COVID-19 大流行期间困难气道的管理：具有说明性的头颈部癌症复杂病例。
Management of the difficult airway in the COVID-19 pandemic: Illustrative complex head and neck cancer scenario.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Head Neck. 2020 Jun;42(6):1273-1277. doi: 10.1002/hed.26175. Epub 2020 Apr 22.
BACKGROUND
This case highlights challenges in the assessment and management of the "difficult airway" patient in the SARS-CoV-2 (COVID-19) pandemic era.
METHODS
A 60-year-old male with history of recent transoral robotic surgery resection, free flap reconstruction, and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea 1 month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion.
RESULTS
The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided.
CONCLUSIONS
This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other "difficult airway" patients during the COVID-19 epidemic.
背景
本病例凸显了在 SARS-CoV-2（COVID-19）大流行期间评估和管理“困难气道”患者所面临的挑战。
方法
一位 60 岁男性，患有 p16+鳞状细胞癌，近期行经口机器人手术切除、游离皮瓣重建和气管造口术。多学科团队进行了仔细的规划，包括适当的人员配备和个人防护设备、紧急气道管理的准备、经鼻咽喉镜检查和 COVID 检测。患者 COVID 检测结果为阴性，并进行了影像学检查，结果显示有新的肺结节和气管病变。
结果
患者在手术室经口安全插管。气管病变经内镜切除，避免了气管切开术。
结论
本病例强调了在 COVID-19 流行期间，对管理头颈部癌症和其他“困难气道”患者进行仔细和协作的决策的重要性。
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