Programa de Residência Médica em Anestesiologia, Hospital Universitário João de Barros Barreto, Belém, Brasil.
Departamento de Anestesiologia, Hospital Metropolitano de Urgência e Emergência, Belém, Brasil.
Medicine (Baltimore). 2023 Jun 9;102(23):e34028. doi: 10.1097/MD.0000000000034028.
Nasotracheal intubation is an advanced airway modality used in specific contexts, such as limited mouth opening, macroglossia, cervical spine instability. In addition, it can be performed with the patient awake, especially when predictors a difficult airway are unknown.
A 41-year-old male with a lesion in the C1 cervical vertebra, associated with a fracture of the right maxilla, was intubated through the nasopharyngeal route while awake. The forms of induction were discussed.
Based on the mechanism of trauma and on the report of pain, associated with imaging examination, fracture of the body of the right maxilla and a complex fracture of the anterior arch of the C1 cervical vertebra were diagnosed.
In this case, we present a patient with trauma to the face and spine who was intubated through the nasopharyngeal route while awake and guided by video laryngoscopy and using a rigid cervical collar. The patient was operated on under total general anesthesia (propofol and remifentanil) and plates and screws were placed for maxillary osteosynthesis. The pain was alleviated with a peripheral block of the trigeminal nerve of the maxillary branch with 0.5% levobupivacaine.
The patient woke up from surgery, was extubated uneventfully and without pain. Cervical spine injuries were followed up by the neurosurgery team for conservative treatment.
Patients with neck injury and facial trauma may need a definitive airway either for emergencies or for elective procedures. Intubating the awake patient may be an option when the anatomy of the cavity is unknown, and inducing the anesthetic act without this knowledge may be a inappropriate option, due to the risk of intubation/ventilation difficulties.
经鼻气管插管是一种在特定情况下使用的高级气道方式，例如张口受限、巨舌症、颈椎不稳定。此外，它可以在患者清醒时进行，特别是当预测困难气道的因素未知时。
一位 41 岁男性，C1 颈椎病变，伴右侧上颌骨骨折，在清醒状态下经鼻咽途径插管。讨论了诱导方式。
根据创伤机制和疼痛报告，结合影像学检查，诊断为右侧上颌骨体部骨折和 C1 颈椎前弓复杂骨折。
在这种情况下，我们介绍了一位面部和脊柱受伤的患者，在清醒状态下经鼻咽途径插管，使用视频喉镜引导，并使用刚性颈椎领。患者在全身麻醉（丙泊酚和瑞芬太尼）下接受手术，并放置钢板和螺钉进行上颌骨骨内固定。使用 0.5%左旋布比卡因行上颌支三叉神经周围阻滞缓解疼痛。
患者从手术中醒来，无疼痛地顺利拔管。颈椎损伤由神经外科团队进行保守治疗。
颈部损伤和面部创伤的患者可能需要明确的气道，无论是紧急情况还是择期手术。当腔道解剖结构未知时，对清醒患者插管可能是一种选择，而在缺乏这些知识的情况下诱导麻醉行为可能是不合适的，因为存在插管/通气困难的风险。
