經常使用另類氣道使困難插管減少也更容易

Frequent Use of Alternative Airway Techniques Makes Difficult Intubations Less and Easier

背景：本科在日常麻醉工作廣泛使用各種不同的氣道技術，本研究旨在探討這些技術在不同的困難插管情形的功用。方法：這是一個開放性、前瞻性的研究。一共一萬二百二十九個病人參與了這項為期七個月的研究。當負責的麻醉醫師遇到一例困難插管時，他要填寫一份問卷，回答可能造成困難插管的原因，面罩通氣的困難度，最後成功的插管技術，以及給予這位病人下次插管的建議。結果：全身麻醉插管的病人中，約有百分之二十二的病人接受了喉頭鏡插管以外的插管技術。在八千零五十八名病人計劃接受喉頭鏡插管，困難插管的發生率是0.44％。困難插管的病人最後接受的成功插管技術，十三位病人是傳統喉頭鏡，二十位是發光式導管，兩位是咽喉面罩氣道，一位是盲目式口腔插管。如果這些困難插管的病人下回要接受全麻醉插管，只有四名病人被建議清醒插管為宜。結論：在選擇性的全身麻醉中，經常使用另類的氣道技術，例如咽喉面罩氣道於短時間的手術與發光式導管於疑似困難插管，可以減少非預期性困難插管的機會。發光式導管對於咽喉視野不良的困難插管似乎較傳統的喉頭鏡更佔優勢。

Background: This study is to evaluate how alternative airway techniques work at different scenarios of difficult airways in our department where those techniques are popularized in daily practice. Methods: This is an open and observational study. Ten thousand two hundred and twenty nine adult patients were included in the 7-month period of investigation. When a difficult intubation was recognized, the responsible anesthesiologist would complete a questionnaire that was designed to explore the possible causes relative to the difficulty, i.e. the laryngoscopic view grade, the muscle relaxant administered during induction, any difficulty of mask ventilation, the eventually successful intubation technique, and the recommendation on the next intubation to the same patient. Results: About 22% of the patients received various airway techniques for intubation other than laryngoscopic technique in general anesthesia. Laryngoscopic intubation was planned firstly on 8,058 cases; the incidence of difficult intubation was 0.44% (36/8058). Laryngoscopic view was found to be grade 2 in 10 patients, grade 3 in 24, and grade 4 in 2 patients, respectively. In these difficult airway intubations were accomplished ultimately with a conventional laryngoscope in 13 patients, a lighting stylet in 20 patients, a laryngeal mask airway (LMA) in 2 patients, and surface tactile oral intubation (STOI) in 1 patient. As to these patients with difficult airways who would undergo general anesthesia with endotracheal intubation next time awake intubation was suggested only to 4 patients. Conclusions: In elective general anesthesia, frequent use of the alternative airway techniques, such as LMA for a surgical procedure of short duration and lighting stylet for a possibly difficult airway, will decrease the events of difficult intubations. Lighting stylet seems more advantageous than laryngoscope in management of difficult intubation caused by poor laryngoscopic view.