Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
J Anesth. 2011 Oct;25(5):781-3. doi: 10.1007/s00540-011-1204-6. Epub 2011 Jul 26.
In patients in whom a tracheal tube cannot be inserted through the nostrils due to multiple facial trauma or hypoplasty of the nose, submental orotracheal intubation (SOI) is performed to avoid tracheostomy. We report a new modification for SOI to minimize the risk of apnea. A 20-year-old man was scheduled for sagittal split ramus osteotomy. As the patient had severe hypoplasia of the nose, SOI was planned. Following orotracheal intubation with a spiral tube (first tube), a submental tunnel was surgically created. A second tube that had been confirmed, in advance, to snugly fit into the proximal end of the first tube was passed into the submental tunnel via a polypropylene cylinder and connected between the first tube and the breathing circuit. After careful withdrawal of the second tube through the submental tunnel, the first tube was directly connected to the breathing circuit after removal of the second tube. Although this technique requires additional time, apnea time is minimal even in patients in whom withdrawal of the tracheal tube through the submental tunnel takes time, because the second tube forms a link between the first tube and the breathing circuit, making it possible to ventilate the patient throughout the procedure.
由于多发性面部创伤或鼻部发育不全，无法通过鼻腔插入气管导管的患者，可进行颏下经口气管插管（SOI）以避免气管切开术。我们报告了一种新的 SOI 改良方法，以最大限度地降低呼吸暂停的风险。一名 20 岁男性拟行矢状劈开下颌骨截骨术。由于患者鼻部严重发育不全，计划进行 SOI。在使用螺旋管（第一管）进行经口气管插管后，通过手术在颏下创建一个隧道。通过聚丙烯管将事先确认可紧密贴合第一管近端的第二管穿过颏下隧道，并将其连接在第一管和呼吸回路之间。小心地通过颏下隧道撤出第二管后，在撤出第二管后，第一管直接连接到呼吸回路。尽管该技术需要额外的时间，但即使通过颏下隧道撤出气管导管需要时间的患者，呼吸暂停时间也最短，因为第二管在第一管和呼吸回路之间形成了连接，使患者能够在整个过程中进行通气。
