Schmidt Alexander R, Weiss Markus, Engelhardt Thomas
From the Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland (ARS, MW), and Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK (TE).
Eur J Anaesthesiol. 2014 Jun;31(6):293-9. doi: 10.1097/EJA.0000000000000023.
Perioperative airway problems frequently result in significant morbidity and mortality in children. Therefore, proficiency in airway management is one of the most important key elements in the safe conduct of paediatric anaesthesia. This review includes important anatomical and physiological aspects of the paediatric airway, challenges encountered, and their management with commonly available resources. The importance of early recognition and treatment of anatomical or functional airway obstruction using locally adapted algorithms is highlighted. Children deemed at risk of aspiration require a controlled rapid sequence induction with sufficiently deep anaesthesia, confirmed complete muscle paralysis and intermittent ventilation prior to tracheal intubation. The benefits of a supraglottic airway device and a cuffed tracheal tube in paediatric airway management are discussed. The primary goal of mastering the paediatric airway is to ensure oxygenation and ventilation. This requires intricate knowledge, regular practice and experience.
围手术期气道问题常常导致儿童出现严重的发病和死亡情况。因此,气道管理技能是小儿麻醉安全实施过程中最重要的关键要素之一。本综述涵盖了小儿气道的重要解剖和生理方面、遇到的挑战以及使用常用资源对其进行的管理。强调了使用因地制宜的算法对解剖或功能性气道梗阻进行早期识别和治疗的重要性。被认为有误吸风险的儿童在气管插管前需要进行可控的快速顺序诱导,要有足够深的麻醉、确认完全的肌肉麻痹和间歇性通气。文中还讨论了声门上气道装置和带套囊气管导管在小儿气道管理中的益处。掌握小儿气道的主要目标是确保氧合和通气。这需要详尽的知识、定期的练习和经验。