Wang Ruofan, He Yi, Li Xiaoqiang, Zuo Yunxia
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
West China Hospital, The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, Sichuan University, Chengdu, China.
BMC Anesthesiol. 2025 Jun 6;25(1):288. doi: 10.1186/s12871-025-03163-2.
Rapid sequence induction (RSI) is the standard airway management technique for patients requiring emergency surgery with a full stomach or intestinal obstruction, aiming to reduce aspiration risk. RSI may fail if an unexpected difficulty intubation occurred and then a mask ventilation had to be applied. The worst scenario is that mask ventilation also failed, severe hypoxia developed followed by cardiac arrest.
A 14-year-old child with a history of pulmonary tuberculosis diagnosed with intestinal obstruction scheduled for emergency surgery. Due to high risk of aspiration, rapid sequence induction was applied. Although the preoperative airway assessment was normal, unexpectedly difficult airway was encountered. There was a failure of vocal cord exposure under video laryngoscope. A crisis happened when mask ventilation failed. Facing the disaster of "cannot intubate, cannot ventilate" and following severe hypoxia and cardiac arrest, the anesthesiologist established a surgical airway which successfully resuscitated the patient. A rare disease of laryngeal tuberculosis might be the underlying cause.
Patients with a history of pulmonary tuberculosis should be carefully evaluated for the presence of laryngeal tuberculosis, with laryngeal imaging as an optional diagnostic component. When encountering unexpected difficult airways during rapid sequence intubation leading to hypoxic cardiac arrest, immediate surgical airway intervention is critical for patient survival.
快速顺序诱导（RSI）是需要急诊手术的饱胃或肠梗阻患者气道管理的标准技术，旨在降低误吸风险。如果发生意外的插管困难，随后不得不进行面罩通气，RSI可能会失败。最糟糕的情况是面罩通气也失败，继而出现严重缺氧并导致心脏骤停。
一名14岁有肺结核病史的儿童被诊断为肠梗阻，计划进行急诊手术。由于误吸风险高，采用了快速顺序诱导。尽管术前气道评估正常，但仍遇到了意外的困难气道。视频喉镜下无法暴露声带。面罩通气失败时出现了危机。面对“无法插管，无法通气”的灾难以及随之而来的严重缺氧和心脏骤停，麻醉医生建立了外科气道，成功使患者复苏。潜在原因可能是一种罕见的喉结核疾病。
有肺结核病史的患者应仔细评估是否存在喉结核，喉部影像学检查可作为一种诊断手段。在快速顺序插管过程中遇到意外的困难气道导致缺氧性心脏骤停时，立即进行外科气道干预对患者的生存至关重要。
