Thierbach Andreas R, Werner Christian
Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Best Pract Res Clin Anaesthesiol. 2005 Dec;19(4):595-609. doi: 10.1016/j.bpa.2005.06.001.
Airway management involves far more than just proficiency with tracheal intubation techniques. There are several infraglottic techniques available and the method chosen will depend on the accessibility of equipment, the level of training and expertise, and the patient's specific injury or disease. Endotracheal intubation is most commonly performed by direct laryngoscopy. Several modifications of laryngoscope blades and a variety of adjuncts such as bougies may help to accomplish even a difficult airway. Rigid intubation fibrescopes do improve the view of the larynx, especially in patients with difficult anatomy. They also permit tracheal intubation with less head and cervical spine movement than is often generated by direct laryngoscopy. Successful intubation, however, requires considerable experience, as in intubation techniques using flexible fibrescopes. Both the EasyTube and the Combitube serve as an infraglottic or a supraglottic airway. The tip of the EasyTube resembles the one of an endotracheal tube, whereas the Combitube is much more bulky.
气道管理所涉及的远不止熟练掌握气管插管技术。有几种声门下技术可供选择,所选用的方法将取决于设备的可及性、培训水平和专业技能,以及患者的具体损伤或疾病情况。气管内插管最常用直接喉镜检查法来进行。喉镜镜片的几种改良型以及诸如探条等各种辅助工具可能有助于完成即使是困难气道的插管。硬质插管纤维镜确实能改善喉部视野,尤其是在解剖结构复杂的患者中。与直接喉镜检查法相比,它们还能在气管插管时减少头部和颈椎的移动。然而,成功插管需要相当多的经验,这与使用柔性纤维镜的插管技术情况相同。EasyTube和食管气管联合导管都可作为声门下或声门上气道使用。EasyTube的尖端类似于气管内导管的尖端,而食管气管联合导管则要粗大得多。