 今日共读 2019困难气道指南（一） Summary ·Awake tracheal intubation 清醒插管 has a high success rate and a favourable safety profifile（成功率高，安全性好 ）but is underused不足 in cases of anticipated diffificult airway management可预料困难气道. ·These guidelines are a comprehensive document to support decisionmaking决策, preparation准备 and practical performance实际操作of awake tracheal intubation. ·We performed a systematic review系统性回顾 of the literature seeking all of the available evidence for each element of awake tracheal intubation inorder to make recommendations. ·In the absence of high-quality evidence, expert consensus and a Delphi studywere used to formulate recommendations. ·We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessfulawake tracheal intubation; post-tracheal intubation management; consent; and training.我们强调了清醒气管插管的关键领域，并提出了具体的建议，包括：指征；程序设置；清单；氧合；气道局麻；镇静；验证导管位置；并发症；清醒气管插管不成功的管理；气管插管后的管理；协议；和培训。 ·We recognise that there are a range of techniques and regimens that may be effective and one such example technique isincluded. ·Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation,oxygenation and performance might help practitioners to plan, perform and address complications. 将清醒气管插管的关键实用要素分解为镇静、局麻、供氧和可能有助于是实施者去计划、实施和处理并发症。 ·These guidelines aim to support clinical practice and help lower the threshold for performing awake trachealintubation when indicated. Recommendations 1 Awake tracheal intubation must be considered in the presence of predictors of diffiicult airway management.在有困难气道管理的预测因素的情况下，必须考虑清醒的气管插管。 2 A cognitive aid such as a checklist清单is recommended before and during performance of awake tracheal intubation. 3 Supplemental oxygen should always be administered during awake tracheal intubation.在清醒气管插管时，应始终给予补充氧。 4 Effective topicalisation有效的局麻 must be established and tested.The maximum dose of lidocaine should not exceed 9 mg.kg1 lean body weight. 5 Cautious use of minimal sedation can be beneficial. 谨慎使用最低限度的镇静是有益的。This should ideally be administered by an independentpractitioner. Sedation should not be used as a substitutefor inadequate airway topicalisation. 6 The number of attempts should be limited to three 限制尝试次数, withone further attempt by a more experienced operator(3 + 1). 7 Anaesthesia should only be induced after a two-point check双保险后给药 (visual confirmation and capnography) hasconfirmed correct tracheal tube position. 8 All departments should support anaesthetists所有手术室人员支持 to attain competency and maintain skills in awake trachealintubation. |
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