Viallard M, Sok S, Olivera C, Dehghani J, Riou B
Département d'Anesthésie-Réanimation, Hôpital Tenon, Paris.
Ann Fr Anesth Reanim. 1990;9(5):460-2. doi: 10.1016/s0750-7658(05)80955-4.
A typical case of upper airway obstruction due to deformation of a low pressure tracheal tube cuff is reported. It would seem that this herniation may have been due to nitrous oxide diffusing with in the air-filled cuff, thereby causing it to overdistend. This increase in pressure occurred after 3 hours of inhalation of a mixture of oxygen and nitrous oxide. The deformed cuff may either block the lumen at the end of the tube, or push the tube against the tracheal wall. The result is, in either case, a mechanical obstruction of the airway, with hypoxia, and then anoxia. In the reported case, it was the decrease of SpO2 which alerted the anaesthetist. Pulse oximetry was helpful for an early diagnosis. To avoid such accidents, it is suggested either to inflate the cuff with the gas mixture with which the patient is ventilated, or to deflate it every 30 min.
报告了一例因低压气管导管套囊变形导致上呼吸道梗阻的典型病例。这种套囊疝出似乎可能是由于一氧化二氮在充满空气的套囊中扩散，从而使其过度膨胀。在吸入氧气和一氧化二氮的混合物3小时后出现了这种压力增加。变形的套囊可能会阻塞导管末端的管腔，或者将导管推向气管壁。无论哪种情况，结果都是气道出现机械性梗阻，导致缺氧，进而发展为无氧血症。在所报告的病例中，是SpO2的下降提醒了麻醉医生。脉搏血氧饱和度测定有助于早期诊断。为避免此类事故，建议要么用患者通气所用的气体混合物给套囊充气，要么每隔30分钟放气一次。
