Marsh A M, Nunn J F, Taylor S J, Charlesworth C H
Division of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex.
Br J Anaesth. 1991 Nov;67(5):517-23. doi: 10.1093/bja/67.5.517.
Soft tissue lateral neck radiography was used in 22 male patients older than 60 yr, to determine the cause of pharyngeal airway obstruction during anaesthesia, before and after insertion of a Guedel airway. In six of the patients, the airway was radiologically and clinically clear with the head in the neutral position. Nine patients showed obstruction of the airway by a "shelf" of tongue, but seven were cleared clinically by dorsiflexion at the atlanto-occipital joint, and the remaining two by the Esmarch-Heiberg manoeuvre. In four of the 22 patients, the Guedel airway was lodged in the vallecula in the neutral position. This was cleared clinically by dorsiflexion at the atlanto-occipital joint in all these patients. In three patients the Guedel airway was obstructed by the epiglottis, but this was cleared by dorsiflexion at the atlanto-occipital joint in two; in the third patient, the Guedel airway slipped into the vallecula after dorsiflexion at the atlanto-occipital joint and remained there despite the Esmarch-Heiberg manoeuvre. There was only one instance in 66 trials of a clinically obstructed airway without an apparent radiological cause. However, there were 10 instances in 66 trials of a clinically clear airway with an apparent radiological cause for obstruction.
对22名60岁以上的男性患者进行了颈部软组织侧位X线摄影，以确定在插入 Guedel 气道前后麻醉期间咽气道阻塞的原因。6名患者在头部处于中立位时气道在影像学和临床上均清晰。9名患者显示气道被舌“架”阻塞，但7名通过寰枕关节背屈在临床上气道阻塞得到缓解，其余2名通过 Esmarch-Heiberg 手法缓解。22名患者中有4名，Guedel 气道在中立位时嵌顿于会厌谷。所有这些患者通过寰枕关节背屈在临床上气道阻塞得到缓解。3名患者中，Guedel 气道被会厌阻塞，但2名通过寰枕关节背屈得到缓解；在第3名患者中，Guedel 气道在寰枕关节背屈后滑入会厌谷，尽管采用了 Esmarch-Heiberg 手法仍留在那里。在66次试验中，只有1例临床上气道阻塞但无明显影像学原因。然而，在66次试验中有10例临床上气道通畅但有明显的影像学阻塞原因。
