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

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

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。

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 and mortality 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 we would like to highlight how to accurately and quickly diagnose and manage the ETT kinking intraorally while 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.