Bokhari A, Benham S W, Popat M T
The John Radcliffe, Nuffield Department of Anaesthetics, Headley Way, Oxford, UK.
Eur J Anaesthesiol. 2004 Feb;21(2):123-7. doi: 10.1017/s0265021504002078.
Unanticipated difficulty in tracheal intubation in an anaesthetized patient has always been a cause of concern to anaesthesiologists. This difficulty may lead to morbidity and mortality. This survey was carried out to determine the technique commonly favoured in centres in the Oxford region in the UK for the management of unanticipated difficult intubation.
We conducted a clinical scenario-based questionnaire survey of 181 anaesthesiologists in the Oxford region. In this scenario, difficulty in endotracheal intubation is recognized only after induction of anaesthesia. A number of options were available to deal with this situation. We used this scenario as a tool to gain insight into the training and the training needs of anaesthesiologists at various levels of training.
Of the 181 questionnaires sent, we received 143 (79%) completed replies. The vast majority (141/143 (99%)) of anaesthesiologists would use a gum-elastic bougie together with head and neck positioning and optimal external laryngeal manipulation to gain the best attempt at intubation. If intubation still failed, overall 129/143 (90%) had a back-up plan, while 14/143 (10%) had no plan. Flexible fibreoptic techniques were more commonly planned by 92/143 (64%) anaesthesiologists compared to blind techniques which were less commonly planned by 37/143 (26%) anaesthesiologists. Differences in choice of technique among anaesthesiologists in teaching and district general hospitals were not significant (P = 0.87). Overall, trainees were less likely to choose fibreoptic techniques compared to consultants (P = 0.0009) and would use blind techniques or ask a more experienced colleague to take over. The main reason for the choice was previous experience with the technique.
Although fibreopric techniques were most commonly planned, these were less often chosen by trainees than consultants due to lack of experience/training, while unavailability of intubating laryngeal mask airway (Intavent) was an additional issue precluding its use as an adjunct to intubation.
麻醉患者气管插管时出现意外困难一直是麻醉医生关注的问题。这种困难可能导致发病和死亡。开展此项调查以确定英国牛津地区各中心处理意外困难插管时普遍青睐的技术。
我们对牛津地区181名麻醉医生进行了基于临床情景的问卷调查。在此情景中，气管插管困难仅在麻醉诱导后才被发现。有多种应对此情况的选择。我们将此情景作为一种工具，以深入了解不同培训水平的麻醉医生的培训情况和培训需求。
在发出的181份问卷中，我们收到了143份（79%）完整回复。绝大多数（141/143（99%））麻醉医生会使用弹性橡胶探条，同时配合头颈部定位及最佳的外部喉操作，以尽力完成插管。如果插管仍失败，总体上129/143（90%）有备用计划，而14/143（10%）没有计划。与盲目技术相比，92/143（64%）麻醉医生更常计划采用可弯曲纤维光学技术，而37/143（26%）麻醉医生较少计划采用盲目技术。教学医院和地区综合医院麻醉医生在技术选择上的差异不显著（P = 0.87）。总体而言，与顾问医生相比，实习医生选择纤维光学技术的可能性较小（P = 0.0009），他们会采用盲目技术或请经验更丰富的同事接手。选择的主要原因是对该技术的既往经验。
尽管纤维光学技术是最常计划采用的，但由于缺乏经验/培训，实习医生选择该技术的频率低于顾问医生，而插管型喉罩气道（Intavent）无法获取是妨碍其作为插管辅助工具使用的另一个问题。
