Durbin Charles G, Bell Christopher T, Shilling Ashley M
Department of Anesthesiology, University of Virginia Health Science System, Charlottesville, Virginia.
Respir Care. 2014 Jun;59(6):825-46; discussion 847-9. doi: 10.4187/respcare.02802.
Endotracheal intubation is a commonly performed operating room (OR) procedure that provides safe delivery of anesthetic gases and airway protection during surgery. The most common intubation technique in the perioperative environment is direct laryngoscopy with orotracheal tube insertion. Infrequently, difficulties that require an alternative intubation technique are encountered due to patient anatomy, equipment limitations, or patient pathophysiology. Careful patient evaluation, advanced planning, equipment preparation, system redundancy, use of checklists, familiarity with airway algorithms, and availability of additional help when needed during OR intubations have resulted in exceptional success and safety. Airway difficulties during intubation outside the controlled environment of the OR are more frequent and more serious. Translating the intubation processes practiced in the OR to intubations outside the perioperative setting should improve patient safety. This paper considers each step in the OR intubation process in detail and proposes ways of incorporating perioperative procedures into intubations outside the OR. Management of the physiologic impact of intubation, lack of readily available specialized equipment and experienced help, and planning for transfer of care following intubation are all challenges during these intubations.
气管插管是手术室（OR）中常见的操作，可在手术期间安全输送麻醉气体并保护气道。围手术期环境中最常见的插管技术是直接喉镜检查并插入口气管导管。由于患者解剖结构、设备限制或患者病理生理状况，偶尔会遇到需要采用替代插管技术的困难情况。对患者进行仔细评估、提前规划、准备设备、系统冗余、使用检查表、熟悉气道算法以及在手术室插管期间必要时提供额外帮助，已取得了卓越的成功率和安全性。在手术室可控环境之外进行插管时，气道困难更为常见且更为严重。将手术室中实施的插管流程应用于围手术期以外的插管操作应可提高患者安全性。本文详细探讨了手术室插管过程中的每一步，并提出了将围手术期程序纳入手术室以外插管操作的方法。在这些插管过程中，应对插管的生理影响、缺乏随时可用的专业设备和经验丰富的帮助以及插管后护理交接的规划都是挑战。
