An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™) A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery
An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™) A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery
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DOI：
10.1097/aln.0b013e318201c44f
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发表时间：
2011-01-01
期刊：
影响因子：
8.8
通讯作者：
Dhonneur, Gilles
中科院分区：
文献类型：
--
作者：
Amathieu, Roland;Combes, Xavier;Dhonneur, Gilles
背景：由于困难气道管理的算法，包括使用新的光学气管插管装置，需要在常规实践中进行前瞻性评估，我们前瞻性地评估了包括两个新的气道设备在内的困难气道管理算法。方法：经过6个月的指导、培训和临床测试，15名资深麻醉师被要求在麻醉和瘫痪患者中使用已建立的困难气道管理算法。纳入了腹部、妇科和甲状腺手术患者。急诊、产科和被认为有误吸风险的患者被排除在外。如果使用Macintosh喉镜进行气管插管是不可能的，建议第一步使用Airtraq喉镜(VYGON，法国埃库昂)，第二步使用LMA CTrach(TM)(SEBAC，法国潘廷)。在Macintosh和Airtraq喉镜检查中，提倡使用牙胶弹性探条以方便气管进入。如果不能使用面罩进行呼吸，则使用LMA CTrach(TM)，如有必要，随后进行经气管氧合。记录患者特征、对算法的依从性、疗效和早期并发症。结果：2年内共纳入12,225名患者。98%的患者在Macintosh喉镜下完成插管。在其余病例(236例)中，207例(84%)在Macintosh喉镜下使用牙胶弹性探条。Airtraq喉镜成功率97%(27/28)。LMA CTrach(TM)支持抢救性通风(n=2)和目视引导气管插管(n=3)。1例患者不能通过面罩进行呼吸，并成功使用了LMA CTrach(TM)。结论：结合使用胶弹探条、Airtraq和LMA CTrach(TM)装置的新管理算法可以在大量患者中成功实现气管插管。
Background: Because algorithms for difficult airway management, including the use of new optical tracheal intubation devices, require prospective evaluation in routine practice, we prospectively assessed an algorithm for difficult airway management that included two new airway devices.Methods: After 6 months of instruction, training, and clinical testing, 15 senior anesthesiologists were asked to use an established algorithm for difficult airway management in anesthetized and paralyzed patients. Abdominal, gynecologic, and thyroid surgery patients were enrolled. Emergency, obstetric, and patients considered at risk of aspiration were excluded. If tracheal intubation using a Macintosh laryngoscope was impossible, the Airtraq laryngoscope (VYGON, Ecouen, France) was recommended as a first step and the LMA CTrach (TM) (SEBAC, Pantin, France) as a second. A gum elastic bougie was advocated to facilitate tracheal access with the Macintosh and Airtraq laryngoscopes. If ventilation with a facemask was impossible, the LMA CTrach (TM) was to be used, followed, if necessary, by transtracheal oxygenation. Patient characteristics, adherence to the algorithm, efficacy, and early complications were recorded.Results: Overall, 12,225 patients were included during 2 yr. Intubation was achieved using the Macintosh laryngoscope in 98% cases. In the remainder of the cases (236), a gum elastic bougie was used with the Macintosh laryngoscope in 207 (84%). The Airtraq laryngoscope success rate was 97% (27 of 28). The LMA CTrach (TM) allowed rescue ventilation (n = 2) and visually directed tracheal intubation (n = 3). In one patient, ventilation by facemask was impossible, and the LMA CTrach (TM) was used successfully.Conclusions: Tracheal intubation can be achieved successfully in a large cohort of patients with a new management algorithm incorporating the use of gum elastic bougie, Airtraq, and LMA CTrach (TM) devices.