Retrograde intubation with epidural catheter and Cook airway exchange catheter
Retrograde intubation with epidural catheter and Cook airway exchange catheter
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硬膜外导管和库克气道交换导管逆行插管
DOI：
10.1007/bf03022668
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
K. Leissner
中科院分区：
文献类型：
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作者：
K. Leissner
致编辑：直接喉镜仍然是辅助气管插管的首选技术。当认为气道困难或气管插管不成功时，需要替代插管技术。逆行插管（RI）技术是控制气道的一种选择，已列入美国麻醉学会困难气道算法。1我们使用一种新的RI技术，该技术利用硬膜外套件（Braun，Bethlehem，PA，USA）和86 cm长的Cook气道交换导管（CAEC）（Cook Critical Care，布卢明顿，IN，USA），这两种器械都是麻醉工作室中常见的。在准备中，将20cm的CAEC从尾端切下，使其刚好短于牙龈弹性探条。在标准监测下，患者仰卧，颈部处于中立位或略微伸展。病人的气道是局部麻醉的局部，当无菌溶液应用于颈部时，可以滴定镇静作用。接下来，用17G硬膜外穿刺针以45º角穿刺环甲膜，斜面指向喙侧。硬膜外导管（EC）用于逆行进入口腔。拔出舌头并使用马吉尔钳通常有助于取出EC。EC的尾端必须用夹子或助手固定。然后将EC穿过缩短的CAEC的中央管腔，并在其出现时在吻端固定。CAEC通过声带在EC上被引导。拔出舌头和环状软骨的压力可能有助于气管插管。一旦由于EC阻止进一步通过而使CAEC停止，则在嘴端释放EC，并且将CAEC小心地进一步插入气管中。如果患者仍在自主呼吸，则可听到通过CAEC的呼吸声。然后将气管内导管（ETT）在CAEC上引导到气管中。喉镜检查可促进这一通道。
To the Editor: Direct laryngoscopy remains the technique of choice to facilitate tracheal intubation. Alternative intubation techniques are required whenever an airwayis deemed difficult or when tracheal intubation is unsuccessful. The retrograde intubation (RI) technique is an option for controlling the airway and is listed on the American Society of Anesthesiology difficult airway algorithm. 1We use a new technique for RI that utilizes an epidural kit (Braun, Bethlehem, PA, USA) and an 86-cm long Cook airway exchange catheter (CAEC)(Cook Critical Care, Bloomington, IN, USA), which are both commonly found in an anesthesia work room. In preparation, 20 cm of the CAEC are cut off the caudal end making it just short of a gum elastic bougie. Under standard monitoring, the patient is positioned supine with the neck in the neutral position or slightly extended. The patient’s airway is the topicalized with local anesthesia, and sedation may be titrated to effect while sterile solution is applied to the neck. Next, the cricothyroid membrane is punctured with a 17G epidural needle in a 45º angle with the bevel pointing rostrally. An epidural catheter (EC) is used for retrograde passage into the oral cavity. Pulling out the tongue and using a Magill forceps usually helps to retrieve the EC. The caudal end of the EC must be secured with a clamp or by an assistant. The EC is then threaded through the central lumen of the shortened CAEC and is secured at the rostral end once it appears. The CAEC is guided over the EC through the vocal cords. Pulling out the tongue and cricoid pressure may facilitate tracheal intubation. Once the CAEC stops because the EC prevents further passage, the EC is released at the rostral end and the CAEC is inserted carefully further into the trachea. Breath sounds through the CAEC may be heard, if the patient is still breathing spontaneously. An endotracheal tube (ETT) is then guided over the CAEC into the trachea. Laryngoscopy may facilitate this passage.