Kristensen M S, Fried E, Biro P
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2018 Jan;62(1):19-25. doi: 10.1111/aas.13016. Epub 2017 Oct 24.
Tracheal intubation with a flexible scope is a cornerstone technique in patients with severely difficult airways, but may fail. We report on a technique, Infrared Red Intubation System (IRRIS), that seems to facilitate the identification of the glottis.
The IRRIS is placed over the patient's cricothyroid membrane and emits blinking infrared light through the patient's skin into the subglottic space. When a flexible videoscope (one that does not filter infrared light) is introduced into the airway, it will display this as a blinking white light emerging from the glottis, retrograde transillumination, showing the pathway to the trachea. We have introduced this as an adjunct when managing our patients with difficult airways. We describe the technique and retrospectively report on the first ten patients where it was used.
All ten patients had significant pathology in the airway, radiation therapy, predictors for difficult intubation and/or morbid obesity. In all cases the blinking light was visible during the flexible endoscopy and provided unambiguous identification of the glottis, from a distance. The blinking nature of the light from the IRRIS helped to distinguish it from the reflections in the mucosa that inevitably arise when the mucosa is hit by the light from the flexible scope itself.
The addition of the IRRIS technique to intubation with flexible videoscopes may be a tool that will make intubation of the most difficult airways easier and may be of special help to the clinician who only rarely uses flexible videoscopes for tracheal intubation.
使用可弯曲喉镜进行气管插管是气道严重困难患者的一项关键技术，但可能会失败。我们报告一种技术，即红外插管系统（IRRIS），它似乎有助于声门的识别。
将IRRIS放置在患者的环甲膜上，通过患者皮肤向声门下间隙发射闪烁的红外光。当将可弯曲视频喉镜（一种不滤过红外光的喉镜）插入气道时，它会将此显示为从声门发出的闪烁白光，即逆行透照，显示通向气管的路径。我们在处理气道困难的患者时引入了这一辅助手段。我们描述了该技术，并回顾性报告了首批使用该技术的10例患者的情况。
所有10例患者气道均有明显病变、接受过放射治疗、存在插管困难的预测因素和/或病态肥胖。在所有病例中，在可弯曲内镜检查期间均可看到闪烁的光，并能从一定距离明确识别声门。IRRIS发出的光的闪烁特性有助于将其与可弯曲喉镜自身发出的光照射黏膜时不可避免产生的黏膜反射区分开来。
在使用可弯曲视频喉镜插管时增加IRRIS技术可能是一种工具，它将使最难插管的气道插管更容易，对于很少使用可弯曲视频喉镜进行气管插管的临床医生可能会有特别帮助。
