Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view
Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view
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病例报告：经鼻气管插管——先看再评估喉部视图
DOI：
10.1007/bf03017208
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
S. Backman
中科院分区：
文献类型：
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作者：
Maria Uria;K. Kost;T. Schricker;S. Backman
目的：描述气道管理计划，包括在意外困难气道中需要鼻插管时进行口鼻气管插管更换。临床特征：接受口咽手术的患者需要鼻插管。在意识丧失和瘫痪后，获得了 Cormack-Lehane 3 级视图，对甲状软骨施压未能显露声带。将埃施曼探条插入口咽部并盲目地进入气管。将经口气管插管推进探条上方的气管中，并在探条移除后用 100% O^ sub 2^ 对患者进行通气。然后将气管内管引导通过右鼻孔进入下咽部。将埃施曼探条插入鼻管，并在喉镜下朝声门开口前进。对舌根处的口腔管施加手指压力，可以看到声带。将口腔气管内套囊放气，并将探条（插入鼻管）沿着经口气管管推进气管。拔出经口气管导管，并将鼻管在探条上推进到气管中。在这些操作过程中，患者的 O^ sub 2^ 饱和度和呼气末 CO^ sub 2^ 浓度分别保持在 99-100% 和 30-33 mmHg，仅需几分钟即可完成。结论：当需要经鼻气管插管时，需要制定气道管理计划以安全保护气道。我们强调在通过鼻子插入气管插管之前进行直接喉镜检查的重要性，并描述了口鼻气管插管更换的策略。[发表摘要]
Purpose: To describe an airway management plan, including oral to nasal endotracheal tube exchange, when nasal intubation is required in the unanticipated difficult airway.Clinical features: A nasal intubation was required for a patient undergoing oropharyngeal surgery. Following loss of consciousness and paralysis, a Cormack-Lehane class 3 view was obtained, and pressure over the thyroid cartilage failed to reveal the vocal cords. An Eschmann bougie was inserted into the oropharynx and blindly entered the trachea. An orotracheal tube was advanced into the trachea over the bougie, and the patient was ventilated with 100% O^ sub 2^ following the bougie's removal. An endotracheal tube was then guided through the right nostril into the hypopharynx. An Eschmann bougie was inserted into the nasal tube, and advanced towards the glottic opening under laryngoscopic view. Digital pressure applied to the oral tube at the base of the tongue brought the vocal cords into view. The oral endotracheal cuff was deflated, and the bougie (inserted into the nasal tube) was advanced into the trachea alongside the orotracheal tube. The orotracheal tube was withdrawn, and the nasal tube was advanced into the trachea over the bougie. The patient's O^ sub 2^ saturation and end-tidal CO^ sub 2^ concentration remained at 99-100% and 30-33 mmHg, respectively, during these maneuvers, which required only a few minutes to perform.Conclusion: When nasotracheal intubation is required, a plan of airway management is required to safely secure the airway. We emphasize the importance of direct laryngoscopy prior to insertion of an endotracheal tube through the nose, and describe a strategy for oral to nasal tracheal tube exchange.[PUBLICATION ABSTRACT]