Flaishon Ron, Sotman Alexander, Ben-Abraham Ron, Rudick Valery, Varssano David, Weinbroum Avi A
Department of Anesthesiology and Critical Care Medicine, Directorate, and Outpatient Surgery and Post-Anesthesia Care Units, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Anesthesiology. 2004 Feb;100(2):260-6. doi: 10.1097/00000542-200402000-00013.
Airway management is the first step in resuscitation. The extraordinary conditions in mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The authors evaluated whether wearing surgical attire or antichemical protective gear made any difference in anesthetists' success of airway control with either an endotracheal tube or a laryngeal mask airway.
Fifteen anesthetists with 2-5 yr of residency and wearing either full antichemical protective gear or surgical attire intubated or inserted laryngeal masks in 60 anesthetized patients. The study was performed in a prospective, randomized, crossover manner. The duration of intubation/insertion was measured from the time the device was grasped to the time a normal capnography recording was obtained.
Endotracheal tubes were introduced significantly (P < 0.01) faster when the anesthetist wore surgical attire (31 +/- 7 vs. 54 +/- 24 s for protective gear), but the mean times necessary to successfully insert laryngeal masks were similar (44 +/- 20 s for surgical attire vs. 39 +/- 11 s for protective gear). Neither performance failure nor incidences of hypoxemia were recorded.
This first report in humans shows to what extent anesthetists' wearing of antichemical protective gear slows the time to intubate but not to insert a laryngeal mask airway compared with wearing surgical attire. Laryngeal mask airway insertion is faster than tracheal intubation when wearing protective gear, indicating its advantage for airway management when anesthetists wear antichemical protective gear. If chances for rapid and successful tracheal intubation under such chaotic conditions are poor, laryngeal mask airway insertion is a viable choice for airway management until a proper secured airway is obtainable.
气道管理是复苏的第一步。在大规模伤亡情况下的特殊条件给气道管理带来了特殊困难，即使对于经验丰富的护理人员也是如此。作者评估了麻醉医生穿着手术服或防化防护装备在使用气管内导管或喉罩气道进行气道控制时的成功率是否存在差异。
15名具有2 - 5年住院医师经验的麻醉医生，分别穿着全套防化防护装备或手术服，对60名麻醉患者进行气管插管或插入喉罩。该研究以前瞻性、随机、交叉的方式进行。插管/插入的持续时间从握住设备的时间到获得正常二氧化碳图记录的时间进行测量。
当麻醉医生穿着手术服时，气管内导管插入速度明显更快（P < 0.01）（手术服组为31 ± 7秒，防护装备组为54 ± 24秒），但成功插入喉罩所需的平均时间相似（手术服组为44 ± 20秒，防护装备组为39 ± 11秒）。未记录到操作失败或低氧血症的发生率。
这篇人类的首次报告表明，与穿着手术服相比，麻醉医生穿着防化防护装备在多大程度上会减慢气管插管的时间，但不会减慢插入喉罩气道的时间。穿着防护装备时，插入喉罩气道比气管插管更快，这表明在麻醉医生穿着防化防护装备时，其在气道管理方面具有优势。如果在这种混乱条件下快速成功气管插管的机会很小，在获得合适的安全气道之前，插入喉罩气道是气道管理的一个可行选择。
