当前位置： SCI文献检索 > ANESTHESIA AND ANALGESIA期刊下所有文献 > Gastric tubes and airway management in patients at risk of aspiration: history, current concepts, and proposal of an algorithm.

Gastric tubes and airway management in patients at risk of aspiration: history, current concepts, and proposal of an algorithm.

Abstract：

:Rapid sequence induction and intubation (RSII) and awake tracheal intubation are commonly used anesthetic techniques in patients at risk of pulmonary aspiration of gastric or esophageal contents. Some of these patients may have a gastric tube (GT) placed preoperatively. Currently, there are no guidelines regarding which patient should have a GT placed before anesthetic induction. Furthermore, clinicians are not in agreement as to whether to keep a GT in situ, or to partially or completely withdraw it before anesthetic induction. In this review we provide a historical perspective of the use of GTs during anesthetic induction in patients at risk of pulmonary aspiration. Before the introduction of cricoid pressure (CP) in 1961, various techniques were used including RSII combined with a head-up tilt. Sellick initially recommended the withdrawal of the GT before anesthetic induction. He hypothesized that a GT increases the risk of regurgitation and interferes with the compression of the upper esophagus during CP. He later modified his view and emphasized the safety of CP in the presence of a GT. Despite subsequent studies supporting the effectiveness of CP in occluding the esophagus around a GT, Sellick's early view has been perpetuated by investigators who recommend partial or complete withdrawal of the GT. On the basis of available information, we have formulated an algorithm for airway management in patients at risk of aspiration of gastric or esophageal contents. The approach in an individual patient depends on: the procedure; type and severity of the underlying pathology; state of consciousness; likelihood of difficult airway; whether or not the GT is in place; contraindications to the use of RSII or CP. The algorithm calls for the preanesthetic use of a large-bore GT to remove undigested food particles and awake intubation in patients with achalasia, and emptying the pouch by external pressure and avoidance of a GT in patients with Zenker diverticulum. It also stipulates that in patients with gastric distension without predictable airway difficulties, a clinical and imaging assessment will determine the need for a GT and in severe cases an attempt to insert a GT should be made. In the latter cases, the success of placement will indicate whether to use RSII or awake intubation. The GT should not be withdrawn and should be connected to suction during induction. Airway management and the use of GTs in the surgical correction of certain gastrointestinal anomalies in infants and children are discussed.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Salem MR,Khorasani A,Saatee S,Crystal GJ,El-Orbany M

doi

10.1213/ANE.0b013e3182917f11

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

569-79

issue

eissn

0003-2999

issn

1526-7598

pii

ANE.0b013e3182917f11

journal_volume

118

pub_type

杂志文章,评审

在线工具

Gastric tubes and airway management in patients at risk of aspiration: history, current concepts, and proposal of an algorithm.