Tessmann R, Wittenbeck J, Lüpke U, Marx A
Abteilung für Anästhesie und Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Frankfurt a. M.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Mar;32(3):164-8. doi: 10.1055/s-2007-995031.
This study was made to investigate the suitability of a modified laryngeal mask airway as an aid for fibreoptic endotracheal intubation in patients with a difficult airway. We used a laryngeal mask airway split lengthwise on its convex site, the incision going from a point corresponding to the teeth down to the base of the cuff. The cuff remains uncut. By this modification it is possible to ventilate an anaesthetised patient and to pass down a fibreoptic bronchoscope via splitting of the laryngeal mask airway into the trachea at the same time. An endotracheal tube of any diameter already mounted over the bronchoscope is then guided into the trachea. The feasibility of this technique was tested and haemodynamic reactions and changes of the parameters of respiration were recorded.
This technique was used in 105 patients, 68 male and 37 female, mean age 34 years, when difficult intubation was expected or occurred. Blood pressure, pulse rate and peripheral oxygen saturation was recorded on arrival in the anaesthetic room, after induction of anaesthesia, during and after fibreoptic endotracheal intubation. The respiratory minute volume was measured after insertion of the laryngeal mask airway and during the course of fibreoptic intubation. The time needed was recorded.
In all cases endotracheal intubation was successful using this technique. The time needed was between 4 and 16 minutes. There was a statistically significant increase in peripheral oxygen saturation and decrease of the pulse rate after induction of anaesthesia. There were no further significant changes of the recorded haemodynamic parameters and the oxygen saturation during and after fibreoptic intubation compared to the results after induction of anaesthesia.
It could be demonstrated that a fibreoptic intubation is possible in cases of a difficult airway using the technique described here. There is no haemodynamic strain on the patient. This method can be carried out without pressure of time and without to endanger the patient by hypoxia as the patient can be ventilated during the fibreoptic intubation. In cases of impossible intubation and insufficient mask ventilation it can be tried to establish ventilation and to avoid a emergency surgical airway or transtracheal jet ventilation by using this technique.
本研究旨在探讨改良喉罩气道作为困难气道患者纤维光导气管插管辅助工具的适用性。我们使用了一种在其凸面纵向切开的喉罩气道，切口从对应牙齿的点向下延伸至套囊底部。套囊保持完整。通过这种改良，能够为麻醉患者通气，并同时通过将喉罩气道分开，使纤维支气管镜经其插入气管。然后将已套在支气管镜上的任何直径的气管导管导入气管。测试了该技术的可行性，并记录了血流动力学反应和呼吸参数的变化。
在预计或发生困难插管的105例患者（68例男性，37例女性，平均年龄34岁）中使用了该技术。在进入麻醉室时、麻醉诱导后、纤维光导气管插管期间及插管后记录血压、脉搏率和外周血氧饱和度。在插入喉罩气道后及纤维光导插管过程中测量每分钟呼吸量。记录所需时间。
使用该技术所有病例气管插管均成功。所需时间为4至16分钟。麻醉诱导后外周血氧饱和度有统计学意义的升高，脉搏率下降。与麻醉诱导后的结果相比，纤维光导插管期间及插管后记录的血流动力学参数和血氧饱和度无进一步显著变化。
可以证明，使用本文所述技术在困难气道病例中可行纤维光导插管。对患者无血流动力学负担。该方法可以从容进行，且不会因缺氧危及患者，因为在纤维光导插管期间患者能够通气。在插管不可能且面罩通气不足的情况下，可尝试使用该技术建立通气，避免紧急手术气道或经气管喷射通气。
