Department of Anaesthesiology and Critical Care, CHU Pitié-Salpêtrière, Paris, France.
Eur J Anaesthesiol. 2012 Apr;29(4):197-203. doi: 10.1097/EJA.0b013e32834f8343.
Airway management of patients with dental cellulitis can be difficult due to laryngeal deviation and oedema. Awake fibre-optic intubation has been recommended.
The aim of this study was to assess our routine procedure which is based mainly on direct laryngoscopy.
This was a prospective observational study.
In a single centre between February 2008 and February 2009.
All patients suffering from dental cellulitis and requiring emergency surgery were included except pregnant women and patients under 18 years.
Nasotracheal intubation by direct laryngoscopy under general anaesthesia was performed unless the supine position was not tolerated, or difficult mask ventilation or intubation was anticipated, when awake nasotracheal fibre-optic intubation was indicated. In the case of failure at the first attempt, orotracheal intubation by direct laryngoscopy was attempted. If failure persisted, tracheotomy was then performed.
The principal endpoint was the incidence of difficult mask ventilation which was expected to be less than 5%. Secondary endpoints were the incidence of difficult tracheal intubation and tracheotomy.
We included 127 consecutive patients (mouth opening 20±10 mm). One did not tolerate the supine position and was successfully intubated using the fiberscope. Among the 126 remaining, difficult mask ventilation did not occur [0%, 95% confidence interval (CI) 0-3%], 124 (98%) patients were intubated by direct laryngoscopy and two (2%) required tracheotomy. Retrognathia (odds ratio 8.2, 95% CI 1.3-50.1) and extension to oral floor (odds ratio 15.1, 95% CI 1.8-129.5) were significantly associated with the prediction of intubation failure at the first attempt.
Most patients with dental cellulitis can be safely intubated through direct laryngoscopy even if mouth opening is limited.
由于会厌偏斜和水肿，患有蜂窝织炎的患者的气道管理可能会很困难。已建议进行清醒纤维光插管。
本研究旨在评估我们的常规程序，该程序主要基于直接喉镜检查。
这是一项前瞻性观察性研究。
在 2008 年 2 月至 2009 年 2 月之间的一家单中心进行。
所有患有蜂窝织炎并需要紧急手术的患者均被纳入研究，除非孕妇和 18 岁以下的患者无法耐受仰卧位，或预计面罩通气或插管困难，否则需要清醒鼻插管纤维光插管。如果首次尝试失败，或通过直接喉镜进行气管插管。如果持续失败，则进行气管切开术。
主要终点是预期发生率低于 5%的面罩通气困难。次要终点是气管插管困难和气管切开术的发生率。
我们纳入了 127 例连续患者（张口度 20±10mm）。有 1 例患者无法耐受仰卧位，通过纤维镜成功插管。在其余 126 例患者中，未发生面罩通气困难[0%，95%置信区间（CI）0-3%]，124 例（98%）患者通过直接喉镜插管，2 例（2%）需要气管切开术。后缩（优势比 8.2，95%CI 1.3-50.1）和延伸至口腔底（优势比 15.1，95%CI 1.8-129.5）与首次尝试插管失败的预测显著相关。
即使张口度有限，大多数患有蜂窝织炎的患者也可以通过直接喉镜安全插管。
