Pothmann W, Eckert S, Füllekrug B
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Anaesthesist. 1993 Sep;42(9):644-7.
Although the incidence of difficult airway is very low, involving less than 1% of all patients, failed air-way management is the main cause of mortality or serious morbidity during anaesthesia. Successful management of a difficult airway starts with recognition of the potential problem. A careful preoperative history and clinical examination should elicit obvious problems to allow prediction of a potentially difficult airway. Besides the introduction of different instruments and techniques, the laryngeal mask (LMA) has been suggested to be effective both in when difficult airway is known in advance to be present and after failed intubation. CASE REPORT. The use of the LMA in a patient scheduled for endoscopic resection of a ureteral stone as day surgery is described. The patient presented reduced mobility of the atlanto-occipital joint, temporomandibular ankylosis (mouth opening of 1.9 cm), dislocated teeth, and kyphosis of the thoracic spine. Due to deformation of the spine, the patient was placed in a half-sitting position (30 degrees). Anaesthesia was induced with fentanyl (1.5 micrograms.kg-1) and propofol (2 mg.kg-1). Although the conditions made it difficult to manage the patient's airway, the LMA was inserted without complications or trauma. Anaesthesia was maintained with isoflurane and nitrous oxide in oxygen. After 1.5 h of assisted ventilation the LMA was removed when the patient opened his mouth on request. DISCUSSION. Significant advances in the management of the difficult airway have been achieved in recent years. However, avoidable deaths on intubation have been attributed to unexpected difficulties and poorly managed situations. Thus every anaesthetist should be prepared for potential difficulties by training and be able to follow a rational plan of action. If despite all manoeuvres a tracheal tube cannot be passed, a failed intubation drill must be instituted, and if oxygenation is still not possible a failed ventilation drill must be followed. The LMA is a new device developed to provide an airway for anaesthesia. However, since the LMA can be inserted quickly and blind, it can be used as an alternative airway in patients in whom the trachea is difficult to intubate. The lower incidence of post-operative complications than with endotracheal intubation is a further advantage, particularly during anaesthesia for day surgery.
尽管困难气道的发生率很低，在所有患者中不到1%，但气道管理失败是麻醉期间死亡或严重发病的主要原因。成功管理困难气道始于识别潜在问题。仔细的术前病史和临床检查应能发现明显问题，以便预测潜在的困难气道。除了引入不同的器械和技术外，喉罩（LMA）已被认为在预先知道存在困难气道时以及插管失败后均有效。病例报告。描述了LMA在一名计划作为日间手术进行输尿管结石内镜切除术患者中的应用。该患者寰枕关节活动度降低、颞下颌关节强直（开口度1.9厘米）、牙齿脱位以及胸椎后凸。由于脊柱变形，患者被置于半坐位（30度）。用芬太尼（1.5微克·千克⁻¹）和丙泊酚（2毫克·千克⁻¹）诱导麻醉。尽管这些情况使患者气道管理困难，但LMA插入时无并发症或创伤。用异氟烷和氧化亚氮与氧气维持麻醉。在辅助通气1.5小时后，当患者应要求开口时取出LMA。讨论。近年来，困难气道管理取得了重大进展。然而，插管时可避免的死亡归因于意外困难和处理不当的情况。因此，每位麻醉医生都应通过培训为潜在困难做好准备，并能够遵循合理的行动计划。如果尽管采取了所有操作仍无法插入气管导管，必须启动插管失败预案，如果仍无法进行氧合，则必须遵循通气失败预案。LMA是一种为麻醉提供气道而开发的新装置。然而，由于LMA可以快速盲目插入，它可作为气管插管困难患者的替代气道。与气管插管相比，术后并发症发生率较低是另一个优点，特别是在日间手术麻醉期间。
