Gutierres M, Guedes F, Rosa F, Oliveira F, Castro R, Fernandes V
Department of Anaesthesiology Centro Hospitalar Universitário de S. João Porto Portugal.
Faculty of Medicine University of Porto Porto Portugal.
Anaesth Rep. 2024 Dec 17;12(2):e12338. doi: 10.1002/anr3.12338. eCollection 2024 Jul-Dec.
Patients with facial trauma are complex; difficult airway management is often anticipated and challenging for the anaesthetist. Awake tracheal intubation is the gold standard in the management of predicted difficult airway because of its high success rate and safety profile. We present the case of a patient with facial trauma who underwent orotracheal intubation with combined videolaryngoscopy and flexible bronchoscopy, under conscious sedation with intermittent boluses of ketamine and dexmedetomidine. Videolaryngoscopy showed significant oedema and epiglottic laceration, not diagnosed by the computed tomography scan, with visualisation of a false passage that could have led to a failed intubation and further trauma. Airway management in patients with facial trauma is challenging and should be planned and discussed by a multidisciplinary team. A technique combining videolaryngoscopy and flexible bronchoscopy during awake intubation has previously been described and, when used in this case, was successful.
面部创伤患者情况复杂；麻醉医生常常预计气道管理困难且具有挑战性。清醒气管插管因其高成功率和安全性，是预计困难气道管理的金标准。我们报告一例面部创伤患者，在间断推注氯胺酮和右美托咪定进行清醒镇静的情况下，采用视频喉镜和可弯曲支气管镜联合进行经口气管插管。视频喉镜显示有明显水肿和会厌撕裂，这在计算机断层扫描中未被诊断出来，还可见一个可能导致插管失败和进一步创伤的假通道。面部创伤患者的气道管理具有挑战性，应由多学科团队进行规划和讨论。此前已有文献描述在清醒插管期间联合使用视频喉镜和可弯曲支气管镜的技术，本病例应用该技术获得成功。
