Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea

El manejo de la vía a área es un componente fundamental de la práctica diaria en anestesiología. La ASA define vía aérea difícil como la situación clínica en la cual un anestesiólogo entrenado experimenta dificultad con ventilación con mascara facial, dificultad para intubación traqueal o ambas. Con...

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Autores:
Chaverra Kornerup, Santiago
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
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oai:repository.unab.edu.co:20.500.12749/7149
Acceso en línea:
http://hdl.handle.net/20.500.12749/7149
Palabra clave:
Intubación intratraqueal
Anesthesiology
Medical sciences
Health sciences
Medicine
Videolaringoscope
Laryngoscope
Airway simulation
Video stylet
Intratracheal intubation
Apparatus and instruments
Medical supplies
Anestesiología
Ciencias médicas
Medicina
Aparatos e instrumentos
Suministros médicos
Ciencias de la salud
Videolaringoscopio
King visión
Laringoscopio
Simulación en vía aérea
Vídeo estilete
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openAccess
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
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dc.title.spa.fl_str_mv Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
dc.title.translated.eng.fl_str_mv Tracheal intubation by non expert personel: wireless videostylet asisted laryngoscopy vs kingvision and conventional laryngoscopy en simulated airway scenario
title Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
spellingShingle Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
Intubación intratraqueal
Anesthesiology
Medical sciences
Health sciences
Medicine
Videolaringoscope
Laryngoscope
Airway simulation
Video stylet
Intratracheal intubation
Apparatus and instruments
Medical supplies
Anestesiología
Ciencias médicas
Medicina
Aparatos e instrumentos
Suministros médicos
Ciencias de la salud
Videolaringoscopio
King visión
Laringoscopio
Simulación en vía aérea
Vídeo estilete
title_short Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
title_full Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
title_fullStr Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
title_full_unstemmed Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
title_sort Intubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aérea
dc.creator.fl_str_mv Chaverra Kornerup, Santiago
dc.contributor.advisor.spa.fl_str_mv Rangel Jaimes, German William
Meléndez Flórez, Héctor Julio
dc.contributor.author.spa.fl_str_mv Chaverra Kornerup, Santiago
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001425741
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000129266
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0003-1791-8099
dc.subject.mesh.spa.fl_str_mv Intubación intratraqueal
topic Intubación intratraqueal
Anesthesiology
Medical sciences
Health sciences
Medicine
Videolaringoscope
Laryngoscope
Airway simulation
Video stylet
Intratracheal intubation
Apparatus and instruments
Medical supplies
Anestesiología
Ciencias médicas
Medicina
Aparatos e instrumentos
Suministros médicos
Ciencias de la salud
Videolaringoscopio
King visión
Laringoscopio
Simulación en vía aérea
Vídeo estilete
dc.subject.keywords.eng.fl_str_mv Anesthesiology
Medical sciences
Health sciences
Medicine
Videolaringoscope
Laryngoscope
Airway simulation
Video stylet
Intratracheal intubation
Apparatus and instruments
Medical supplies
dc.subject.lemb.spa.fl_str_mv Anestesiología
Ciencias médicas
Medicina
Aparatos e instrumentos
Suministros médicos
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Videolaringoscopio
King visión
Laringoscopio
Simulación en vía aérea
Vídeo estilete
description El manejo de la vía a área es un componente fundamental de la práctica diaria en anestesiología. La ASA define vía aérea difícil como la situación clínica en la cual un anestesiólogo entrenado experimenta dificultad con ventilación con mascara facial, dificultad para intubación traqueal o ambas. Con frecuencia el personal médico se enfrenta a situaciones en las cuales se requieren herramientas adicionales para optimizar el abordaje de determinada vía aérea. El presente trabajo es un estudio de evaluación de tecnologías y dispositivos médicos e industriales en el cual se compara el éxito de intubación traqueal con videolaringoscopio King visión, prototipo de videoestilete y laringoscopia directa con hoja macintosh en modelos simulados de vía aérea normal y vía aérea difícil en operadores no expertos. Los resultados demuestran un éxito de intubación comparable en términos de tiempo de intubación e intentos de intubación con los 3 dispositivos evaluados. Este trabajo sienta las bases en miras de una validación clínica futura del prototipo de videoestilete, un dispositivo costo efectivo y útil para el manejo de la vía aérea.
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-08-04T22:56:51Z
dc.date.available.none.fl_str_mv 2020-08-04T22:56:51Z
dc.date.issued.none.fl_str_mv 2020
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
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dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/7149
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv 1. Hagberg, Carin. Hagberg and Benumofs Airway Management, Fourth Edition. Elsevier, 2018.
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5. Berkow, Lauren C., et al. “The Technology of Video Laryngoscopy.” Anesthesia & Analgesia, vol. 126, no. 5, 2018, pp. 1527–1534.
6. Walls, Ron M., et al. Rosens Emergency Medicine: Concepts and Clinical Practice. Elsevier, 2018.
7. Silverberg, Michael J., et al. “Comparison of Video Laryngoscopy Versus Direct Laryngoscopy During Urgent Endotracheal Intubation.” Critical Care Medicine, vol. 43, no. 3, 2015, pp. 636–641.
8. Kelly, F.e., and T.m. Cook. “Seeing Is Believing: Getting the Best out of Videolaryngoscopy.” British Journal of Anaesthesia, vol. 117, 2016, pp. i9–i13.
9. Frerk, C., et al. “Difficult Airway Society 2015 Guidelines for Management of Unanticipated Difficult Intubation in Adults.” British Journal of Anaesthesia, vol. 115, no. 6, 2015, pp. 827–848.
10. Apfelbaum, Jeffrey L., et al. “Practice Guidelines for Management of the Difficult Airway.” Anesthesiology, vol. 118, no. 2, 2013, pp. 251–270.
11. Law, J. Adam, et al. “The Difficult Airway with Recommendations for Management – Part 1 – Difficult Tracheal Intubation Encountered in an Unconscious/Induced Patient.” Canadian Journal of Anesthesia/Journal Canadien Danesthésie, vol. 60, no. 11, 2013, pp. 1089–1118.
12. Cheney, Frederick W., Karen L. Posner, Lorri A. Lee, Robert A. Caplan, and Karen B. Domino. "Trends in Anesthesia-related Death and Brain Damage." Anesthesiology 105, no. 6 (2006): 1081-086.
13. King Vision® Laryngoscope instruction manual. Disponible en: (http://www.ambucorp.com/blade/ifu/King-Vision-IFU-English-UK.pdf)
14. Jarvis, Jeffrey L., et al. “EMS Intubation Improves with King Vision Video Laryngoscopy.” Prehospital Emergency Care, vol. 19, no. 4, 2015, pp. 482–489.
15. Gaba, D M. “The Future Vision of Simulation in Health Care.” Quality and Safety in Health Care, vol. 13, no. suppl_1, 2004, pp. i2–i10.
16. Berkenstadt, Haim, et al. “Incorporating Simulation-Based Objective Structured Clinical Examination into the Israeli National Board Examination in Anesthesiology.” Anesthesia & Analgesia, vol. 102, no. 3, 2006, pp. 853–858.
17. Okuda, Yasuharu, et al. “The Utility of Simulation in Medical Education: What Is the Evidence?” Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, vol. 76, no. 4, 2009, pp. 330–343.
18. Yunoki, Kazuma, and Tetsuro Sakai. “The Role of Simulation Training in Anesthesiology Resident Education.” Journal of Anesthesia, vol. 32, no. 3, 2018, pp. 425–433.
19. Kennedy, Cassie C., et al. “Advanced Airway Management Simulation Training in Medical Education.” Critical Care Medicine, vol. 42, no. 1, 2014, pp. 169–178.
20. Mulcaster, Julian T., et al. “Laryngoscopic Intubation.” Anesthesiology, vol. 98, no. 1, 2003, pp. 23–27.
21. Wamg, Henry E., et al. “Defining the Learning Curve for Paramedic Student Endotracheal Intubation.” Prehospital Emergency Care, vol. 9, no. 2, 2005, pp. 156–162.
22. Especifiaciones del fabricante. Disponible en: (http://www.nidageo.com/products/164.html)
23. Hagberg, C.A (2018) Current concepts in the management of the difficult airway. Anesthesiology news. Vol 15 No 2.
24. Griesdale, Donald E. G., et al. “Glidescope® Video-Laryngoscopy versus Direct Laryngoscopy for Endotracheal Intubation: a Systematic Review and Meta-Analysis.” Canadian Journal of Anesthesia/Journal Canadien Danesthésie, vol. 59, no. 1, 2011, pp. 41–52.,
25. Kaplan, Marshal B., et al. “Comparison of Direct and Video-Assisted Views of the Larynx during Routine Intubation.” Journal of Clinical Anesthesia, vol. 18, no. 5, 2006, pp. 357–362.
26. Kovacs, George, et al. “A Comparison of a Fiberoptic Stylet and a Bougie as Adjuncts to Direct Laryngoscopy in a Manikin-Simulated Difficult Airway.” Annals of Emergency Medicine, vol. 50, no. 6, 2007, pp. 676–685.
27. Pieters, B. M. A., et al. “Videolaryngoscopy vs. Direct Laryngoscopy Use by Experienced Anaesthetists in Patients with Known Difficult Airways: a Systematic Review and Meta-Analysis.” Anaesthesia, vol. 72, no. 12, 2017, pp. 1532–1541.
28. Aziz, Michael F., Dawn Dillman, Rongwei Fu, and Ansgar M. Brambrink. "Comparative Effectiveness of the C-MAC Video Laryngoscope versus Direct Laryngoscopy in the Setting of the Predicted Difficult Airway." Anesthesiology 116, no. 3 (2012): 629-36.
29. Xue, Fu-Shan., et al. "Comparative Performance of Direct and Video Laryngoscopes in Patients with Predicted Difficult Airway." Anesthesiology Vol 117, no. 4, 2012, pp. 911-12.
30. Ruetzler, K., et al. “Comparison of five video laryngoscopes and conventional direct laryngoscopy.” Der Anaesthesist, vol. 64, no. 7, 2015, pp. 513–519.
31. Rendeki, Szilárd, et al. “Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for Difficult and Normal Airways in Mannequins by Novices.” BMC Anesthesiology, vol. 17, no. 1, 2017.
32. Xue, Fu-Shan, et al. “Current Evidence for the Use of C-MAC Videolaryngoscope in Adult Airway Management: a Review of the Literature.” Therapeutics and Clinical Risk Management, Volume 13, 2017, pp. 831–841.
33. Langeron, O., et al. “Difficult Intubation and Extubation in Adult Anaesthesia.” Anaesthesia Critical Care & Pain Medicine, 2018.
34. Shih, Chiao Yen, and Chia Ming Chang. “Experience of Airway Management Training Program for Low- and Middle-Income Countries.” Anesthesia & Analgesia, vol. 127, no. 4, 2018.
35. Griesdale, Donald E. G., et al. “Glidescope® Video-Laryngoscopy versus Direct Laryngoscopy for Endotracheal Intubation: a Systematic Review and Meta-Analysis.” Canadian Journal of Anesthesia/Journal Canadien Danesthésie, vol. 59, no. 1, Jan. 2011, pp. 41–52.
36. Amathieu, Roland, et al. “An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™).” Survey of Anesthesiology, vol. 55, no. 6, 2011, pp. 310–311.
37. Ander F., et al. Time-to-intubation in obese patients. A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anesthetists. Minerva Anestesiol 2017; 83:906-13.
38. Jepsen, Cecilie H., et al. “Tracheal Intubation with a Flexible Fibreoptic Scope or the McGrath Videolaryngoscope in Simulated Difficult Airway Scenarios.” European Journal of Anaesthesiology, vol. 31, no. 3, 2014, pp. 131–136.
39. Hoshijima, Hiroshi, et al. “Videolaryngoscope versus Macintosh Laryngoscope for Tracheal Intubation in Adults with Obesity: A Systematic Review and Meta-Analysis.” Journal of Clinical Anesthesia, vol. 44, 2018, pp. 69–75.
40. Lewis, S.r., et al. “Videolaryngoscopy versus Direct Laryngoscopy for Adult Patients Requiring Tracheal Intubation: a Cochrane Systematic Review.” British Journal of Anaesthesia, vol. 119, no. 3, 2017, pp. 369–383.
41. Strauss, Robert A., and Roseanna Noordhoek. “Management of the Difficult Airway.” Atlas of the Oral and Maxillofacial Surgery Clinics, vol. 18, no. 1, 2010, pp. 11–28.
42. Walls, Ron M., et al. Rosens Emergency Medicine: Concepts and Clinical Practice. Elsevier, 2018.
43. Levitan, Richard M., et al. “The Complexities of Tracheal Intubation With Direct Laryngoscopy and Alternative Intubation Devices.” Annals of Emergency Medicine, vol. 57, no. 3, 2011, pp. 240–247.
44. Konrad, Christoph, et al. “Learning Manual Skills in Anesthesiology.” Anesthesia & Analgesia, vol. 86, no. 3, 1998, pp. 635–639.
45. Rosenstock, Charlotte V., Bente Thøgersen, Arash Afshari, Anne-Lise Christensen, Claus Eriksen, and Mona M. Gätke. "Awake Fiberoptic or Awake Laryngoscopic Tracheal Intubation in Patients With Anticipated Difficult Airway Management." Survey of Anesthesiology 57, no. 1 (2013): 46.
46. Suppan, L., Tramèr, M., Niquille, M., Grosgurin, O., & Marti, C. (2016). Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: Systematic review and meta-analysis of randomized controlled trials. British Journal of Anaesthesia, 116(1), 27-36.
47. Levitan, R. M., Heitz, J. W., Sweeney, M., & Cooper, R. M. (2011). The Complexities of Tracheal Intubation With Direct Laryngoscopy and Alternative Intubation Devices. Annals of Emergency Medicine, 57(3), 240-247.
48. Vanderbilt, A., Pastis, N. J., Mayglothling, & Franzen, D. (2014). A review of the literature: Direct and video laryngoscopy with simulation as educational intervention. Advances in Medical Education and Practice, 15.
49. Arulkumaran, N., et al. “Videolaryngoscopy versus Direct Laryngoscopy for Emergency Orotracheal Intubation Outside the Operating Room: a Systematic Review and Meta-Analysis.” British Journal of Anaesthesia, vol. 120, no. 4, 2018, pp. 712–724.
50. Maharaj, C. H., J. Costello, B. D. Higgins, B. H. Harte, and J. G. Laffey. “Retention of Tracheal Intubation Skills by Novice Personnel: a Comparison of the Airtraq and Macintosh Laryngoscopes.” Anaesthesia 62, no. 3 (2007): 272–78.
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dc.publisher.faculty.spa.fl_str_mv Facultad Ciencias de la Salud
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institution Universidad Autónoma de Bucaramanga - UNAB
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spelling Rangel Jaimes, German Williamb121cf26-0456-448f-b5c6-5942af08fa0d-1Meléndez Flórez, Héctor Julio20cc143a-86c7-44c4-bcab-57fb40719b36-1Chaverra Kornerup, Santiagoc6ca4824-4232-4e77-9752-a8b5b0f6f1fd-1https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001425741https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000129266https://orcid.org/0000-0003-1791-8099Bucaramanga (Santander, Colombia)2020-08-04T22:56:51Z2020-08-04T22:56:51Z2020http://hdl.handle.net/20.500.12749/7149instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coEl manejo de la vía a área es un componente fundamental de la práctica diaria en anestesiología. La ASA define vía aérea difícil como la situación clínica en la cual un anestesiólogo entrenado experimenta dificultad con ventilación con mascara facial, dificultad para intubación traqueal o ambas. Con frecuencia el personal médico se enfrenta a situaciones en las cuales se requieren herramientas adicionales para optimizar el abordaje de determinada vía aérea. El presente trabajo es un estudio de evaluación de tecnologías y dispositivos médicos e industriales en el cual se compara el éxito de intubación traqueal con videolaringoscopio King visión, prototipo de videoestilete y laringoscopia directa con hoja macintosh en modelos simulados de vía aérea normal y vía aérea difícil en operadores no expertos. Los resultados demuestran un éxito de intubación comparable en términos de tiempo de intubación e intentos de intubación con los 3 dispositivos evaluados. Este trabajo sienta las bases en miras de una validación clínica futura del prototipo de videoestilete, un dispositivo costo efectivo y útil para el manejo de la vía aérea.1. INTRODUCCION………………………………………………………………………………………… 5 2. PLANTEAMIENTO DEL PROBLEMA……………………………………………………………… 6 3. PREGUNTA DE INVESTIGACION…………………………………………………………………. 7 4. HIPOTESIS INVESTIGATIVA……………………………………………………………………… 8 5. MARCO TEORICO Y ESTADO DEL ARTE………………………………………………………. 9 6. JUSTIFICACION…………………………………………………………………………………………… 17 7. OBJETIVOS 7.1. OBJETIVO GENERAL....................................................……………………. 19 7.2. OBJETIVO ESPECIFICO…………………………………………………………………. 19 8. METODOLOGIA 8.1. TIPO DE ESTUDIO………………………………………………………………………. 20 8.2 MATERIALES Y METODOS……………………………………………………………. 20 8.3 LUGAR DE REALIZACION……………………………………………………………. 20 8.4 TIEMPO DE EJECUCION………………………………………………………………… 20 8.5 POBLACION ELEGIBLE…………………………………………………………………… 20 8.6 CRITERIOS DE INCLUSION……………………………………………………………… 20 8.7 CRITERIOS DE EXCLUSION……………………………………………………………… 21 8.8 SELECCIÓN Y TAMAÑO DE LA MUESTRA……………………………………… 21 8.9 VARIABLES…………………………………………………………………………………… 21 8.10 ACTIVIDAD EN ESCENARIO SIMULADO…………………………………… 22 9. CONSIDERACIONES ETICAS…………………………………………….........………………… 23 10. RESULTADOS ……………………………………………………………………………………….. 24 11. BIBLIOGRAFIA……………………………………………………………………………………………. 27EspecializaciónAirway management is fundamental in the daily clinical practice in anesthesiology. ASA defines difficult airway as the clinical situation in which a trained anesthesiologist has difficulty with facial mask ventilation, intubation or both. With certain frequency healthcare providers have to face situations in which additional elements are required to improve approach of certain airway. This paper is a technology and medical devices study in which intubation success is compared between King vision, video stylet prototype and macintosh laryngoscopy in simulated difficult and normal airway scenario in non-expert operators. The results show a similar intubation success in terms of intubation time and intubation attempts in both scenarios with the three devices evaluated. This study sets ground for future clinical validation of the wireless video stylet, a cost effective and useful airway management device.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaIntubación intratraquealAnesthesiologyMedical sciencesHealth sciencesMedicineVideolaringoscopeLaryngoscopeAirway simulationVideo styletIntratracheal intubationApparatus and instrumentsMedical suppliesAnestesiologíaCiencias médicasMedicinaAparatos e instrumentosSuministros médicosCiencias de la saludVideolaringoscopioKing visiónLaringoscopioSimulación en vía aéreaVídeo estileteIntubación orotraqueal por personal inexperto: laringoscopio asistido por prototipo de estilete óptico inalámbrico vs kingvision y laringoscopia convencional en modelos simulados de vía aéreaTracheal intubation by non expert personel: wireless videostylet asisted laryngoscopy vs kingvision and conventional laryngoscopy en simulated airway scenarioEspecialista en AnestesiologíaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Anestesiologíainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TM1. 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Laffey. “Retention of Tracheal Intubation Skills by Novice Personnel: a Comparison of the Airtraq and Macintosh Laryngoscopes.” Anaesthesia 62, no. 3 (2007): 272–78.ORIGINAL2019_Tesis_Santiago_Chaverra_Kornerup.pdf2019_Tesis_Santiago_Chaverra_Kornerup.pdfTesisapplication/pdf1159412https://repository.unab.edu.co/bitstream/20.500.12749/7149/1/2019_Tesis_Santiago_Chaverra_Kornerup.pdf429155b4230b29db06638ba3b0666a57MD51open access2019_Licencia_Santiago_Chaverra_Kornerup.pdf2019_Licencia_Santiago_Chaverra_Kornerup.pdfLicenciaapplication/pdf473437https://repository.unab.edu.co/bitstream/20.500.12749/7149/2/2019_Licencia_Santiago_Chaverra_Kornerup.pdfde588f82d718e6fa3ae1f56e475110d7MD52metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repository.unab.edu.co/bitstream/20.500.12749/7149/3/license.txt8a4605be74aa9ea9d79846c1fba20a33MD53open accessTHUMBNAIL2019_Tesis_Santiago_Chaverra_Kornerup.pdf.jpg2019_Tesis_Santiago_Chaverra_Kornerup.pdf.jpgIM Thumbnailimage/jpeg7273https://repository.unab.edu.co/bitstream/20.500.12749/7149/4/2019_Tesis_Santiago_Chaverra_Kornerup.pdf.jpg78b8a10b20d44b73690f649c5f074178MD54open access2019_Licencia_Santiago_Chaverra_Kornerup.pdf.jpg2019_Licencia_Santiago_Chaverra_Kornerup.pdf.jpgIM Thumbnailimage/jpeg11045https://repository.unab.edu.co/bitstream/20.500.12749/7149/5/2019_Licencia_Santiago_Chaverra_Kornerup.pdf.jpg1b3ced1b5922ecc80d4781738511ba64MD55open access20.500.12749/7149oai:repository.unab.edu.co:20.500.12749/71492022-11-18 19:11:55.278open accessRepositorio Institucional | Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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