Department of Anaesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka 570-8507, Japan.
Br J Anaesth. 2010 Jan;104(1):108-11. doi: 10.1093/bja/aep316.
In patients with unstable necks and at risk of pulmonary aspiration, awake fibreoptic intubation is often appropriate. However, stabilization of the neck can make fibreoptic intubation more difficult. I report the use of awake nasal intubation using the Pentax-Aiway Scope (AWS) in three patients with restricted neck movement, in whom awake fibreoptic intubation had failed. Case 1: a 59-yr-old man, at risk of aspiration, required an emergency cervical laminectomy. Awake fibreoptic intubation was attempted while a Halo vest was being applied, but it was impossible to see the glottis, mainly due to pharyngeal and laryngeal oedema. The Pentax-AWS was easily inserted orally, and nasotracheal intubation was achieved within 20 s. Case 2: an 85-yr-old woman with neck injury required emergency surgical stabilization. A retropharyngeal haematoma prevented a fibreoptic bronchoscope from being advanced beyond the epiglottis. Nasotracheal intubation using the Pentax-AWS (with the aid of a gum elastic bougie) was achieved within 1 min. Case 3: a 22-yr-old man, with partial spinal cord damage, was undergoing cervical laminoplasty. He was at risk of aspiration and had an oedematous larynx. Although it was possible to insert a fibreoptic bronchoscope into the trachea while the neck was stabilized with a Halo vest, it was impossible to advance a tube over the fibrescope. Awake nasotracheal intubation using the Pentax-AWS was achieved within 15 s. The Pentax-AWS may be useful for nasotracheal intubation in awake patients with restricted necks.
在颈部不稳定且有发生肺吸入风险的患者中，通常适合进行清醒纤维支气管镜插管。然而，颈部的稳定可能会使纤维支气管镜插管更加困难。我报告了在 3 名颈部活动受限且清醒纤维支气管镜插管失败的患者中使用 Pentax-Aiway 镜（AWS）进行清醒经鼻插管的情况。病例 1：一名 59 岁男性，有发生吸入的风险，需要紧急行颈椎减压术。在应用 Halo 背心时尝试进行清醒纤维支气管镜插管，但由于咽和喉水肿，无法看到声门。Pentax-AWS 很容易经口插入，在 20 秒内完成经鼻气管插管。病例 2：一名 85 岁女性因颈部受伤需要紧急手术稳定。咽后血肿阻止纤维支气管镜进一步进入会厌。在使用 Pentax-AWS（借助弹性胶导尿管）的情况下，在 1 分钟内完成经鼻气管插管。病例 3：一名 22 岁男性，部分脊髓损伤，正在接受颈椎板切除术。他有发生吸入的风险，且喉部水肿。尽管在 Halo 背心稳定颈部的情况下，可以将纤维支气管镜插入气管，但无法将管子穿过纤维支气管镜。在 15 秒内完成经鼻清醒 Pentax-AWS 插管。Pentax-AWS 可能有助于对颈部受限的清醒患者进行经鼻插管。
