OSCE, the OSCE runtime, time to obtain the first effective ventilation, number of attempts to insert the LM to obtain effective ventilation. Results: 16 students were female and one male, mean age 24.4±4.2 years. In the pre-test the score average of CG was 6.6±1.0 and of IG was 6.5±0.5 and the median for both was 6.5. At post-test, the average score of CG was 8.4±0.8 (median 8.5), of IG was 8.6±1.1 (median 8.6). Comparing the averages obtained in the pre-test for both groups, there was no statistically significant difference (p=0.7427). This fact could also be observed in the post-test (p=0.7117). Comparing notes of pre and post-test of CG there was a statistically significant difference (p=0.0025) which also occurred for IG (p=0.0002). The mean of the OSCE for CG was 7.8±0.52 and for IG was 8,4±0,89; compared to such notes and it was verified that there is no statistically significant difference (p=0.0822). The average obtained by CG in the post-test was higher than the average obtained IG in the OSCE, and for IG they were equivalent. The average execution time of the OSCE for CG was 479.8 ± 183.3s (median 468.5s) and for IG 520.3±157s (506s median), with no statistically significant difference (p=0.6311) and also for obtaining the first effective ventilation (p=0.9835). The average of attempts to insert the LM by CG was 1.63±0.74 and by IG was 1.56±0.63 GI. Although the results do not indicate a statistically significant difference between the averages of the groups in the post-test, the scores were higher for IG. In this study, although different teaching strategies addressing airway management in emergencies through LM were used, the results show that they were effective and the learning objectives have been achieved, because there was an increase in the scores obtained in the post-test and in the OSCE in both groups.

Estudo com objetivo de avaliar e comparar o desempenho teórico e prático de estudantes de enfermagem submetidos a estratégias de ensino-aprendizagem, aula expositivo-dialogada e atividade prática em laboratório de habilidades ou aula simulada, no manejo da via aérea em emergências por meio da máscara laríngea (ML). Estudo com delineamento experimental, abordagem quantitativa, de intervenção tipo Ensaio Clínico Randomizado Controlado. A população consistiu dos estudantes do oitavo período, bacharelado, da Escola de Enfermagem de Ribeirão Preto e a amostra de 17 estudantes, randomizados para grupo controle (GC) e grupo intervenção (GI). O GC foi submetido à aula expositivo-dialogada seguida de atividade prática em laboratório de habilidades com manequim de baixa fidelidade e o GI à aula simulada em laboratório utilizando o mesmo manequim. Elaboraram-se os instrumentos de avaliação escrita, cenário de simulação e avaliação clínica objetiva e estruturada no cenário de simulação (checklist), validados em aparência e conteúdo por comitê de juízes. A estratégia de coleta de dados foi Workshop intitulado \"Manejo da via aérea em emergências: uso da ML\". Foram avaliados teste escrito e OSCE (Exame Clínico Objetivo Estruturado) - avaliação clínica estruturada em Laboratório de Simulação, este último empregando como ferramenta o manequim de média-fidelidade. A atividade foi filmada e analisada por três avaliadores. Analisaram-se os desfechos: desempenho teórico no teste escrito e prático no OSCE, tempo de execução do OSCE, tempo para obtenção da primeira ventilação eficaz, número de tentativas para inserção da ML até obtenção de ventilação efetiva. Resultados: 16 estudantes eram do sexo feminino e um do sexo masculino, a idade média 24,4±4,2 anos. No pré-teste a nota média do GC de 6,6±1,0 e do GI de 6,5±0,5 e a mediana para ambos 6,5. No pós-teste a nota média do GC foi 8,4±0,8 (mediana 8,5), do GI de 8,6±1,1 (mediana 8,6). Comparando-se as médias obtidas no pré-teste por ambos os grupos, não há diferença estatisticamente significante (p=07427). Tal fato também pôde ser constatado no pós-teste (p=0,7117). Comparando as notas pré e pós-teste do GC evidenciou diferença estatisticamente significante (p=0,0025) o que também ocorreu para o GI (p=0,0002). A média no OSCE do GC foi 7,8±0,52 e GI 8,4±0,89; comparou-se tais notas verificando-se que não há diferença estatisticamente significante (p=0,0822). A média obtida pelo GC no pós-teste foi maior que a média obtida no OSCE e, para o GI, são equivalentes. O tempo médio de execução do OSCE pelo GC foi 479,8±183,3s (mediana 468,5s) e no GI 520,3±157s (mediana 506s), não havendo diferença estatisticamente significante (p=0,6311) e também para obtenção da primeira ventilação eficaz (p=0,9835). A média do nº tentativas para inserção da ML pelo GC 1,63±0,74 e GI 1,56±0,63. Embora os resultados não apontem diferença estatisticamente significante entre as médias dos grupos no pós-teste, para o GI os escores foram superiores. No presente estudo, apesar de diferentes estratégias de ensino abordarem o manejo da via aérea em emergências com a ML, os resultados demonstram que as mesmas foram eficazes e os objetivos de aprendizagem foram alcançados, pois houve incremento nas notas obtidas no pós-teste e no OSCE em ambos os grupos. / Study aimed to evaluate and compare the theoretical and practical performance of nursing students subjected to teaching and learning strategies, exhibition-dialogued class, and practical activity in skill lab or simulated class in airway management in emergencies through laryngeal mask (LM). This is a study of experimental design, quantitative approach, intervention type, Controlled Randomized Trials. The population consisted of students in the eighth semester from the Bachelor\'s Degree of the University of São Paulo at Ribeirão Preto College of Nursing and the sample consisted of 17 students, randomly assigned to the control group (CG) and the intervention group (IG). The CG was subjected to exhibition-dialogued class followed by practical activity in skill lab with low-fidelity mannequin and the IG to simulated class in the lab using the same mannequin. Written evaluation instruments, simulation scenario and objective structured clinical evaluation in simulation scenario (checklist) were developed and validated in appearance and content by a committee of judges. The strategy for data collection was the workshop entitled \"Airway management in emergencies: use of LM\". They were evaluates through written test and the OSCE (Objective Structured Clinical Examination) - structured clinical evaluation in Simulation Laboratory, the latter employing the medium-fidelity mannequin as tool. The activity was filmed and analyzed by three evaluators. The outcomes were analyzed: theoretical performance in written and practical test in the OSCE, the OSCE runtime, time to obtain the first effective ventilation, number of attempts to insert the LM to obtain effective ventilation. Results: 16 students were female and one male, mean age 24.4±4.2 years. In the pre-test the score average of CG was 6.6±1.0 and of IG was 6.5±0.5 and the median for both was 6.5. At post-test, the average score of CG was 8.4±0.8 (median 8.5), of IG was 8.6±1.1 (median 8.6). Comparing the averages obtained in the pre-test for both groups, there was no statistically significant difference (p=0.7427). This fact could also be observed in the post-test (p=0.7117). Comparing notes of pre and post-test of CG there was a statistically significant difference (p=0.0025) which also occurred for IG (p=0.0002). The mean of the OSCE for CG was 7.8±0.52 and for IG was 8,4±0,89; compared to such notes and it was verified that there is no statistically significant difference (p=0.0822). The average obtained by CG in the post-test was higher than the average obtained IG in the OSCE, and for IG they were equivalent. The average execution time of the OSCE for CG was 479.8 ± 183.3s (median 468.5s) and for IG 520.3±157s (506s median), with no statistically significant difference (p=0.6311) and also for obtaining the first effective ventilation (p=0.9835). The average of attempts to insert the LM by CG was 1.63±0.74 and by IG was 1.56±0.63 GI. Although the results do not indicate a statistically significant difference between the averages of the groups in the post-test, the scores were higher for IG. In this study, although different teaching strategies addressing airway management in emergencies through LM were used, the results show that they were effective and the learning objectives have been achieved, because there was an increase in the scores obtained in the post-test and in the OSCE in both groups.

<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>