Successful Detection and Management of Unexpected Endotracheal Tube Kinking during Neurosurgery - A Case Report

神經外科手術進行中非預期氣管內管彎折之成功偵測及處置

牛興華(Hsing-Hua Niu) ； 何敬之(Ching-Tzu Ho) ； 蔡佩珊(Pei-Shan Tsai)

《Acta Anaesthesiologica Taiwanica》 42卷2期 (2004/06) Pp. 119-123

摘要

在全身麻醉插管病患中， 氣管內管彎折其實是常見的問題。然而， 若因管子彎折或其他問題
導致呼吸道阻塞而無法及時排除和處理常常造成病患死亡。在此， 我們描述一例在開顱手術
進行中， 氣管內管在口腔內非預期彎折的病例。造成氣管內管彎折的可能原因是因為頸部屈
曲及口腔溫度較氣管內管高以致管子變軟所導致的過度彎曲。所以， 早期偵測及積極處理氣
管內管彎折可以降低麻醉致病及死亡的可能性。但是， 在手術進行的情況下， 重新換管插管
是很困難的。這篇病例報告強調於神經麻醉過程中， 尤其是開顱手術， 如何正確且快速診斷
及處理口腔內氣管內管彎折的情形。我們更強調在任何手術開始前就要注意頭頸部的位置是
否過度伸展或屈曲。此外， 含鐵絲且有彈性之氣管內管可以取代聚氯乙醯管子作為預防氣管
內管彎折之代替品。

關鍵字

氣管內插管 ； 呼吸道阻塞 ； 神經外科手術

並列摘要

Kinking of endotracheal tube (ETT) is not an infrequent problem during general anesthesia. However, failure to
secure free airway following airway obstruction due to kinking of endotracheal tube or other tube problems may
lead to lethality instead of lifesaving. We describe a case of unexpected kinking of ETT intraorally while craniotomy
was underway. The kink might result from over-bending of the softening tube in the oral cavity due to oral
temperature and neck flexion. Early detection and immediate management of the ETT kinking may reduce the
possibility of morbidity andmortality in anesthesia. It could be more difficult to carry out reintubation in such an
awful situation when the operation was proceeding. In this case report wewould like to highlight how to accurately
and quickly diagnose andmanage the ETT kinking intraorallywhile craniotomy was in process under anesthesia.
Emphasis is also laid on the importance of properly positioning of the head and neck prior to any operation especially
in craniotomy. Besides, the flexometallic (FM) or armoured endotracheal tubes may be good substitutes
for the polyvinyl chloride (PVC) ones in preventing the ETT kinking during general anesthesia.

並列關鍵字

Intubation, intratracheal ； Airway obstruction ； Neurosurgery.