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題名 | Airway Obstruction in General Anesthesia--Two Different Episodes in the Same Patient: Case Report=全身麻醉過程中發生呼吸道阻塞--同一病患發生兩次獨立事件:病例報告 |
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作 者 | 李育豪; 劉雪全; 陳捷; 黃潔文; 譚培炯; | 書刊名 | 長庚醫學 |
卷期 | 22:4 1999.12[民88.12] |
頁次 | 頁682-686 |
分類號 | 416.52 |
關鍵詞 | 呼吸道阻塞; 全身麻醉; 亞伯特氏症候群; 氣管造口術; Airway obstruction; General anesthesia; Apert's syndrome; Tracheostomy; |
語文 | 英文(English) |
中文摘要 | 全身麻醉過程中發生呼吸道阻塞是一項高危險性的事件。我們報告一位接受過氣 管造口術的亞伯特氏症候群病患,在兩次接受全身麻醉進行顱顏手術的過程中,分別發生呼 吸道阻塞的緊急事件。第一次事件可能是由於顱顏手術部位之血液流入氣管造口內管而導致 呼吸道阻塞,第二大事件可能是來自氣管造口周圍之增生組纖進入氣管內管並進而阻礙呼吸 道。 我們更進一步討論帶有氣管造口內管的病患發生呼吸道阻塞之可能機轉,臨床表徵,與 其處理方式。我們認為對於接受全身麻醉的病患,特別是帶有氣管造口內管者,應隨時注意 呼吸道阻塞之徵兆,以求早期診斷,並及時給予適當的治療。 |
英文摘要 | The case of a patient with Apert's syndrome (acrocephalosyndactyly) who had a tracheostomy tube and who encountered two different episodes of critical airway obstruction during two different general-anesthetic procedures for craniofacial surgery is reported. The first episode, at the age of four, involved occlusion of the uncuffed tracheostomy tube by a blood clot, which might have come from the surgical field of the maxillary Le-Fort III advancement procedure. The second episode was encountered during his emergence from the general anesthesia of a degloving midface osteoplasty and a maxillary Le-Fort I osteotorny procedure 3 years later. Although a cuffed armored tube had been inserted through the tracheostoma to prevent aspiration of blood from the surgical field, the armored tube was plugged by a piece of granulation tissue that might have been dislodged from the peri-stomal area. Factors that lead to tracheostomy tube obstruction, their clinical features and preventive measures are discussed. We believe that being alert to changes in the airway pressure, the ventilation pattern, and the hemodynamic status is necessary during the administration of general anesthesia. Precautions should be taken at all times, particularly for patients with a tracheostomy. |
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