#35833清醒插管的模式转变

Rita Dinis, Bárbara Sousa, Andreia Puga
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引用次数: 0

摘要

请确认已申请或授予伦理委员会批准:不相关(见本页底部信息)申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的:耳廓周围脓肿是耳鼻喉科常见的急症。手术引流可能是必要的,但清醒的患者难以耐受。在某些情况下,有必要进行清醒插管,以安全保护气道。方法患者:男性32岁,既往有药物依赖史。手术方法:扁桃体脓肿手术引流。麻醉方案:由于可预测气道困难,我们决定采用清醒插管内镜(C-MAC®D-blade)。使用10%的木卡因进行气道局部化,并通过鼻导管给予补充氧气。镇静时给予右美托咪定(1mcg/kg)和氯胺酮(1mg/kg),然后输注右美托咪定(1mcg/kg/h)和氯胺酮(1mg/kg/h)。结果在开始给药10分钟后,可以进行视屏镜检。在确认脓肿和声带的良好显像后,开始快速顺序插管,给予异丙酚(1mg/kg)和罗库溴铵(1,2mg/kg)。1分钟后,进行新的内镜检查和成功的口内窥镜检查。手术过程和手术过程都很顺利。结论右美托咪定与氯胺酮联用在清醒插管中并不常见,但均具有镇静镇痛作用,且不影响呼吸功能和气道保护反射,是一种有价值的联用方法。当谈到清醒插管气道管理时,纤维插管一直被认为是选择的技术,但应该考虑使用视频喉镜插管,因为它在困难的气道中成功率很高。附件同意书,附件附件。pdf
本文章由计算机程序翻译,如有差异,请以英文原文为准。
#35833 Paradigm shift in awake intubation

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims

Peritonsillar abscess is a frequent otolaryngology emergency. Surgical drainage may be necessary and is poorly tolerated by the awake patient. In some cases is necessary to proceed with awake intubation in order to safely secure the airway.

Methods

Patient: 32-year-old male, with previous history of drug addiction. Procedure: surgical drainage of tonsilar abcess. Anesthetic plan: because a difficult airway was predictable, an awake intubation with videolaringoscopy (C-MAC® D-blade) was decided. Topicalization of the airway was performed with xylocaine 10% and supplemental oxygen was delivered via a nasal catheter. For sedation a bolus of dexmedetomidine (1mcg/kg) and ketamine (1mg/kg) was administered followed by an infusion with dexmedetomidine (1mcg/kg/h) and ketamine (1mg/kg/h).

Results

Videolaringoscopy was possible 10 minutes after the initiation of the infusion. After confirmation of good visualization of both abcess and vocal cords rapid sequence intubation was initiated, with administration of propofol (1mg/kg) and rocuronium (1,2mg/kg). After 1 minute, a new videolaringoscopy and sucessful orotraqueal was performed. The procedure as well as the emergence went uneventful.

Conclusions

The combination of dexmedetomidine and ketamine, not the most common in awake intubation, is a valuable one, as both drugs induce sedation and analgesia without depressing respiratory function or airway protection reflexes. When it comes to airway management in awake intubation, fibreoptic intubation has been considered the technique of choice, but intubation with videolaryngoscope should be considered since it yields high sucess rates in difficult airways.

Attachment

Consentimento informado sem dados do doente.pdf
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