Burtner D D, Goodman M
Arch Otolaryngol. 1978 Nov;104(11):657-61. doi: 10.1001/archotol.1978.00790110047012.
Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. In carcinoma of the supraglottic larynx and in pharyngeal abscess, the unobstructed airway in the conscious patient became impossible to secure once general anesthesia was begun. Unappreciated pathological deformity prohibited endotracheal intubation, and anesthesia precipitated obstruction. In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia.
当开始全身麻醉时，潜在的或实际的声门上气道梗阻就变得至关重要。有4例说明了这种梗阻情况，并且对每种情况的麻醉和手术处理都很关键。在声门上喉癌和咽脓肿病例中，一旦开始全身麻醉，清醒患者原本通畅的气道就无法确保安全。未被察觉的病理畸形使气管插管无法进行，麻醉引发了梗阻。在会厌炎和扁桃体周围脓肿病例中，人们意识到即将发生气道梗阻的性质，并选择了一种安全的气道保障技术。对潜在声门上梗阻的麻醉和手术处理包括五种选择：(1) 在患者清醒时通过喉镜进行经口气管插管；(2) 清醒状态下经鼻气管插管；(3) 全身麻醉吸入诱导并插管；(4) 用巴比妥类药物和肌肉松弛剂进行快速诱导并插管；(5) 局部麻醉下行气管切开术。
