[THE CHOICE OF TRACHEAL INTUBATION METHOD IN RECONSTRUCTIVE MAXILLO-FACIAL SURGERY WITH DIFFICULT AIRWAYS.]

Abstract

Background: The development of modern video - and endoscopic equipment allows for revision and adjust to modern protocols for maintaining patency of the difficult airway, especially in maxillofacial or ENT -surgery.

The purpose of the study: Comparison the efficacy ofvarious methods of maintaining the airway patency in the practice of reconstructive maxillofacial surgery.

Materials and methods: 89 patients, who were divided into 4 groups, were examined. Group I (n=57) - classic laryngos- copy with the Macintosh blade, group II (n=14) -fiber-optic bronchoscopy (FBS) in clear consciousness. In group III (n=10) tracheal intubation was performed by the blade D-Blade of videolaryngoscope C-MAC (Karl Storz) or McGrath (Aircraft Medical Ltd.). In group IV (n=12) - retromolar endoscope (RAE) intubation by videostylet Shikani (Clarus Medical) and RME Bonfils (Karl Storz). At the time of laryngoscopy and tracheal intubation the duration of tracheal intubation (t), the maximum values of arterial blood pressure and heart rate, galvanic skin response (GSR) (NASTYA, Neyrok, Russia) were analyzed. The results and discussion. Unexpected difficult tracheal intubation occurredfor 31.6 % of the 1st group patients, need two attempts at laryngoscopy and tracheal intubation occurred in the subgroup 1B patients at 61.1 % (n=11), three at- tempts at 33.3 % (n=6), more than three attempts at 5.6% (n=1). FBS is the method of choice in patients with a planned difficult intubation, in cases of facial skeleton severe deformations . At the same time, local anesthesia and sedation is not capable ofproviding psycho-emotional comfort forpatients during FBS procedure. Visualization in 100% of the hy- popharynx structures at the McCormack I-II degree when using the blade D-Blade is appeared. The use of RME should not be recommended for routine planned and especially unexpected emergency difficult intubation.

Conclusion: Comparison of methods of maintaining the airway allows to adjust the plan of sequential actions in difficult intubation, both planned and in an emergency situation. The effectiveness of blades type D-Blade is confirmed. In patients with facial skull deformity and impaired mouth opening (less than 1.3 cm) method of choice is awake intubation by fibrobronchoscope. The use if retromolar intubation is also justified, but this method may be accompanied by a lot number of failures.