Bohringer Christian, Duca James, Liu Hong
Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, California, USA.
Transl Perioper Pain Med. 2019;6(1):5-16. Epub 2019 Jan 15.
New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.
最近出现了一些新的气道设备，这些设备降低了发病率和死亡率。然而，气道灾难仍有发生。本文讨论了谨慎逐步增加使用高级气道设备以预防这些灾难的方法。我们阐述了何时以及如何使用弹性橡胶探条和视频喉镜（VL）。我们还强烈建议在处理真正困难气道时，无论是在患者入睡还是清醒状态下进行插管，都将视频喉镜与可弯曲插管镜（FIS）联合使用。如今不应再进行盲目插管。当气道被认定为困难时，如果情况不允许进行清醒插管，那么最安全的做法是争取进行清醒插管或至少是自主呼吸状态下的插管。需要做好紧急环甲膜切开术的准备，以便在尝试清醒插管导致完全气道梗阻时能够迅速实施。
