Division of Anesthesiology and Algology, KU Leuven, Belgium.
Curr Opin Anaesthesiol. 2013 Aug;26(4):481-8. doi: 10.1097/ACO.0b013e328362cc69.
The number of diagnostic and interventional procedures outside the operating room has dramatically increased over the last years. However, providing well tolerated anesthesia with the same standard of care in these locations is often challenging to the anesthesiologist. The remote locations include different organizational aspects and hazards. Airway management in general is still confronted with scenarios of difficult intubation and ventilation and often leads to significant morbidity and mortality. Continuous awareness of the potential complications is urged when providing anesthesia for remote procedures.
Recent studies have poorly addressed the issue of airway management by trained anesthesiologists outside the operating room. The majority of evidence is provided in the field of emergency medicine and intensive care settings. However, when dealing with difficult airway management in the remote setting, careful assessment and preparation is even more important than in the operating room. New evidence concerning prediction of ventilation and intubation must be incorporated in algorithms of airway management. Different anesthetic regimens using remifentanil and avoiding the use of neuromuscular blockers have to be carefully considered since they might change the scenario of intubation conditions. The new era of video laryngoscopes offers important potential to increase the tools for airway management. These new devices have the perfect design to be incorporated in remote settings. However, studies mainly focus on the emergency department and ICU. Also, there is currently a lack of consensus among professionals about their use and the large number of different devices seems to avoid careful comparisons.
Airway management outside the operating room is challenging and needs the implementation of algorithms including the new airway devices. The recent update of the practice guidelines about difficult airway management of the American Society of Anesthesiologists remains the standard reference guide.
近年来，手术室以外的诊断和介入操作数量显著增加。然而，在这些场所为患者提供耐受良好的麻醉并达到相同的护理标准对麻醉医师而言颇具挑战。这些远程场所包括不同的组织方面和危害。一般来说，气道管理仍然面临着插管和通气困难的情况，并且常常导致显著的发病率和死亡率。在为远程操作提供麻醉时，强烈需要持续意识到潜在的并发症。
最近的研究对在手术室外接受训练有素的麻醉师进行的气道管理问题的研究不足。大多数证据来自急诊医学和重症监护环境。然而，在远程环境中处理困难的气道管理时，仔细的评估和准备比在手术室中更为重要。必须在气道管理的算法中纳入有关通气和插管预测的新证据。使用瑞芬太尼并避免使用神经肌肉阻滞剂的不同麻醉方案必须仔细考虑，因为它们可能会改变插管条件的情况。视频喉镜的新时代为增加气道管理工具提供了重要的潜力。这些新设备的设计非常完美，可以纳入远程环境。然而，这些研究主要集中在急诊室和 ICU。此外，目前专业人员对其使用缺乏共识，并且大量不同的设备似乎避免了仔细的比较。
手术室以外的气道管理具有挑战性，需要实施包括新气道设备的算法。美国麻醉医师学会（ASA）关于困难气道管理的实践指南的最新更新仍然是标准参考指南。
