Ramesh S, Jayanthi R, Archana S R
Department of Anaesthesia, Kanchi Kamkoti Child Trust Hospital, Chennai, Tamil Nadu, India.
Indian J Anaesth. 2012 Sep;56(5):448-53. doi: 10.4103/0019-5049.103959.
Airway management plays a pivotal role in Paediatric Anaesthesia. Over the last two decades many improvements in this area have helped us to overcome this final frontier. From an era where intubation with a conventional laryngoscope or blind nasal intubation was the only tool for airway management, we have come a long way. Today supraglottic airway devices have pride of place in the Operating Room and are becoming important airway devices used in routine procedures. Direct and indirect fibreoptic laryngoscopes and transtracheal devices help us overcome difficult and previously impossible airway situations. These developments mean that we need to update our knowledge on these devices. Also much of our basic understanding of the physiology and anatomy of the paediatric airway has changed. This article attempts to shed light on some of the most important advances/opinions in paediatric airway management like, cuffed endotracheal tubes, supraglottic airway devices, video laryngoscopes, rapid sequence intubation, the newly proposed algorithm for difficult airway management and the role of Ex Utero Intrapartum Treatment (EXIT) procedure in the management of the neonatal airway.
气道管理在小儿麻醉中起着关键作用。在过去二十年里,该领域的诸多改进帮助我们攻克了这一最后的难关。从传统喉镜插管或盲目鼻腔插管是气道管理唯一手段的时代起,我们已经取得了长足的进步。如今,声门上气道装置在手术室中占据重要地位,并且正成为常规手术中使用的重要气道装置。直接和间接纤维喉镜以及经气管装置帮助我们克服困难以及此前无法处理的气道情况。这些进展意味着我们需要更新关于这些装置的知识。此外,我们对小儿气道生理和解剖的许多基本认识也已发生变化。本文试图阐明小儿气道管理中的一些最重要的进展/观点,如带套囊气管内导管、声门上气道装置、视频喉镜、快速顺序插管、新提出的困难气道管理算法以及产时宫外治疗(EXIT)程序在新生儿气道管理中的作用。