Yokogawa Fumiko, Oe Katsunori, Hosokawa Maiko, Masui Kenichi
Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan.
Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan.
JA Clin Rep. 2022 Mar 3;8(1):16. doi: 10.1186/s40981-022-00509-4.
Reconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction.
A 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side.
Preanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.
头颈部重建手术可改变上气道解剖结构。我们报告了1例有半侧舌切除术及重建病史患者的困难插管情况。
一名65岁女性患者，曾接受带蒂皮瓣重建半侧舌切除术，因食管癌接受电视辅助胸腔镜食管癌切除术。麻醉诱导后意识消失，我们在仰卧位使用可视喉镜未能成功进行直接和经口纤维光导插管，在有无可视喉镜辅助的情况下经鼻纤维光导插管也未成功。最后，将患者转为左侧卧位后经鼻纤维光导插管成功。术后，我们得知她因气道梗阻无法仰卧位睡眠，因此总是侧卧睡眠。
麻醉前评估体位对睡眠或镇静期间气道通畅性的影响可能有助于气道管理。
