Youn Ann Misun, Yoon Seok-Hwa, Park Soo-Yong
Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Korean J Anesthesiol. 2016 Apr;69(2):167-70. doi: 10.4097/kjae.2016.69.2.167. Epub 2016 Mar 30.
Encountering a patient with unanticipated laryngotracheal stenosis (LTS) during anesthetic induction is challenging for an anesthesiologist. Because routine history taking and pre-anesthetic evaluation cannot rule out the possibility of LTS, other measures should be taken. Perioperative airway maintenance is considered crucial for avoiding complications such as airway edema, bleeding, obstruction, collapse, and ultimately respiratory failure and arrest. We report an unanticipated tracheal stenosis discovered during anesthetic induction that hindered endotracheal intubation. Because airway maintenance was difficult, we postponed surgery until determining the cause of the difficult entry, considered possible therapeutic approaches (both anesthetic and surgical), and provided successful surgery with a continuous epidural block.
麻醉诱导期间遇到意外的喉气管狭窄(LTS)患者对麻醉医师来说是一项挑战。由于常规病史采集和麻醉前评估无法排除LTS的可能性,因此应采取其他措施。围手术期气道维护被认为对于避免诸如气道水肿、出血、梗阻、塌陷以及最终的呼吸衰竭和心跳骤停等并发症至关重要。我们报告了一例在麻醉诱导期间发现的意外气管狭窄,该狭窄阻碍了气管插管。由于气道维护困难,我们推迟了手术,直到确定进入困难的原因,考虑了可能的治疗方法(包括麻醉和手术方面),并通过连续硬膜外阻滞成功完成了手术。