Mashio H, Kojima T, Goda Y, Kawahigashi H, Ito Y, Kato M
Department of Anaesthesia, Sapporo City General Hospital.
Masui. 1997 Dec;46(12):1639-43.
A 71-year-old male patient with rheumatoid arthritis was scheduled for posterior fusion of the cervical spine. He showed limited cervical movement and atrophic mandible. Tracheal intubation was difficult in his last anesthetic management for the same surgery. This time, we planned a special procedure for predicted difficult tracheal intubation. After induction of general anesthesia, a size-4 laryngeal mask airway was inserted. Next, a flexible fiberscope sheathed with a 6.0-mm-ID cuffed endotracheal tube was inserted through a laryngeal mask airway into the trachea, and the fiberscope was withdrawn. Then, an endotracheal tube changer was inserted through the endotracheal tube. The laryngeal mask airway and the endotracheal tube were withdrawn simultaneously leaving the tube changer. Finally, a 7.5-mm-ID armored endotracheal tube was inserted through the tube changer. The procedure applied in this case is a safe and reliable intubating method in patients with difficult tracheal intubation.
一名71岁的类风湿性关节炎男性患者计划接受颈椎后路融合术。他的颈部活动受限，下颌萎缩。在他上次因同一手术进行麻醉管理时，气管插管困难。这次，我们针对预计的困难气管插管制定了特殊程序。全身麻醉诱导后，插入了一个4号喉罩气道。接下来，将一根套有内径6.0毫米带套囊气管内导管的可弯曲纤维喉镜通过喉罩气道插入气管，然后撤出纤维喉镜。然后，通过气管内导管插入一个气管内导管更换器。同时撤出喉罩气道和气管内导管，留下导管更换器。最后，通过导管更换器插入一根内径7.5毫米的钢丝加强气管内导管。本病例应用的操作方法对于困难气管插管患者是一种安全可靠的插管方法。
