Yeh Lijen, Chen Hung-Shu, Tan Ping-Heng, Liu Ping-Hsin, Hsieh Shao-Wei, Hung Kuo-Chuan
Department of Anesthesiology, E-Da Hospital, Kaohsiung, Taiwan, ROC.
Department of Anesthesiology, E-Da Hospital, Kaohsiung, Taiwan, ROC.
Acta Anaesthesiol Taiwan. 2013 Dec;51(4):180-3. doi: 10.1016/j.aat.2013.10.001. Epub 2013 Dec 22.
Airway management in patients with giant neck masses is usually a challenge to anesthesiologists. A giant neck mass could compress the airway and thus impede endotracheal intubation. We encountered a situation where the giant neck masses of a patient pushed the epiglottis posteriorly toward the posterior pharyngeal wall and compressed the laryngeal aperture narrowing after anesthetic induction, causing direct laryngoscopic intubation and sequential fiber-optic intubation failed. The neck masses twisted the aryepiglottic fold tortuously and clogged the laryngeal aperture tightly, making a flexible fiber-optic bronchoscope unable to pass through the laryngeal aperture. Later, we utilized a McCoy laryngoscope alternately to lift the compressed larynx up and away from the posterior pharyngeal wall, creating a passage and completing endotracheal intubation successfully with the aid of a gum elastic bougie. Our case suggested that the tilting tip blade of the McCoy laryngoscope could lever the tongue base up against the tumor mass compression to improve laryngeal views and facilitate endotracheal intubation when a difficult fiber-optic intubation was encountered on a compressed laryngeal aperture.
对于患有巨大颈部肿块的患者，气道管理通常是麻醉医生面临的一项挑战。巨大颈部肿块可能会压迫气道，从而妨碍气管插管。我们遇到过这样一种情况：一名患者的巨大颈部肿块在麻醉诱导后将会厌向后推向咽后壁，并压迫喉口使其变窄，导致直接喉镜插管和随后的纤维光导喉镜插管均失败。颈部肿块使杓会厌襞扭曲，并紧紧堵塞喉口，使得可弯曲纤维光导支气管镜无法通过喉口。后来，我们交替使用麦考伊喉镜将受压的喉部向上抬起并使其远离咽后壁，开辟出一条通道，并借助弹性橡胶探条成功完成了气管插管。我们的病例表明，当在受压的喉口遇到困难的纤维光导喉镜插管时，麦考伊喉镜的可倾斜前端叶片可撬起舌根以对抗肿瘤肿块的压迫，从而改善喉镜视野并便于气管插管。
