Drolet Pierre
Département d'anesthésiologie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC H3C 3J7, Canada.
Can J Anaesth. 2009 Sep;56(9):683-701. doi: 10.1007/s12630-009-9144-4. Epub 2009 Jul 28.
The purpose of this Continuing Professional Development module (CPD) is to update clinicians regarding a systematic approach for anticipated difficult airway management.
The focus of the approach should be directed towards providing adequate oxygenation and ventilation and not necessarily intubating the trachea. The purpose of preoperative airway assessment is not only to detect possible difficult direct laryngoscopy, but also to evaluate the probability of effective ventilation using supraglottic airway devices, such as the oropharyngeal airway or the laryngeal mask airway. Predicting the degree of difficulty with direct laryngoscopy or ventilation with a supraglottic device remains an imperfect science, and the experience of the anesthesiologist plays an important role in the clinical decision-making process. When a difficult airway is anticipated, the need for tracheal intubation should be carefully assessed. If tracheal intubation is deemed non-essential, the role of a supraglottic device should be considered. If adequate management with a supraglottic device is unlikely, then intubation is indicated with the patient awake. In certain cases, a sevoflurane induction may be chosen to test the efficacy of a supraglottic device while simultaneously maintaining spontaneous ventilation. If tracheal intubation is required, a supraglottic device may be used as a bridge during induction of anesthesia and may even be used to insert the tracheal tube. The choice of either the supraglottic device or another aid to intubation depends essentially on the anesthesiologist's experience.
Airway management should be approached systematically, always keeping in mind the importance of uninterrupted oxygenation and ventilation, especially when difficulties are anticipated. Supraglottic devices can play an important role in the management of the difficult airway, whether used for the duration of surgery or inserted as an aid to intubation.
本继续职业发展模块（CPD）的目的是向临床医生介绍一种针对预期困难气道管理的系统方法。
该方法的重点应是提供充足的氧合和通气，而不一定是气管插管。术前气道评估的目的不仅是检测可能的直接喉镜检查困难，还在于评估使用声门上气道装置（如口咽气道或喉罩气道）进行有效通气的可能性。预测直接喉镜检查或使用声门上装置通气的困难程度仍然是一门不完善的科学，麻醉医生的经验在临床决策过程中起着重要作用。当预期为困难气道时，应仔细评估气管插管的必要性。如果认为气管插管并非必要，则应考虑使用声门上装置。如果不太可能通过声门上装置进行充分管理，则应在患者清醒时进行插管。在某些情况下，可以选择七氟醚诱导来测试声门上装置的效果，同时维持自主通气。如果需要气管插管，声门上装置可在麻醉诱导期间用作桥梁，甚至可用于插入气管导管。选择声门上装置或其他插管辅助工具主要取决于麻醉医生的经验。
气道管理应系统进行，始终牢记持续氧合和通气的重要性，尤其是在预期有困难时。声门上装置在困难气道管理中可发挥重要作用，无论是在手术期间使用还是作为插管辅助工具插入。
