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神经麻醉中的气道管理。

AIRWAY MANAGEMENT IN NEUROANESTHESIA.

机构信息

Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Sveti Duh University Hospital, Zagreb, Croatia.

Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Therapy, Zagreb University Hospital Center, Zagreb, Croatia.

出版信息

Acta Clin Croat. 2023 Apr;62(Suppl1):119-124. doi: 10.20471/acc.2023.62.s1.15.

Abstract

Neurosurgical patients have specific airway management. Various conditions and diagnoses make intubation difficult and may also cause neurological damage. Spinal pathology, neurotrauma, cervical spine surgery, and pituitary gland surgery are just some examples. The aim of this review article is to present a broad spectrum of neurosurgical operations and potential complications in maintaining airway patency related to these issues. Quality perioperative preparation is a prerequisite to avoid the potentially irreversible consequences of difficult airways with a poor neurological or even fatal outcome. Patients with tumors of the pituitary region who present with Cushing's disease are prone to difficult ventilation, tracheal obstruction and difficult intubation. Awake craniotomy is also a challenge for the anesthesiologist, given that access to the airway is problematic due to the fixed frame. Unstable cervical spine occurs in cases of rheumatoid arthritis or blunt trauma, requiring precautions to be taken with spinal stabilization during intubation and induction. Pharyngeal edema and hematomas, possible complications of cervical spine surgery can endanger airway patency after extubation; postoperative patient supervision is thus required. Due to the potential threat to the patient's airway during neurosurgical procedures, quality anesthetic preoperative preparation is necessary to avoid irreversible damage and death.

摘要

神经外科患者有特定的气道管理需求。各种情况和诊断使得插管变得困难,并且可能导致神经损伤。脊髓病理、神经创伤、颈椎手术和垂体手术只是其中的一些例子。本文的目的是介绍广泛的神经外科手术以及与这些问题相关的保持气道通畅的潜在并发症。高质量的围手术期准备是避免因气道困难而导致不可逆转的神经损伤甚至致命后果的前提。患有库欣病的垂体区域肿瘤患者容易出现通气困难、气管阻塞和插管困难。由于固定框架,清醒开颅术对麻醉师来说也是一个挑战,因为气道的进入存在问题。不稳定的颈椎发生在类风湿关节炎或钝性创伤的情况下,需要在插管和诱导期间注意脊髓稳定。咽水肿和血肿是颈椎手术后可能发生的并发症,可能危及拔管后的气道通畅性;因此需要对术后患者进行监护。由于在神经外科手术过程中存在对患者气道的潜在威胁,因此需要进行高质量的麻醉术前准备,以避免不可逆转的损伤和死亡。

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