Ardhaoui Ichraf, Chbeb Oumayma, Rebai Lotfi
Department of Anesthesia and Intensive Care, Ben Arous Trauma and Burn Center, 2013 Ben Arous, Tunisia; University of Tunis Medical School, Tunisia; University Tunis El Manar Medical School, Tunisia.
University of Tunis Medical School, Tunisia; University Tunis El Manar Medical School, Tunisia.
Int J Surg Case Rep. 2024 Dec;125:110498. doi: 10.1016/j.ijscr.2024.110498. Epub 2024 Oct 28.
Airway management in patient with cervical trauma is often challenging, especially when it involves intubation.
An uncommon case of posterolateral blunt traumatic cervical spine injury was seen in our emergency department following an assault on a 19-year-old young man. The only point of impact was cervical, the initial examination found a GCS = 15/15, no motor or sensory deficit. The head was slightly rotated 30° to the left, the patient was hemodynamically and respiratorily stable, he was fasting. The patient was directly transported to the neurosurgery operating room for exploration. Positioning could only be achieved with assistance; the patient was placed in the supine position, head turned 30° to the left, secured in a horseshoe-shaped headrest. We chose the LMA Factrach for intubation to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt.
Airway management in patient with cervical trauma is often challenging, especially when it involves intubation; maintaining the head in neutral position is not always feasible in cases of stab wounds, as the entry point of the sharp object often determines the head's position. Intubating in non-standard positions is more challenging and often leads to poorer laryngoscopic visibility. This can create a disconnect between the quality of the laryngoscopic view and the ease of performing endotracheal intubation. Awake fiberoptic nasotracheal intubation remains the gold standard in cases of difficult intubation with difficult ventilation criteria and nonstandard positioning. Several scientific societies recommend videolaryngoscopy as the first-line approach for difficult intubations in the absence of difficult ventilation criteria. Nonetheless, the absence of such criteria does not guarantee effective ventilation following anesthetic induction, which necessitates the use of the laryngeal mask as a secondary measure to ensure oxygenation. The LMA Fastrach can facilitate the subsequent intubation process, particularly in situations where the stomach is not full. We chose the LMA Fastrach to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt.
The LMA Fastrach appears to be a very useful mean for air way management when the head cannot be kept in a neutral position.
颈椎创伤患者的气道管理通常具有挑战性，尤其是在进行插管时。
在一名19岁年轻男子遭受袭击后，我院急诊科接诊了一例罕见的颈椎后外侧钝性创伤病例。唯一的撞击点在颈部，初始检查发现格拉斯哥昏迷量表（GCS）评分为15/15，无运动或感觉功能障碍。头部向左轻微旋转30°，患者血流动力学和呼吸稳定，处于禁食状态。患者被直接送往神经外科手术室进行探查。只能在辅助下完成体位摆放；患者仰卧，头部向左旋转30°，固定在马蹄形头托中。我们选择喉罩通气道（LMA）Fastrach进行插管，以确保患者获得最佳通气。结果令人满意，首次尝试即成功插管。
颈椎创伤患者的气道管理通常具有挑战性，尤其是在进行插管时；在刺伤病例中，将头部保持在中立位置并不总是可行的，因为尖锐物体的刺入点往往决定了头部的位置。在非标准体位下进行插管更具挑战性，且常常导致喉镜视野较差。这可能会导致喉镜视野质量与气管插管操作的难易程度之间出现脱节。对于通气困难且体位不标准的困难插管病例，清醒纤维光导鼻气管插管仍是金标准。在没有通气困难标准的情况下，多个科学学会推荐视频喉镜作为困难插管的一线方法。然而，缺乏这些标准并不能保证麻醉诱导后有效通气，这就需要使用喉罩作为辅助措施来确保氧合。LMA Fastrach可以促进后续的插管过程，特别是在胃未充满的情况下。我们选择LMA Fastrach以确保患者获得最佳通气。结果令人满意，首次尝试即成功插管。
当头部无法保持在中立位置时，LMA Fastrach似乎是气道管理的一种非常有用的手段。
