Tobias J D
Department of Child Health, University of Missouri, Columbia 65212, USA.
Pediatr Ann. 1996 Jun;25(6):317-20, 323-8. doi: 10.3928/0090-4481-19960601-07.
Several factors increase the difficulty and urgency of airway management in children in the emergency setting. Early and appropriate airway management are of prime importance in improving the outcome of such patients. The major decision points of airway management include one's assessment of the airway and ability to perform endotracheal intubation. If the airway is judged to be normal, oral endotracheal intubation following sedation and neuromuscular blockade is suggested. Rapid sequence intubation to prevent acid aspiration should be used. While the medications for airway management generally are administered intravenously, it should be kept in mind that intraosseous access is an acceptable alternative for the administration of several different agents, including those used for endotracheal intubation. If the airway cannot be secured following the administration of anesthetic and neuromuscular blocking agents, the ASA algorithm for the "cannot intubate/cannot ventilate" scenario should be followed (Figure). When the airway is judged to be abnormal, one of the above described awake techniques may be used. While there is ample literature concerning these techniques in adults, their use in children has been limited. Most importantly, considerable practice may be required to become and stay facile with many of these "alternative techniques" of airway management. In certain circumstances, surgical cricothyrotomy should be considered as an alternative to airway management. Regardless of the technique chosen, appropriate personnel and preparation are mandatory to ensure the safe and effective management of the airway in the pediatric trauma patient. Due to the various skills and expertise of different subspecialists, a multidisciplinary approach to such patients is recommended. Such an approach may include pediatricians, emergency room physicians, surgical subspecialists, anesthesiologists, and critical care physicians.
在急诊情况下，有几个因素会增加儿童气道管理的难度和紧迫性。早期且恰当的气道管理对于改善此类患者的预后至关重要。气道管理的主要决策点包括对气道的评估以及进行气管插管的能力。如果判断气道正常，建议在镇静和使用神经肌肉阻滞剂后进行经口气管插管。应采用快速顺序插管以防止酸性物质误吸。虽然气道管理药物一般通过静脉给药，但应记住，骨内通路是几种不同药物给药的可接受替代方法，包括用于气管插管的药物。如果在给予麻醉药和神经肌肉阻滞剂后气道仍无法确保安全，应遵循美国麻醉医师协会针对“无法插管/无法通气”情况的算法（图）。当判断气道异常时，可采用上述清醒技术之一。虽然关于这些技术在成人中的文献很多，但它们在儿童中的应用有限。最重要的是，要熟练掌握许多这些气道管理的“替代技术”，可能需要大量练习。在某些情况下，应考虑行外科环甲膜切开术作为气道管理的替代方法。无论选择何种技术，都必须有合适的人员并做好准备，以确保对小儿创伤患者的气道进行安全有效的管理。由于不同亚专科医生具有不同的技能和专业知识，建议对此类患者采用多学科方法。这种方法可能包括儿科医生、急诊室医生、外科亚专科医生、麻醉医生和重症监护医生。
