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口腔颌面外科手术行全身麻醉时常需保护气道。而经鼻腔的气管插管给手术提供了良好的条件。一般鼻腔插管时,当插管进入口咽后,需用直接喉镜和一个辅助的管钳将插管通过声门送入气管内。然而由于有限的张口、喉镜的占位常常限制和妨碍了管钳的操作。另外,管钳也会撕破插管的套囊。作者应用下述方法帮助鼻腔气管插管:先按常规方法将插管经鼻孔进入口咽,把10～155ml的空气注入插管套囊内,使插管头向上抬起,离开咽后壁。当插管头位于气管开口处时,将管稍向下插使充气的插管套囊抵达声带,随着套囊的放气,麻醉师即可将插管通过声门而进入气管。这种方法不需管钳的帮助,也避免了过分扩张患者的颈部(附图)。作者在过去一年中曾对25例患者成功地应用了这项技术。有3例,作者曾先用管钳插管,由于解剖学的缘故,口腔内使用不便,后改用套囊充气的方法都顺利地插了管。这种方法也可使用于经鼻腔的盲式插管。
Oral and maxillofacial surgery is often required to protect the airway during general anesthesia. Transnasal endotracheal intubation provides good conditions for surgery. General nasal intubation, when the intubation into the oropharyngeal, the need for direct laryngoscope and an auxiliary pipe clamp will intubation through the glottis into the trachea. However, due to the limited opening, the placement of the laryngoscope often limits and hinders the operation of the pipe wrench. In addition, the pipe wrench will tear the cannula cuff. The authors apply the following methods to help nasotracheal intubation: first according to the usual method of intubation through the nostril into the oropharynx, the 10 ~ 155ml of air into the intubation cuff, so that the intubation head up, leaving the pharyngeal wall. When the cannula head is located at the tracheal opening, the tube is inserted slightly down to inflate the cannula cuff to the vocal cords. As the cuff deflates, the anesthesiologist can insert the cannula through the glottis and into the trachea. This method does not require the help of a pipe wrench and also avoids over-dilating the patient's neck (photo). The authors have successfully applied this technique to 25 patients in the past year. In 3 cases, the author first used pipe vise intubation, due to anatomical reasons, the use of the oral inconvenience, after the switch to cuff inflation method are successfully inserted into the tube. This method can also be used for transnasal blind intubation.