Use of the laryngeal tube for difficult fibreoptic tracheal intubation
Use of the laryngeal tube for difficult fibreoptic tracheal intubation
复制标题
使用喉管进行困难的纤维支气管镜气管插管
DOI：
10.1111/j.1365-2044.2005.04313.x
复制
发表时间：
2005
期刊：
影响因子：
10.7
通讯作者：
T. Asai
中科院分区：
文献类型：
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作者：
T. Asai
I have previously reported that ventilation can be controlled via the laryngeal tube (VBM, Medizintechnik, Sulz, Germany) during attempts at fibreoptic nasotracheal intubation and used this technique in a patient with multiple fractures of the jaw in whom thrusting the jaw forward (during mask ventilation) and tracheal intubation using a laryngoscope might worsen the damage to the jaw [1]. I now report successful use of this technique in a patient in whom laryngoscopy, conventional fibreoptic intubation and insertion of the laryngeal mask airway had failed. A 71-year-old man with a history of partial resection of the tongue was scheduled for revision of the resection, due to recurrence of cancer. Because of radiotherapy, mouth opening was limited to 3 cm and extension of the neck was restricted. After induction of anaesthesia and confirmation of adequate mask ventilation, vecuronium was given. Attempted nasotracheal intubation using a Macintosh laryngoscope, followed by use of a fibrescope, failed because a large epiglottis reclining to posterior pharyngeal wall prevented visualisation of the glottis. Insertion of a size 4 followed by a size 3 laryngeal mask airway also failed, due mainly to inability to insert an index finger into the oropharynx to drive the mask into position. In contrast, insertion of a size 4 laryngeal tube was easy, and adequate ventilation was obtained. It was easy to advance the fibrescope and a reinforced tracheal tube through the nose into the oral cavity (without deflating the cuffs of the laryngeal tube), and identify the distal cuff of the laryngeal tube in the hypopharynx, and anterior to that, the glottis through a narrow gap (< 1 cm) between the epiglottis and arytenoids. The laryngeal inlet was tilted to the right, due possibly to the radiotherapy. After 20 min and with considerable difficulty, the fibrescope was advanced into the trachea while the lungs were kept ventilated through the laryngeal tube. It was then relatively easy to advance the tracheal tube into the trachea. The laryngeal tube was then removed. Fibreoptic intubation is useful in patients with a difficult airway, but it can be difficult to locate the glottis, to advance a tracheal tube over the fibrescope, and to ventilate the lungs during the procedure [2]. In the case reported, the laryngeal tube provided a clear airway and enabled delivery of oxygen and inhalational anaesthetics during the prolonged attempt at fibreoptic nasotracheal intubation. It also facilitated location of the glottis through a fibrescope: the glottis should be anterior to the distal cuff of the laryngeal tube in the hypopharynx. Insertion of the laryngeal mask failed whereas insertion of the laryngeal tube was successful. Insertion of the laryngeal mask, or of the laryngeal tube, may be difficult in some circumstances [3, 4]. However, there have been reports in which the laryngeal tube provided adequate ventilation after failed insertion of the laryngeal mask [5, 6]. Elucidating the causes of difficult insertion of the laryngeal mask and of laryngeal tube would establish the role of these devices in patients with difficult airways.
Koh Shingu：“一氧化二氮对大鼠的抗惊厥作用的循环性质。”
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