Morimoto Yoshinari, Ohyamaguchi Aiko, Inoue Mika, Yokoe Chizuko, Hanamoto Hiroshi, Imaizumi Uno, Sugimura Mitsutaka, Niwa Hitoshi
Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
J Clin Anesth. 2017 Feb;36:127-132. doi: 10.1016/j.jclinane.2016.10.019. Epub 2016 Dec 1.
To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia.
Retrospective, observational study.
Operating room of a university hospital between January 2003 and March 2015. All operations were performed by oral and maxillofacial surgeons.
Thirteen patients who received general anesthesia for glossopexy and reversal after 7 months.
The medical records of these infants were retrospectively examined to evaluate the following: age, sex, height and weight at surgery, preoperative airway status, tracheal intubation route (oral or nasal), method for inducing general anesthesia, method for establishing the airway during mask ventilation, apparatus used for tracheal intubation, Cormack-Lehane classification when using a Macintosh laryngoscope and video laryngoscope, and the need for airway placement after extubation.
Prone positioning and/or an airway of some kind before surgery were required in 38.5% of infants needing glossopexy. Difficult mask ventilation was common, occurring in 50% of the patients, and the incidence of airway placement during mask ventilation was significantly higher in infants with preoperative complete or incomplete obstruction (100%) than in infants with snoring (25%). Of these high-risk infants, 25% could not be intubated with a direct laryngoscope or Glidescope Cobalt and required fiberoptic intubation.
There are severe cases of infants with difficult mask ventilation and difficult tracheal intubation in which a fiberscope is required because video laryngoscopy fails to improve the view of the larynx.
确定全身麻醉下对已有气道梗阻的婴儿进行舌固定术时的气道管理和气管插管技术。
回顾性观察研究。
2003年1月至2015年3月间一所大学医院的手术室。所有手术均由口腔颌面外科医生进行。
13例接受舌固定术全身麻醉并在7个月后进行松解的患者。
对这些婴儿的病历进行回顾性检查，以评估以下内容：手术时的年龄、性别、身高和体重、术前气道状况、气管插管途径（经口或经鼻）、全身麻醉诱导方法、面罩通气时建立气道的方法、气管插管所用器械、使用麦金托什喉镜和视频喉镜时的科马克-莱汉内分级，以及拔管后气道放置的必要性。
38.5%需要进行舌固定术的婴儿术前需要俯卧位和/或某种气道支持。面罩通气困难很常见，发生在50%的患者中，术前完全或不完全梗阻的婴儿面罩通气时气道放置的发生率（100%）显著高于打鼾婴儿（25%）。在这些高危婴儿中，25%不能用直接喉镜或Glidescope Cobalt进行插管，需要纤维光导插管。
存在面罩通气困难和气管插管困难的严重婴儿病例，由于视频喉镜未能改善喉镜视野，因此需要纤维光导镜。
