Paix A D, Williamson J A, Runciman W B
Princess Royal University Hospital, Orpington, Kent, UK.
Qual Saf Health Care. 2005 Jun;14(3):e5. doi: 10.1136/qshc.2002.004135.
Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation.
To examine the role of a specific sub-algorithm for the management of difficult intubation.
The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.
There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors.
The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient's cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.
麻醉医生可能会意外遇到插管困难的情况，这可能与患者通气困难相关。如果处理不当，可能会给患者带来严重后果。针对这一问题开发了一种简单的结构化方法，以帮助麻醉医生应对这种困难局面。
探讨一种特定子算法在困难插管管理中的作用。
通过文献综述和对澳大利亚事件监测研究（AIMS）报告的前4000起相关事件中的每一起进行分析，制定了一种结构化方法，将其潜在性能与参与的麻醉医生报告的实际管理情况进行比较。
在报告给AIMS的前4000起事件中，有147份关于困难插管的报告可供分析。52%的病例中困难是意外发生的；其中37%的病例出现了重大生理变化。22%的病例血氧饱和度降至90%以下，19%的病例报告有食管插管，4%的病例需要紧急经气管气道。肥胖、颈部活动受限和张口受限是最常见的解剖学促成因素。
数据证实了先前报道的现有术前临床检查无法预测困难插管的情况，并表明持续需要教授一种预先学习的策略来应对困难插管及任何相关的通气问题。概述了一种易于遵循的针对这些问题的结构化方法。建议在预计有困难或患者心肺储备较低时寻求熟练的帮助（最好是另一位麻醉医生）。术后应对患者进行评估，以排除任何后遗症，并告知他们所遇到的困难。这些情况应清晰记录，并采取适当措施警告未来的麻醉医生。
