Wiesel S, Gutman J B, Kleiman S J
Department of Anaesthesia, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada.
J Clin Anesth. 1993 Mar-Apr;5(2):158-62. doi: 10.1016/0952-8180(93)90146-6.
Epiglottitis is a rare cause of upper airway obstruction that may lead to death in the adult. We report the case of a patient with severe coronary artery disease with adult epiglottitis who required emergency endotracheal intubation. Relief of the airway obstruction was followed by the development of postobstructive pulmonary edema. The literature is reviewed and the following recommendations are made: Patients with adult epiglottitis should be intubated in the presence of any respiratory signs or symptoms. All others should be observed in an intensive care unit with a skilled anesthesiologist available to carry out emergency endotracheal intubation. Inhalation induction with halothane in oxygen should be considered initially; failing that, rigid bronchoscopy, tracheostomy, or transtracheal ventilation should be available. Postobstructive pulmonary edema should be anticipated after relief of airway obstruction has occurred; it can be treated with fluid restriction, diuretics, and continuous positive airway pressure.
会厌炎是成人上气道梗阻的罕见病因，可能导致死亡。我们报告一例患有严重冠状动脉疾病并伴有成人会厌炎的患者，该患者需要紧急气管插管。气道梗阻解除后出现了梗阻后肺水肿。本文回顾了相关文献并提出以下建议：患有成人会厌炎的患者出现任何呼吸体征或症状时均应进行插管。其他所有患者应在重症监护病房观察，并有技术熟练的麻醉医生随时准备进行紧急气管插管。最初应考虑用氟烷在氧气中进行吸入诱导；若无法进行，则应准备好硬质支气管镜、气管切开术或经气管通气。气道梗阻解除后应预计到会发生梗阻后肺水肿；可通过限制液体摄入、使用利尿剂和持续气道正压通气进行治疗。
