George Jayan, Kader Jishar Abdul, Arumugam Sivasundari, Murphy Anthony
Department of Otorhinolaryngology, Abertawe Bro Morgannwg University Health Board, Swansea, UK.
Department of Anaesthetics, Singleton Hospital, Swansea, UK.
BMJ Case Rep. 2015 Dec 1;2015:bcr2015210905. doi: 10.1136/bcr-2015-210905.
We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.
我们描述了一例通过精心规划成功完成的极具挑战性的插管病例。我们的患者最初在6个月的时间里出现声音嘶哑加重和呼吸急促的症状。经过检查，发现患者有一个大的声带肿物，并被转诊进行紧急显微喉镜检查和声带息肉切除术。手术当天，发现了梗阻情况，遂在输注瑞芬太尼的情况下使用了清醒纤维支气管镜检查。鉴于肿物较大且在呼气时增大，插管的时间非常短。我们进行了经气管局部麻醉注射。这种方法使气管内导管得以安全通过。对于这样的患者，或许一开始就值得考虑使用经气管注射法。
