Department of Anaesthesia, Royal United Hospital, Bath, UK.
Anaesthesia. 2011 Sep;66(9):828-36. doi: 10.1111/j.1365-2044.2011.06650.x. Epub 2011 Apr 12.
Anticipated problems with airway management during anaesthesia require careful planning, particularly when they involve a risk of airway obstruction. Advice may be sought from published literature (usually written by experts) or through direct communication with experts. More frequently, expert involvement is through retrospective review following patient harm. We present the case of a patient suffering from a retrosternal thyroid mass that was compressing her trachea in the midline and dividing it into two 2 × 3 mm lumens. After local discussion the patient underwent thyroidectomy. We invited international experts in anaesthetic airway management to review her case and submit their opinions regarding the best airway management for this difficult case. Opinions differed markedly, mirroring the published literature. Some experts specifically criticised techniques that, unbeknown to them, were proposed by others. The case raises issues about the nature of expert opinion that extends beyond this particular case. The nature and implications of expert opinion, when evidence is absent or conflicting, are discussed.
在麻醉期间，预计会出现气道管理问题，需要仔细规划，尤其是当涉及气道阻塞风险时。可以从已发表的文献（通常由专家撰写）或通过与专家直接沟通来寻求建议。更常见的是，通过患者受到伤害后的回顾性审查来征求专家意见。我们报告了一例患有胸骨后甲状腺肿块的患者，该肿块压迫她的气管，使其在中线处分为两个 2×3mm 的管腔。在进行局部讨论后，患者接受了甲状腺切除术。我们邀请了麻醉气道管理方面的国际专家来审查她的病例，并就这个困难病例的最佳气道管理提出意见。专家的意见存在明显分歧，反映了已发表的文献。一些专家特别批评了他们不知道是由其他专家提出的技术。该病例提出了一些超出该特定病例的专家意见的性质问题。在没有证据或证据相互矛盾的情况下，讨论了专家意见的性质和影响。
