舌扁桃体肥大的气道管理:叙述回顾。

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-25 DOI:10.1177/0310057X231196910
Patrick Wong, Jamie W Sleigh
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引用次数: 0

摘要

舌扁桃体肥大在常规气道评估中很少被发现,但可能给气道管理带来困难。我们对舌扁桃体肥大的病例报告进行了叙述性回顾,以检查相关的患者因素,气道管理技术的成功率和并发症。我们检索了有关舌扁桃体肥大病例的麻醉处理的文献。我们在各种病例报告中发现89例患者,从中我们得出92例进行分析。64%的病例被评估为气道正常。口罩通气困难和不可能分别占29.6%和1.4%。插管困难和插管失败分别占89.1%和21.7%。多次插管尝试(多达6次),在直接喉镜下进行第三次插管尝试后没有成功。约16.5%的患者醒来,4.3%的患者需要紧急颈前通道。并发症包括食管插管(10.9%)、出血(9.8%)和严重缺氧(3.2%)。我们的研究结果表明,严重的舌部肥大病例可能导致意想不到的气道困难和严重的并发症,包括缺氧脑损伤和死亡。需要一个健全的气道策略,包括限制喉镜检查的次数,并在必要时尽早启动和执行颈部前方紧急通道。对于已知严重舌扁桃体肥大的患者,应考虑清醒插管。
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Airway management of lingual tonsillar hypertrophy: A narrative review.

Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.

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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
150
审稿时长
3 months
期刊介绍: Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine.
期刊最新文献
JG Farrell and The Lung: An early description of intensive care delirium in literature. Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review. MET call prevention. A cross-sectional study of the relationship between iron deficiency anaemia and chronic pain. Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia.
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