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在急诊甲状腺切除术中清醒纤维支气管插管时,肌电图引导型气管内导管(EMG ETT)置管的挑战。

Challenges in electromyographic endotracheal tube (EMG ETT) placement via awake fibreoptic intubation during emergency thyroidectomy.

机构信息

Department of Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.

Surgical Based Discplines Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

出版信息

BMJ Case Rep. 2021 May 13;14(5):e242286. doi: 10.1136/bcr-2021-242286.

DOI:10.1136/bcr-2021-242286
PMID:33986014
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8126277/
Abstract

Recurrent laryngeal nerve (RLN) injury is one of the main complications of total thyroidectomy. If the injury is bilateral, total airway obstruction, aphonia and hoarseness of voice could be precipitated. Hence, it is wise for the operating surgeon to be guided by neural monitoring during thyroidectomy. We present a valuable experience handling a middle-aged man with a huge papillary thyroid carcinoma . He needed an urgent thyroidectomy due to obstructive symptoms. We highlight our intraoperative dexterity in handling his surgery in the context of continuous monitoring of RLN using electromyography.

摘要

喉返神经(RLN)损伤是甲状腺全切除术的主要并发症之一。如果损伤是双侧的,可能会导致完全气道阻塞、失音和声音嘶哑。因此,在甲状腺切除术中,手术医生最好在神经监测的指导下进行操作。我们介绍了一位中年男性患有巨大甲状腺乳头状癌的宝贵经验。由于阻塞症状,他需要紧急进行甲状腺切除术。我们强调了在使用肌电图连续监测 RLN 的情况下,我们在处理他的手术时的术中灵活性。

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本文引用的文献

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Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess.经口清醒纤维支气管镜插管(AFOI)成功的秘诀:针对伴有齿源性脓肿的患者。
BMJ Case Rep. 2021 Feb 19;14(2):e238600. doi: 10.1136/bcr-2020-238600.
2
Massive airway myiasis: an extreme rarity.大气道蝇蛆病:极为罕见。
BMJ Case Rep. 2020 Dec 9;13(12):e237764. doi: 10.1136/bcr-2020-237764.
3
Influence of Sevoflurane-Based Anesthesia versus Total Intravenous Anesthesia on Intraoperative Neuromonitoring during Thyroidectomy.七氟醚麻醉与全静脉麻醉对甲状腺切除术术中神经监测的影响。
Otolaryngol Head Neck Surg. 2020 Jun;162(6):853-859. doi: 10.1177/0194599820912030. Epub 2020 Mar 17.
4
Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis.术中神经监测(IONM)在甲状腺切除术中预防喉返神经损伤的保护作用:Meta 分析。
Sci Rep. 2018 May 17;8(1):7761. doi: 10.1038/s41598-018-26219-5.
5
Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment.甲状腺和甲状旁腺手术后喉返神经损伤:发生率及术后演变评估
Medicine (Baltimore). 2017 Apr;96(17):e6674. doi: 10.1097/MD.0000000000006674.
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Gland Surg. 2014 Nov;3(4):232-6. doi: 10.3978/j.issn.2227-684X.2014.08.03.
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Examining national outcomes after thyroidectomy with nerve monitoring.检查神经监测下甲状腺切除术的国家结果。
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