Naithani Manish, Jain Alpna
Department of Anesthesiology, Maulana Azad Institute of Dental Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):395-7. doi: 10.4103/0970-9185.83692.
Flexible fiberoptic bronchoscope-guided awake intubation is the most trusted technique for managing an anticipated difficult airway. Even after successfully negotiating the bronchoscope into the trachea, the possibility remains that the preloaded tracheal tube might prove to be inappropriately large, and may not negotiate the nasal structures. In such a situation, the most obvious solution is to take out the bronchoscope, replace the tracheal tube with a smaller one, and repeat the procedure. Unfortunately, sometimes the second attempt is not as easy as the first, as minor trauma during the earlier attempt causes tissue edema and bleeding, which makes the subsequent bronchoscopic view hazy and difficult. We present the anesthetic management of five cases with temporomandibular joint ankylosis where, after successful, though slightly traumatic, bronchoscope insertion into the trachea, the tube could not be threaded in. We avoided a repeat bronchoscopy by making an innovative change in the plan.
可弯曲纤维支气管镜引导下清醒插管是处理预期困难气道最可靠的技术。即使已成功将支气管镜插入气管，预先准备好的气管导管仍有可能过大，无法通过鼻腔结构。在这种情况下，最明显的解决办法是取出支气管镜，换用较小的气管导管，然后重复操作。不幸的是，有时第二次尝试并不像第一次那么容易，因为首次尝试时的轻微创伤会导致组织水肿和出血，使后续支气管镜视野模糊且操作困难。我们介绍了5例颞下颌关节强直患者的麻醉处理情况，在成功（尽管有轻微创伤）将支气管镜插入气管后，导管无法通过。我们通过创新性地改变方案避免了重复支气管镜检查。
