Raval Chetan B, Khan Suleiman
Department of Anesthesia, Al-Nahdha Hospital, P.O. Box: 937, PC: 112, Ruwi, Muscat, Oman.
Middle East J Anaesthesiol. 2012 Feb;21(4):647-51.
Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Skilful airway management is critical in deep neck space infections. There is currently no universal agreement on the ideal method of airway control for these patients because this depends on various factors including available local expertise and equipment. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Any flaw in airway management may lead to grave morbidity and mortality. We present a morbidly obese case of submandibular abscess with difficult intubation underwent incision and drainage. Large facial [jaw] swelling, TRISMUS-limited mouth opening, edema, protruding teeth and altered airway anatomy makes airway management more difficult. The case was further complicated by morbid obesity. Chances of rupture of abscess intraorally and aspiration under GA is a major threat. During GA, there is no change in mouth opening and loss of airway under muscle relaxation, "difficult to ventilate, difficult to intubate" makes these cases most challenging. On the basis of our experience case was successfully intubated by awake fibreoptic intubation.
确保气道安全是麻醉中的一项核心技能，其金标准是气管插管。通常这在麻醉诱导后完成。然而，某些情况下需要清醒插管。在深部颈部间隙感染中，熟练的气道管理至关重要。目前对于这些患者理想的气道控制方法尚无普遍共识，因为这取决于多种因素，包括当地现有的专业知识和设备。尽管有各种可用的方法，但气道受损对麻醉医生来说仍是一个挑战。气道管理中的任何缺陷都可能导致严重的发病率和死亡率。我们报告一例患有下颌下脓肿且插管困难的病态肥胖患者接受切开引流的病例。面部[下颌]肿胀、牙关紧闭导致张口受限、水肿、牙齿突出以及气道解剖结构改变，使得气道管理更加困难。该病例因病态肥胖而进一步复杂化。脓肿在口腔内破裂以及全身麻醉下误吸的可能性是一个重大威胁。在全身麻醉期间，张口度无变化且肌肉松弛时气道丧失，“通气困难、插管困难”使这些病例极具挑战性。根据我们的经验，该病例通过清醒纤维支气管镜插管成功完成插管。
