Equal and opposite expert opinion. Airway obstruction caused by a retrosternal thyroid mass: management and prospective international expert opinion
Equal and opposite expert opinion. Airway obstruction caused by a retrosternal thyroid mass: management and prospective international expert opinion
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DOI：
10.1111/j.1365-2044.2011.06650.x
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发表时间：
2011-09-01
期刊：
影响因子：
10.7
通讯作者：
Hersch, P. E.
中科院分区：
文献类型：
--
作者：
Cook, T. M.;Morgan, P. J.;Hersch, P. E.
麻醉期间气道管理的预期问题需要仔细计划，特别是当它们涉及气道阻塞的风险时。咨询意见可从已发表的文献（通常由专家撰写）或通过与专家的直接沟通来寻求。更常见的情况是，专家参与是通过对患者伤害进行回顾性审查。我们提出的情况下，患者患有胸骨后甲状腺肿块，压迫她的气管中线，并分为两个2 × 3毫米的管腔。在局部讨论后，患者接受了甲状腺切除术。我们邀请了麻醉气道管理方面的国际专家来审查她的病例，并就这一困难病例的最佳气道管理提出他们的意见。意见分歧明显，反映了已发表的文献。一些专家特别批评了他们不知道的、由其他人提出的技术。这一案件提出了关于专家意见的性质的问题，这种意见超出了这一特定案件。专家意见的性质和影响，当证据是不存在的或相互矛盾的，进行了讨论。
Anticipated problems with airway management during anaesthesia require careful planning, particularly when they involve a risk of airway obstruction. Advice may be sought from published literature (usually written by experts) or through direct communication with experts. More frequently, expert involvement is through retrospective review following patient harm. We present the case of a patient suffering from a retrosternal thyroid mass that was compressing her trachea in the midline and dividing it into two 2 x 3 mm lumens. After local discussion the patient underwent thyroidectomy. We invited international experts in anaesthetic airway management to review her case and submit their opinions regarding the best airway management for this difficult case. Opinions differed markedly, mirroring the published literature. Some experts specifically criticised techniques that, unbeknown to them, were proposed by others. The case raises issues about the nature of expert opinion that extends beyond this particular case. The nature and implications of expert opinion, when evidence is absent or conflicting, are discussed.