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`插管探条之临床应用陳昭良主任彰化基督教醫院麻醉科Whatabadluck!!!IfthisisaDifficultIntubationsituation.Whatareourback-upplans???Whatothergadgetsdowehave???Non-inva

siveGlottisInvasiveFromBelowtheGlottis(Invasive)◆TranstrachealJetVentilation(TTJV)◆RetrogradeIntubation◆Percutaneousdilationaltrachealentry◆SurgicalA

irwayFromAbovetheGlottis◆Laryngoscope±GumElasticBougie◆BlindOral/NasalIntubation◆FiberopticBronchoscopy◆IntubatingLMA(Fastrach®)◆GlideScope®◆

LightedStylet(Trachlight®)◆OpticalStyletEschmanntrachealtubeintroducer“GumElasticBougie”HistoryofGum

ElasticBougie◆TheEschmanntrachealtubeintroducer("gumelasticbougie")wasmarketedintheUnitedKingdom(UK)intheearly1970s.◆Itd

iffersfrompreviousintroducersinitsgreaterlength(60cm),angledtip,andthecombinationofflexibilityandmalleability.Anesthesiolog

y:100(5)2019:1146-50“GEB“vsDifficultIntubation2019巴黎聖心堂LightedStylet(Lightwand)光棒HistoryofLightedStylet◆Thefirstreporteduse

ofalightedstyletusedtofacilitateintubationcamein1957.◆Macintoshdescribedan18-inchilluminatedtrachealtubeintroducer,whichwasdesign

edtostiffenthetubeandbetterilluminatethecordsbysupplementingthelightofthelaryngoscope.Anaesthesia1957;12:223–5

HistoryofLightedStylet◆Yamamuraetal.describedalightbulb-tippedwirethatwasinsertedintothetrachealtubebeforeblindnasalintubationinawake

patients.Thetubepositionwasthendeterminedbythemedialtransilluminationoftheexternalthroatandneck.Anesthesiol

ogy1959;20:221HistoryofLightedStylet◆In1977,Fosterusedatransilluminatingfiberopticbundletofacilitatetrac

healintubationinayoungchildwithtrismus.Anaesthesia1977;32:1038◆DucrowusedaFlexi-lum™toachievethesameendbyfirstpassingaguideintothet

racheafollowedbypassageofthetrachealtubeovertheguide.Anaesthesia1978;33:827–9HistoryofLightedStylet◆RayburncommentedthattheFlexi-

lum™(flexiblesurgicallight)couldbepositionedinsidethetrachealtube,therebyshorteningtheintubationsequenceandclaime

dthatthetechnique,nicknamed“lightwandintubation.”Anaesthesia1979;34:677–8Trachlight®WandETTsizeSmall2.5#

~4.0#Medium4.5#~5.5#Large6.0#~LightwandIntubation◆Transilluminationofnecktissues◆Flexiblestyletcontainsadi

stallightbulb1.Jawliftedwithnon-dominanthand2.ObservingtheglowontheneckHelpfulManeuversforTrachlight◆Jawlift(Jawthrust)◆Hyperextensionoftheheadandn

eck◆Useofthethumbtoliftthetongue◆HavinganassistanttopullthetongueAnesthesiology2019;83:509-514IntubationwithTrachlight(I)Intubationwith

Trachlight(II)AdvantagesofTrachlight◆Easytolearnanduse◆Lesstraumatic◆Suitableforpediatricpatients◆Mayusein

nasaltrachealintubation◆MayuseinambientlightComplications◆Instrumentdisarticulation◆Traumatotheupperairway–bleedin

g–sorethroat–hoarseness–dysphagia◆ArytenoidcartilagedislocationIndications◆Difficultairway◆Unintubatablebydirector

fiberopticlaryngoscopy◆Neckmobilityislimitedorcontraindicated◆PreventionofdentalinjuryContraindications◆Absolute–Upperairway

foreignbody,tumor,polyp,retropharyngealabscess.◆Relative–traumavictimwithlaryngealinjury–knowndifficultairwa

yEnvironmentforTrachlight◆Ambientlight--78.5%◆Dimmed--8.7%◆Dark--12.2%Anesthesiology2019;83:509-514EffectofCricoidPressureonLightwandIntub

ation◆Timetosuccessfulintubationissignificantlyprolonged◆Thefailurerateforthefirstattemptis13%.Anesthesiology.94(2):259-262,2019Intubationw

ithTrachlight(I)IntubationwithTrachlight(II)IntubationwithTrachlight(III)HybridTechniques◆WithDirectLaryngoscopy◆Light-gu

idedNasalIntubation◆WithLaryngealMaskAirway◆WithFiberopticScope◆AirwayIntroducer◆Light-guidedRetrogradeIntubationOpticalStylet可視光棒HistoryofOr

otrachealIntubation◆Theearliestreportsofblindorotrachealintubation(BOI)inanaesthesiadatebackto1880.◆WilliamMacEwendescribedawakeBOIbyinternalpalpati

on.◆BrMedJ1880;2:122-4and163-5.HistoryofOrotrachealIntubation◆FranzKuhn(1866-1929)◆Herecommendedtheuseofflexiblemetaltubeswhichweregenerall

yintroducedintothetracheaunderdigitalcontrol.◆HesuggestedtheadvantageoususeofKirstein'sautoscope(aforerunnerofmodernla

ryngoscopes)TechniquesforBOI1.Palpation2.Malleablestylet3.Dividedoropharyngealairway4.Williamsairwayintubator5.Lightwand6.LaryngealMaskA

irway7.Endotroltubewithcapnography8.AugustineGuide9.Combitube10.Retrogradeintubation11.FluoroscopyAlternativeIntu

bationDevices◆Flexiblefiberopticbronchoscope(64%)◆Retrogradeintubationkit(45%)◆Lightedstylet(35%)◆Rigidfiberopticdevice(6%)–Bu

llard–Wu-scopeAnnalsofEmergencyMedicine.33(6):694-8,2019FlexibleFibreopticandIntubation◆In1967Murphyreportedsuccessfulnasalintub

ationusingaflexiblecholedochoscopeplacedthroughatrachealtube.Anaesthesia1967;22:489-91Historyof“OpticalSt

ylet”KatzandBercicoinedtheterm“OpticalStylet”in1979todescribeastraightrigidendoscopeusedasatrachealtube

styletduringintubation.Anesthesiology1979;51:251-4ShikaniOpticalStylet(S.O.S)