Warrillow S
Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
Anaesth Intensive Care. 2005 Oct;33(5):659-61. doi: 10.1177/0310057X0503300518.
This case report describes an alternative method of achieving trans-oral intubation in a patient with a difficult airway who was apnoeic secondary to the therapeutic administration of a non-depolarizing neuromuscular blocking drug given to aid laryngoscopy. After attempts to intubate were unsuccessful by means of direct laryngoscopy utilizing various aids including bougies, a standard laryngeal mask airway was used to ventilate the patient and subsequently, with a swivel Y-connector attached in order to maintain PEEP, to aid the passage of a bronchoscope. The flexible guide-wire from an enteral feeding tube was then passed through the suction port of the bronchoscope into the trachea, after which the laryngeal mask airway and bronchoscope were withdrawn. By passing the enteral feeding tube over the guide-wire and then using this as a guide, a cuffed endotracheal tube was inserted into the trachea. The technique described permitted the continuous application of positive airway pressure, which dramatically improved the bronchoscopic view during the crucial step of placing the guide-wire into the trachea. Passing the feeding tube over the guide-wire aided the subsequent passage of the endotracheal tube, by acting as a stiffer and larger diameter guide through the glottis.
本病例报告描述了一种为气道困难患者实施经口插管的替代方法。该患者因接受非去极化神经肌肉阻滞剂辅助喉镜检查治疗而呼吸暂停。在尝试使用包括探条在内的各种辅助工具通过直接喉镜进行插管未成功后，使用标准喉罩气道为患者通气，随后连接旋转Y形接头以维持呼气末正压，辅助支气管镜通过。然后将肠内营养管的柔性导丝通过支气管镜的吸引端口插入气管，之后拔出喉罩气道和支气管镜。将肠内营养管沿导丝推送，然后以此为引导，将带套囊的气管内导管插入气管。所描述的技术允许持续应用气道正压，这在将导丝插入气管的关键步骤中显著改善了支气管镜视野。将营养管沿导丝推送，通过充当更硬且直径更大的引导物穿过声门，辅助了随后气管内导管的通过。
