中华医学杂志（英文版）2008，Vol.121Issue(11)：989-997,9.
Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck
Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck
XUE Fu-shan 1LIAO Xu 2LI Cheng-wen 3XU Ya-chao 4YANG Quan-yong 4LIU Yi 4LIU Jian-hua 4LUO Mao-ping 4ZHANG Yan-ming4
作者信息
- 1. Xinxiang Medical College, Xinxiang, Henan 453003, China
- 2. Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100041, China
- 3. Department of Anesthesiology, Plastic Surgery Hospit
- 4. Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100041, China
- 折叠
摘要
Abstract
Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients.Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5-67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 (including 1375 patients with the atlanto-occipital extension of ＞20° and the Mallampatti's grade Ⅰ or Ⅱ) and group 2 (containing 308 patients with the atlanto-occipital extension of ＜20° and the Mallampatti's grade Ⅲ or Ⅳ. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia (TIVA) or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope (FOSL). The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients.Results In group 1, the intubation was accomplished during the first attempt in 1279 cases (93%) and the intubation time was ＜3 minutes in 1304 cases (95%). In group 2, the intubation was completed by the first attempt in 114 patients (37%) and 123 patients had an intubation time of ＜3 minutes (40%). Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients required four or more attempts which only occurred in group 2. The incidence of traumatic complication was 2.6% and 9.7% with one intubation attempt in groups 1 and 2, respectively, 12.5% and 17.0% with multiple intubation attempts (one vs multiple attempts in both groups, P＜0.001). All nontrauamatic complications occurred in group 2 and laryngospasm and hypoxemia were more common in patients using the TIVA compared to those using the sevoflurane inhalational anesthesia (P＜0.001).Conclusions This study demonstrated that with a precise airway evaluation, an adequate preoperative preparation and a pre-planned failed intubation strategy, the anesthetist who was experienced in the difficult airway management could safely perform airway control and tracheal intubation under general anesthesia in patients with scar contracture of the neck. We believe that this technique may be very valuable for the management of a known difficult airway because it is comfortable for the patient and saves time for the anesthetist.关键词
scar contracture of the neck/ limitation of head extension/ difficult intubation/airway management/ general anesthesiaKey words
scar contracture of the neck/ limitation of head extension/ difficult intubation/airway management/ general anesthesia分类
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XUE Fu-shan,LIAO Xu,LI Cheng-wen,XU Ya-chao,YANG Quan-yong,LIU Yi,LIU Jian-hua,LUO Mao-ping ,ZHANG Yan-ming..Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck[J].中华医学杂志（英文版）,2008,121(11):989-997,9.
