Winerman I, Ezra S, Man A, Segal S
Can Anaesth Soc J. 1982 Mar;29(2):117-20. doi: 10.1007/BF03007988.
A series is presented of 100 patients who underwent direct laryngoscopy under general anaesthesia. Our preferred technique of ventilation is jet insufflation by an injector attached to the blade of the laryngoscope, as it provides the surgeon with a quiet and completely exposed larynx. In nine cases, chest expansion was assessed as inadequate by the anaesthetist. These patients were obese with a short neck, and/or stiff-necked; thus, insertion of the laryngoscope was difficult and a good seal between it and the larynx could not be achieved. Arterial blood gas values in six of these patients demonstrated marked hypoventilation. To improve ventilation in these patients an alternative technique of insufflation through a nasotracheal catheter was used. Arterial blood gas values indicated that this method resolved the problem of hypoventilation. Although the catheter somewhat limits the view of the endolarynx, the improved ventilation outweighs the drawbacks of this technique. It is suggested that for the obese and/or stiff-necked patient, a nasotracheal catheter be used electively for ventilation.
本文报告了100例在全身麻醉下接受直接喉镜检查的患者。我们首选的通气技术是通过连接在喉镜镜片上的注射器进行喷射通气，因为它能为外科医生提供一个安静且完全暴露的喉部。有9例患者，麻醉医生评估其胸廓扩张不足。这些患者肥胖且脖子短，和/或颈部僵硬；因此，喉镜插入困难，无法在喉镜与喉部之间实现良好的密封。其中6例患者的动脉血气值显示明显通气不足。为改善这些患者的通气，采用了一种通过鼻气管导管进行通气的替代技术。动脉血气值表明该方法解决了通气不足的问题。尽管导管在一定程度上限制了喉内视野，但改善的通气效果超过了该技术的缺点。建议对于肥胖和/或颈部僵硬的患者，选择性地使用鼻气管导管进行通气。
