Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
Curr Opin Anaesthesiol. 2011 Jun;24(3):249-54. doi: 10.1097/ACO.0b013e328345ace3.
This review focuses on difficult intubation in pregnant patients, particularly during the late pregnancy when physiological, patho-physiological and psychological factors may cause or aggravate difficulties with providing sufficient oxygenation and securing the airway. It is intended to highlight the methodological approach to the difficult airway in this particular patient population and to draw relevant principles in dealing with this problem.
There are strong indications for improvement in the outcome of airway management in pregnant patients; however, this is obscured by the growing frequency of caesarean sections and connected to this by more tracheal intubations. Various new airway devices have been suggested as alternative techniques for laryngoscopic intubation if the latter becomes difficult or failed.
A scenario-oriented approach to the problem of difficult intubation in pregnant patients leads to the recognition of the unpredicted difficult or failed intubation as the main concern. The appropriate means to cope with this rare but life-threatening complication lies in a gradual employment of principles beginning with preferential application of regional anaesthesia techniques, followed by proceeding according to locally adapted simple and comprehensive failed intubation algorithms, design of a suitable difficult airway cart that contains only a few but well chosen items and by implementation of a continuous and mandatory training program to which all personnel are subjected to participate in regular intervals.
本文重点讨论了妊娠患者困难插管的问题，尤其是在妊娠晚期，生理、病理生理和心理因素可能导致或加重氧合不足和气道保障困难。本文旨在突出在这一特定患者群体中处理困难气道的方法学方法，并总结出处理这一问题的相关原则。
尽管剖宫产和气管插管的频率越来越高，掩盖了提高妊娠患者气道管理效果的强烈趋势，但仍有强烈的迹象表明这一趋势正在改善。如果直接喉镜插管变得困难或失败，各种新型气道设备已被建议作为替代插管技术。
针对妊娠患者困难插管问题的情景导向方法，可识别出意外的困难或插管失败，将其作为主要关注点。处理这种罕见但危及生命的并发症的适当方法是逐步应用原则，首先是优先应用区域麻醉技术，然后根据当地适应的简单而全面的插管失败算法进行操作，设计合适的困难气道车，其中仅包含少数精选物品，并实施持续的强制性培训计划，所有人员都必须定期参加。
