Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425-9120, USA.
Curr Opin Anaesthesiol. 2010 Feb;23(1):41-6. doi: 10.1097/ACO.0b013e328333b768.
The article reviews the epidemiology of airway injuries, airway anatomy, techniques for airway management, helpful pharmacologic adjuncts and finally alternatives to airway manipulation.
Principles of airway management including the maintenance of spontaneous ventilation and careful and adequate preparation for an alternative plan will always be important. Advances in pharmacologic agents provide a safer, more controlled environment through which the patient's compromised airway can be controlled. Recent publications add to the evidence that alternative methods of oxygenation and ventilation such as cardiopulmonary bypass can be used successfully to treat patients with catastrophic airway injuries.
Trauma to the airway, either blunt or penetrating or iatrogenic, can result in significant patient morbidity and mortality. Although, relatively rare, if we practice long enough, each of us will encounter such a patient. The anesthesiologist must be familiar with airway anatomy and the location of injury for successful treatment. Along with airway injuries, associated injuries are common and often complicate definitive airway treatment. Modern anesthetic medications such as dexmedetomidine and proven techniques such as awake fiberoptic intubation can be used to safely treat these difficult patients. Alternative therapies such as cricothyroidotomy and cardiopulmonary bypass should be available if first-line therapies fail to secure an injured airway.
本文回顾了气道损伤的流行病学、气道解剖、气道管理技术、有帮助的药物辅助以及最后是气道操作的替代方法。
气道管理的原则包括维持自主通气以及仔细和充分地准备替代计划，这始终是很重要的。药物的进步为通过控制患者受损的气道提供了更安全、更可控的环境。最近的出版物增加了证据，表明诸如体外循环等替代的氧合和通气方法可成功用于治疗气道严重损伤的患者。
无论是钝性、穿透性还是医源性气道损伤，都可能导致患者出现严重的发病率和死亡率。虽然相对罕见，但如果我们行医时间足够长，我们每个人都会遇到这样的患者。麻醉师必须熟悉气道解剖和损伤位置，以便成功治疗。除了气道损伤外，还常见相关损伤，这常常使明确的气道治疗复杂化。现代麻醉药物，如右美托咪定，以及已证实的技术，如清醒纤维支气管镜检查，可用于安全地治疗这些困难的患者。如果一线治疗不能确保气道安全，应可使用替代疗法，如环甲膜切开术和体外循环。
