- 期刊
Management of Tracheal Deformity during Intubation: A Case Report
喉部病變之成功插管－病例報告
摘要
困難插管或是插管失敗原因可能是無法看到完整的聲門或是在聲帶處或下方有病變。在此我們提出一個困難插管的病例，懷疑是因為頸部疤痕所導因，及後續處理之經驗，供大家分享。在這次的術前評估中我們採用了更精確的評估方法來了解整個呼吸道，其中包括：電腦斷層掃瞄。以上檢查顯示出既往的頸部手術造成氣管上端形成一個彎曲的角度情形。在本次的麻醉過程中我們採用雙人插管技巧(two-person technique)，當光纖內視鏡順利經口腔進入到氣道中，因氣管內管較光纖內視鏡硬且具前彎之特性，卡在Subglottic angulation處。最後我們試著將氣管內管逆時針旋轉180度以順應氣管彎曲的角度，終於順利將氣管內管成功置入。因此，在面對頸部有疤痕的病人，都應該考慮有困難插管的可能，並同時將各式協助插管的工具備在手邊。再者，我們也發現在這類型的病人使用電腦斷層掃瞄對評估困難插管是有幫助。
並列摘要
Failure or difficulty in intubating the trachea can be either due to inability to visualize the glottis or some pathology at the level of or below the cords. This report describes a case of difficult intubation suspected of being related to neck scarring from previous surgery. Computed tomography (CT) was used to evaluate the patient's airway and revealed upper tracheal angulation. We describe a method to secure the airway in this patient with a two-person technique by rotating an oral endotracheal tube 180° counterclockwise to adjust to the curvature of the trachea. Problems with intubation should be anticipated in patients with scarring of the neck, and equipment for aiding intubation should be on hand. Furthermore, we found that CT contributed to the assessment of the difficulty of intubation in this kind of patient.