喉罩全麻在高危气管切开中的应用

General Anesthesia of Laryngeal Mask in Some High Risk Tracheotomy

目的：探讨喉罩全麻高危气管切开术的有效方法，最大限度减少该类气管切开术的风险。方法：回顾分析我科近3年42例在喉罩全麻下进行高危气管切开术患者的临床资料，其中1例颈短肥胖OSAHS患者插管麻醉失败改用喉罩全麻下气管切开插管麻醉，另1例喉气管狭窄强迫体位进行气管切开失败改用喉罩全麻下气管切开插管麻醉；分析利用喉罩全麻下进行高危气管切开术的安全性和适应证。结果：42例中，41例在喉罩全麻下完成高危气管切开术；1例全口无牙齿喉罩全麻失败，改用可视喉镜下插管麻醉完成手术。全组无一例发生严重手术并发症。结论：有选择性地采用喉罩全麻下气管切开术，是降低高危气管切开术风险、提高安全性的有效方法之一，值得推广。

Objective：To discuss the effective methods for high risk tracheotomy, and to minimize the risk of such tracheotomy. Methods： A retrospective analysis was conducted to analyze 42 high - risk tracheoto- my cases in recent 3 years; each case used a laryngeal mask under general anesthesia. And we analyzed the safety and adaption of the high risk of tracheotomy under general anesthesia laryngeal mask. 1 case of short cer- vical obese OSAHS used laryngeal mask intubation under general anesthesia because of failure to intubation an- esthesia; In 1 laryngeal and trachea narrow patient tracheotomy failed because of the forced body position, la- ryngeal mask was used to trachea intubation under general anesthesia and the surgery succeed. Results：We completed 41 cases with high risk tracheotomy in 42 cases with aryngeal mask and general anesthesia. 1 case of no teeth patient failed to intubation anesthesia by laryngeal mask, and visual laryngoscope was used for intuba- tion anesthesia, and tracheotomy was conducted successfully right after the surgery. None of them had serious complications. Conclusions：Using laryngeal mask under general anesthesia for tracheotomy is an effective way to reduce the risk and improve the safety of high risk tracheotomy, and it deserves to popularize.