接受經蝶骨手術之肢端肥大症病人進行經口氣管內插管失敗之病例報告

Difficult Oral Endotracheal Intubation in an Acromegalic Patient Receiving Transsphenoidal Surgery-- A Case Report

肢端肥大症病人發生呼吸道困難處理之機率較一般人高。我們報告一個肢端肥大症病人，為了進行經蝶骨手術，在全身麻醉之下，接受經口氣管內插管，但是所有插管方式都無法成功。最後以經鼻纖維支氣管鏡方式成功放置氣管內管，確保其呼吸道通暢。但是為了進行經蝶骨手術，這個病人之氣管內插管必須以經口方式為之。因此五天之後，我們改採在病人清醒之狀態下，以經口纖維支氣管鏡成功放置氣管內管。我們建議，將要接受經蝶骨手術之肢端肥大症病人，若預期可能困難插管時，在病人清醒之狀態下，採用經口纖維支氣管鏡來進行氣管內插管是可行之方法之一。

Patients suffering from acromegaly are associated with increased risks of difficult airway management We report a case of acromegaly scheduled for transsphenoidal resection of pituitary adenoma under general anesthesia in whom all possible means failed us in the insertion of the endotracheal tube (ET) through the mouth, a procedure essential for transsphenoidal surgery. The operation was called off and for securing his compromised airway a nasal ET was placed under fiberoptic bronchoscopy. Five days later, awake oral fiberoptic intubation was successful under topical anesthesia. We suggest that oral endotracheal intubation performed awake under topical anesthesia with the aid of a fiberoptic bronchoscope is a choice approach in acromegalic patients with predicated difficult airway who are to receive surgery.