於麻醉誘導時使用Fastrach插管式喉頭罩和換管通條引導插管導致氣胸之病例報告

Pneumothorax Associated with Tube Exchanger-aided Intubation Following LMA-Fastrach™ Placement in a Patient during Anesthesia Induction-- A Case Report

自從Fastrach插管式喉頭罩問世以來，它已廣泛地被運用在困難插管或頸椎有問題的病人插管上。我們報告一位65歲女性病患因頸椎椎間盤突出並有神經壓迫症狀，為了不進一步傷害到神經，我們計劃使用Fastrach插管式喉頭罩插管再運用換管通條換成一般氣管內管；在換管通條置入後，將潮氣末端二氧化碳監視器之管線接到換管通條末端並擠氣以檢測其是否在氣管內時，病人的血氧濃度卻開始降低。胸部放射檢查後發現右側大量氣胸及皮下氣腫，經緊急放置胸管後病人情況穩定，7天後拔除胸管。這篇文章除了討論可能的機轉外，亦參考多篇文章整理出張力性氣胸可能出現之症狀及處理，並建議使用Fastrach插管式喉頭罩和換管通條插管時應注意事項及預防氣胸之道。

The use of intubating laryngeal mask airway (LMA-Fastrach™) is indicated to facilitate endotracheal intubation in a patient with cervical spine disorder or suspected difficult airway. A 65-year-old female patient was referred to our hospital for cervical spine surgery under general anesthesia. During anesthesia induction, an LMA-Fastrach™ was used to facilitate intubation and an airway exchange catheter (AEC) was used to exchange the accompanying armored silicone endotracheal tube for a polyvinyl chloride (PVC) endotracheal tube. However, the pulse oximeter showed a fall of oxygen saturation (Sp02) after insertion of the AEC. As massive pneumothorax associated with subcutaneous emphysema was disclosed by chest roentgenography, a chest drainage was performed immediately. This article discourses the possible mechanism, diagnosis and treatment of pneumothorax during the course of general anesthesia and the prevention of lower airway injury by AEC is also touched.