Pratt Matt, Miller Ann B
is the principal author and a master of science in nursing (MSN) nurse anesthesia student at Florida Gulf Coast University, Fort Myers, Florida. This manuscript was part of the capstone project for the MSN Nurse Anesthesia Program.
is interim assistant program director and assistant professor at Florida Gulf Coast University, Fort Myers, Florida.
AANA J. 2016 Oct;84(5):322-328.
A difficult intubation poses one of the most challenging tasks for anesthesia professionals, representing 27% of all adverse respiratory events, 93% of which are unanticipated. Unanticipated difficult mask ventilation and intubation may result in serious complications. Safe airway management requires a proper and thorough preoperative airway evaluation and a plan to secure the airway, with alternate plans available when the initial plan fails. Pediatric, obese, and obstetric patients undergoing general anesthesia with endotracheal intubation are considered to be at risk of rapid desaturation. As an adjunct to conventional preoxygenation techniques, continuous oxygen administration during the apneic period, termed apneic oxygenation, assists in the maintenance of oxygenation when tracheal intubation is attempted. Nine articles were selected for appraisal in this literature review: 6 randomized control trials, 2 prospective studies, and 1 retrospective study. Multiple apneic oxygenation techniques, including nasopharyngeal catheter, nasal prongs, endotracheal tube, intratracheal catheter, and high-flow transnasal humidified oxygen, demonstrated effectiveness at delaying the onset of hypoxemia during the apnea period. Prolonging the apneic window changes the nature of airway management in patients at high risk of desaturation and when an unanticipated difficult airway arises.
困难插管是麻醉专业人员面临的最具挑战性的任务之一，占所有不良呼吸事件的27%，其中93%是意外发生的。意外的困难面罩通气和插管可能导致严重并发症。安全的气道管理需要进行适当而全面的术前气道评估，并制定确保气道安全的计划，当初始计划失败时要有备用计划。接受全身麻醉并进行气管插管的儿科、肥胖和产科患者被认为有快速去饱和的风险。作为传统预充氧技术的辅助手段，在呼吸暂停期间持续给氧，即所谓的呼吸暂停氧合，有助于在尝试气管插管时维持氧合。在这篇文献综述中选择了9篇文章进行评估：6项随机对照试验、2项前瞻性研究和1项回顾性研究。多种呼吸暂停氧合技术，包括鼻咽导管、鼻氧管、气管导管、气管内导管和高流量经鼻湿化氧疗，都证明在延迟呼吸暂停期间低氧血症的发生方面是有效的。延长呼吸暂停窗口改变了去饱和风险高的患者以及出现意外困难气道时气道管理的性质。
