Pirlich Nina, Lohse Jana A, Noppens Rüdiger R
Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University.
Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University;
J Vis Exp. 2017 Jan 13(119):55116. doi: 10.3791/55116.
A patient's willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can jeopardize their spontaneous breathing, topical anesthesia of the airway is a popular technique. The spray-as-you-go technique represents one of the simplest opportunities to anesthetize the airway mucosa. The application of local anesthetic through the working channel of the flexible endoscope is a widespread practice for anesthetists as well as pulmonologists. There is neither need for additional devices nor special training as a pre-requisite to perform this technique. However, a known clinical problem is the coughing and gagging reflex that may occur when the liquid anesthetic strikes the airway mucosa and other sensitive structures like the vocal cords. This can be avoided by the use of oxygen applied through the working channel with the aim of fogging the local anesthetic into finer particles. Furthermore, the oxygen flow provides a higher oxygen supply and contributes to a better view, dispersing mucus secretions and blood away from the lens. Using an atomizer with a high oxygen flow of 10 L/min we maximized these benefits, caused less coughing and had more satisfied and therefore cooperative patients. Possible, but very rare complications of using oxygen flow including gastric insufflation, organ rupture or barotrauma did not arise. We attribute the complication-free use of high oxygen flow to the design of the set, which permits flow and pressure release.
患者的合作意愿是成功实施清醒气管插管的绝对前提条件。虽然对患者进行药物镇静可能会危及他们的自主呼吸，但气道表面麻醉是一种常用技术。边走边喷技术是麻醉气道黏膜最简单的方法之一。通过柔性内窥镜工作通道应用局部麻醉剂，对麻醉师和肺科医生来说都是一种广泛采用的做法。实施该技术既不需要额外的设备，也不需要特殊培训作为先决条件。然而，一个已知的临床问题是，当液体麻醉剂接触气道黏膜和其他敏感结构（如声带）时，可能会出现咳嗽和 gagging 反射。这可以通过通过工作通道输送氧气来避免，目的是将局部麻醉剂雾化成更细的颗粒。此外，氧气流提供了更高的氧气供应，并有助于获得更好的视野，将黏液分泌物和血液从镜片上驱散。使用氧气流量为 10 L/min 的雾化器，我们最大限度地发挥了这些益处，减少了咳嗽，使患者更满意，因此更愿意合作。使用氧气流可能但非常罕见的并发症，包括胃充气、器官破裂或气压伤，均未出现。我们将高氧气流的无并发症使用归因于该装置的设计，该设计允许流量和压力释放。
