全身麻醉時呼吸道處置的一些小訣竅

10.6666/ClinMed.201910_84(4).0111

鄭澄寰

呼吸道處置（airway management） ； 全身麻醉（general anesthesia） ； 操作技術（handling technique）

臨床醫學月刊

84卷4期（2019 / 10 / 25）

667 - 673

繁體中文

執行全身麻醉時，呼吸道處置對麻醉醫師來說，是一個非常重要的課題，也是必須嫻熟的技能之一。本篇報告，將針對以下八個在執行呼吸道處置時會遇到的問題，分別作介紹，並提供可行的解決之道。八個題目如下：（1）適當的氣管內管插入深度；（2）適當的雙通道支氣管內管（double-lumen endobronchial tube）插入深度；（3）適當的鼻咽通氣導管（nasopharyngeal airway）；(4)適當喉頭罩（laryngeal mask airway，LMA）尺寸的選擇；（5）改良式壓舌板協助ProSeal LMA置放；（6）喉返神經電刺激監測手術時，特殊EMG氣管內管的適當固定位置；（7）進行快速插管（rapid sequence intubation，RSI）時的環狀軟骨壓迫（cricoid pressure）；（8）經鼻腔進行氣管插管（nasotracheal intubation）的幾個問題。

1. Bahk, JH,Oh, YS(1999).Prediction of double-lumen tracheal tube depth.J Cardiothorac Vasc Anesth,13,370-371.
2. Birenbaum, A,Hajage, D,Roche, S(2019).Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: the IRIS Randomized Clinical Trial.JAMA Surg,154,9-17.
3. Bohman, JK,Kashyap, R,Lee, A(2018).A pilot randomized clinical trial assessing the effect of cricoid pressure on risk of aspiration.Clin Respir J,12,175-182.
4. Brodsky, JB,Benumof, JL,Ehrenwerth, J(1991).Depth of placement of left-sided double-lumen endobronchial tubes.Anesth Analg,73,570-572.
5. Cherng, CH,Chen, YW(2010).Using a modified nasotracheal tube to prevent nasal ala pressure sore during prolonged nasotracheal intubation.J Anesth,24,959-961.
6. Cherng, CH,Huang, GS,Wang, CH(2013).A modified lengthened nasopharyngeal airway.J Clin Anesth,25,242-243.
7. Cherng, CH,Huang, YH,Shih, ML(2014).Middle fixation of electromyographic endotracheal tube for intraoperative recurrent laryngeal nerve monitoring.J Clin Anesth,26,252-253.
8. Cherng, CH,Wong, CS,Hsu, CH(2002).Airway length in adults: Estimation of the optimal endotracheal tube length for orotracheal intubation.J Clin Anesth,14,271-274.
9. Cherng, CH,Wu, ZF,Lin, BF(2016).A Modified Nasopharyngeal Tube for Awake Craniotomy.J Neurosurg Anesth,28,275-277.
10. Chow, MYH,Goh, MH,Ti, LK(2002).Predicting the depth of insertion of left-sided double-lumen endobronchial tubes.J Cardiothorac Vasc Anesth,16,456-458.
11. Huang, YH,Cherng, CH(2014).Optimal size selection of the classic laryngeal mask airway by tongue width-based method in male adults.J Chin Med Assoc,77,422-425.
12. Kei, J,Utschig, EE,van, Tonder, RJ(2017).Using Ultrasonography to Assess the Effectiveness of Cricoid Pressure on Esophageal Compression.J Emerg Med,53,236-240.
13. Lin, WL,Cherng, CH(2016).Predicting optimal insertion depth of left-sided double-lumen endobronchial tube.J Cardiothorac Vasc Anesth,30,942-946.
14. Liu, YC,Cherng, CH(2017).A modified tongue depressor facilitates the insertion of ProSeal laryngeal mask airway: Comparison with digital and introducer techniques.J Chin Med Assoc,80,582-586.
15. Takita, K,Morimoto, Y,Kemmotsu, O(2003).the height-based formula for prediction of left-sided double-lumen tracheal tube depth.J Cardiothorac Vasc Anesth,17,412-415.
16. Tseng, WC,Chen, YW,Cherng, CH(2016).Airway protection using a modified nasopharyngeal tube after orthognathic surgery.J Clin Anesth,31,189-190.
17. Tseng, WC,Lin, WL,Cherng, CH(2019).Estimation of nares-to-epiglottis distance for selecting an appropriate nasopharyngeal airway.Medicine,98,e14832.