Chiba Shunsuke, Yokota Miyuki
Department of Anesthesiology, Cancer Institute Hospital, Tokyo 170-0012.
Masui. 2004 Mar;53(3):273-6.
We experienced two cases of malignant tumors in the neck with difficulties in airway control. In case 1, difficult airway was anticipated from the CT scan taken before the operation, but the glottis was observed easily by using laryngoscope. Therefore we judged intubation easy and rapid induction was performed, but the tube did not go in farther. When we pushed it in bleeding made the ventilation impossible, and the airway had to be ensured by tracheotomy. In case 2, difficult airway was anticipated from the CT scan. Making use of our experience in case 1, tracheotomy was performed under neuroleptanesthesia, but it was a too heavy burden for the patient. There are various methods of airway control and it is necessary for us to master the skills of them, but it is much safer to anticipate difficult airway by careful preoperative evaluation and manage accordingly than to find a way out of an emergency with these skills.
我们遇到了两例颈部恶性肿瘤且气道控制困难的病例。病例1中，术前CT扫描预计气道困难，但使用喉镜时声门观察容易。因此我们判断插管容易并进行了快速诱导，但导管无法再深入。当我们推进导管时，出血导致通气无法进行，不得不通过气管切开确保气道通畅。病例2中，CT扫描预计气道困难。借鉴病例1的经验，在神经安定麻醉下进行了气管切开，但对患者来说负担过重。气道控制方法多样，我们有必要掌握这些技能，但通过仔细的术前评估预测气道困难并相应处理，比用这些技能在紧急情况下寻找解决办法要安全得多。
