Heck Jayme da Rocha, Martins Frederico Krieger, Tsukazan Maria Teresa Ruiz, Cristofoli Vivian, Pipkin Maurício, da Silveira Marner Lopes, Rios Jayme de Oliveira, Pinto José Antônio Lopes de Figueiredo
Serviço de Anestesiologia of Hospital São Lucas, PUCRS, Porto Alegro, Brazil.
Rev Bras Anestesiol. 2011 Jul-Aug;61(4):474-8. doi: 10.1016/S0034-7094(11)70055-1.
Difficult airway management in thoracic surgeries is a peculiar subject due to the demands of monopulmonary ventilation with double-lumen tubes. Flexible bronchoscopy guidance is extremely important, but it is not always available. The objective of this report was to describe a case of retrograde selective orotracheal intubation in the absence of specific endoscopy equipment for the procedure.
This is a patient with a history of retosigmoidectomy, admitted for a right thoracotomy for a lung lesion. Preoperative anesthetic evaluation did not reveal any clinical and physical exam particularities. After anesthetic induction and ventilation with face mask, two attempts of orotracheal intubation under direct laryngoscopy were ineffective due to difficult visualization of the vocal folds (Cormack-Lehane grade III). Due to the unavailability of specific material for selective endoscopic intubation it was decided to use the retrograde technique using the double-lumen tube. The patient was extubated in the operating room shortly after the end of the surgery without complications secondary to the alternative technique.
Retrograde selective orotracheal intubation is a minimally invasive technique, low cost, safe, and extremely useful whenever flexible bronchoscopy is not available.
由于双腔管单肺通气的要求，胸外科手术中的困难气道管理是一个特殊的课题。可弯曲支气管镜引导极为重要，但并非总能实现。本报告的目的是描述一例在缺乏该操作专用内镜设备的情况下进行逆行选择性经口气管插管的病例。
这是一名有直肠乙状结肠切除术病史的患者，因肺部病变入院接受右胸开胸手术。术前麻醉评估未发现任何临床和体格检查异常。麻醉诱导并面罩通气后，直接喉镜下经口气管插管两次尝试均未成功，原因是声门可视困难（Cormack-Lehane分级III级）。由于缺乏选择性内镜插管的专用材料，决定使用双腔管采用逆行技术。患者在手术结束后不久在手术室拔管，未出现因替代技术导致的并发症。
逆行选择性经口气管插管是一种微创技术，成本低、安全，在无法进行可弯曲支气管镜检查时极为有用。
