麻醉中同時以喉頭鏡輔助進行纖維鏡經鼻道之氣管內插管－－病例報告

Facilitation of Fiberoptic Nasotracheal Intubation by Simultaneous Direct Laryngoscopy in Anesthetized Patients

我們報告二個在麻醉誘導時，發生非預期困難插管的病例。第一個病例是，68歲男性，預進行冠狀動脈繞道手術；第二個病例是，94歲男性，預進行剖腹探查術。麻醉誘導時，發現病人是困難插管，當仍在深度麻醉下，我們使用二人操作方式，一人以喉頭鏡做挑管動作，另一人以支氣管鏡輔助，做經鼻道之氣管內插管，過程迅速平順。文中討論，此法可做為在麻醉狀態下，當發生非預期困難插管時，若預以支氣管鏡輔助，做氣管內插管時的一種選擇。

Two cases of unexpected difficult intubation during induction of general anesthesia were reported. The first case, a 68-year-old male was scheduled for coronary artery bypass surgery. The second case, a 94-year-old male with senile dementia was arranged for exploratory laparotomy. Anesthesia was induced with diazepam 10 mg, fentanyl 30 μg/kg, and pancuronium 8 mg in the first case while in the second case fentanyl 100 μg, lidocaine 80 mg, thiopental 200 mg and succinylcholine 80 mg were used. In these two cases oral tracheal intubation with laryngoscope was unsuccessful. Assisted ventilation could be maintained via a face mask. With the help of direct laryngoscopy, fiberoptic bronchoscope-aided nasotracheal intubation was successfully achieved.