Blanco G, Melman E, Cuairan V, Moyao D, Ortiz-Monasterio F
Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México 'Dr Federico Gómez' and Hospital Angeles del Pedregal, Mexico City, Me.
Paediatr Anaesth. 2001 Jan;11(1):49-53. doi: 10.1046/j.1460-9592.2001.00621.x.
The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.
对于患有先天性或后天性面部畸形的儿童，通过直接喉镜建立气管气道可能是一项非常困难甚至无法完成的任务。在46例被归类为困难气管插管的患者中，44例接受七氟醚和氧气面罩麻醉或丙泊酚静脉输注及面罩给氧麻醉的儿童成功使用了纤维喉镜。有两例失败（4.3%）。一例是由于多次尝试直接喉镜插管导致出血过多和分泌物增多，另一例失败发生在患有皮埃尔·罗宾综合征且鼻腔非常小以致无法插入内镜的患者身上。首次尝试插管时，纤维喉镜在37例（80.4%）患者中成功，第二次或第三次尝试时在7例（15.2%）患者中成功。我们得出结论，在经过培训人员手中，对于预计或意外气管插管困难的麻醉儿童，纤维喉镜检查是一种安全的技术，可能挽救生命。因此，我们敦促所有麻醉实习生熟练掌握纤维光导气管插管技术。
