Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

C. Frerk, V. Mitchell, A. McNarry, C. Mendonca, R. Bhagrath, Anil K Patel, E. O'sullivan, N. Woodall, I. Ahmad
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引用次数: 1526

Abstract

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.
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困难气道学会2015年成人意外困难插管管理指南
这些指南提供了处理气管插管意外困难的策略。它们是建立在公开的证据之上的。在缺乏证据的情况下,他们根据困难气道协会成员的反馈和专家意见进行指导。这些指导方针是根据对危机管理理解的进步而制定的;他们强调气道管理过程中困难的识别和声明。一种简化的单一算法现在涵盖了常规插管和快速序列诱导中意想不到的困难。插管失败的计划应成为引产前简报的一部分,特别是紧急手术。重点放在评估,准备,定位,预充氧,维持充氧,并尽量减少气道干预的创伤。建议气道干预的数量是有限的,使用bougie或通过声门上气道装置的盲技术已被视频或光纤引导插管所取代。如果气管插管失败,建议声门上气道装置提供氧合途径,同时审查如何进行。第二代设备有优势,推荐使用。当气管插管和声门上气道装置插入都失败时,唤醒患者是默认的选择。如果在这个阶段,在肌肉松弛的情况下,面罩氧合是不可能的,应立即进行环甲状软骨切开术。手术刀环甲状软骨切开术被推荐为首选的抢救技术,所有麻醉师都应该练习。概述的计划设计简单,易于遵循。他们应该定期排练,并使整个剧院团队熟悉。
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