Nakai Kishiko, Kitayama Masatoh, Niwa Hidetomo, Hashiba Eiji, Wada Morito, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8563.
Masui. 2010 Oct;59(10):1315-7.
We report a case of surgical vertical-section of the nasoendotracheal tube during operation, resulting in intra-operative ventilatory difficulties. The patient was a 32-year-old female, scheduled for Maxillo-Mandibular osteotomy under general anesthesia. She was intubated with I.D. 6.0 mm non-kinking tube via left nasal cavity. Forty minutes into a maxillar osteotomy, sudden tracheal tube leak sound was noticed by surgeon. Ten more minutes later, ventilation became difficult, and laryngeal packing was done temporarily. We tried to exchange the nasotracheal tube with Airway Scope, but not with endotracheal tube exchanger, because there was a possibility of complete tube section or difficult extubation from nasal cavity. We could examine the larynx whether it was with edema or not, and two tracheal tubes at the same time. Therefore, we performed tube exchange smoothly and safely. The extubated tracheal tube had serious cut on cuff inflation line made by surgical maneuver. In the case of suspected laryngeal edema or tracheal tube injury, use of Airway Scope for tube exchange may be a safe and reliable method.
我们报告一例手术过程中鼻气管导管垂直切开的病例，导致术中通气困难。患者为一名32岁女性，计划在全身麻醉下行上颌-下颌截骨术。经左鼻腔插入内径6.0 mm的无弯折导管进行气管插管。上颌骨截骨术进行40分钟后，外科医生突然听到气管导管漏气声。又过了10分钟，通气变得困难，遂临时进行了喉填塞。我们试图用气道镜更换鼻气管导管，但未使用气管导管交换器，因为存在导管完全切断或经鼻腔拔管困难的可能性。我们能够检查喉部是否有水肿，以及同时检查两根气管导管。因此，我们顺利且安全地完成了导管更换。拔出的气管导管在气囊充气线上有手术操作造成的严重切口。在怀疑有喉水肿或气管导管损伤的情况下，使用气道镜进行导管更换可能是一种安全可靠的方法。
