Styletted orotracheal intubation in difficult airway management.

摘要

The recently-published continuing medical education module: "Advances in Airway Management" summarizes a variety of techniques and specialized equipment intended in part as rescue measures following failed endotracheal intubation. In their article, Drs. Hung and Law do not discuss reasons why other devices developed as solutions to the unanticipated difficult airway have waxed and waned over the years. A partial explanation justifying development of rescue devices, both past and present, stems from the assumption that improvement to "textbook" intubation is no longer possible, and therefore the only viable alternative is to create new products to deal with the difficult airway. Many "difficult intubations", in fact, are the consequence of technical shortcomings of standard orotracheal intubation, a technique that from its inception was intended only to secure the airway in most, but not all patients. Continued use in its relatively unchanged form for nearly a century has proven that the current procedure fails in approximately 10% of first try intubations when laryngoscopic orotracheal intubation is the appropriate approach. Despite having identified and recognized failures as being unpredictable in some patients, the anesthesia commfenity continues to advocate a technique that in critical situations is time consuming and may eventually have to be supplanted by another method of airway management.