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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???Whatothergadgets

dowehave???Non-invasiveGlottisInvasiveFromBelowtheGlottis(Invasive)◆TranstrachealJetVentilation(TTJV)◆RetrogradeIntubation◆Percutaneousdi

lationaltrachealentry◆SurgicalAirwayFromAbovetheGlottis◆Laryngoscope±GumElasticBougie◆BlindOral/NasalIntuba

tion◆FiberopticBronchoscopy◆IntubatingLMA(Fastrach®)◆GlideScope®◆LightedStylet(Trachlight®)◆OpticalS

tyletEschmanntrachealtubeintroducer“GumElasticBougie”HistoryofGumElasticBougie◆TheEschmanntrachealtubeintroducer("gumelasticbougie")wa

smarketedintheUnitedKingdom(UK)intheearly1970s.◆Itdiffersfrompreviousintroducersinitsgreaterlength(60cm),angledtip,andthecombinationofflexibili

tyandmalleability.Anesthesiology:100(5)2019:1146-50“GEB“vsDifficultIntubation2019巴黎聖心堂LightedStylet(Lightwand)光棒HistoryofLightedStylet◆Thef

irstreporteduseofalightedstyletusedtofacilitateintubationcamein1957.◆Macintoshdescribedan18-inchilluminatedtrachealtubeintroducer,whichwasdesignedtos

tiffenthetubeandbetterilluminatethecordsbysupplementingthelightofthelaryngoscope.Anaesthesia1957;12:223–5HistoryofLightedStylet◆Yamamuraetal.describe

dalightbulb-tippedwirethatwasinsertedintothetrachealtubebeforeblindnasalintubationinawakepatients.Thetubepos

itionwasthendeterminedbythemedialtransilluminationoftheexternalthroatandneck.Anesthesiology1959;20:221HistoryofLighted

Stylet◆In1977,Fosterusedatransilluminatingfiberopticbundletofacilitatetrachealintubationinayoungchildwithtrismus.Anaesthesia1977;32:1038◆

DucrowusedaFlexi-lum™toachievethesameendbyfirstpassingaguideintothetracheafollowedbypassageofthetrachealtubeovertheguide.Anae

sthesia1978;33:827–9HistoryofLightedStylet◆RayburncommentedthattheFlexi-lum™(flexiblesurgicallight)c

ouldbepositionedinsidethetrachealtube,therebyshorteningtheintubationsequenceandclaimedthatthetechnique,nicknamed“lightwandintubation

.”Anaesthesia1979;34:677–8Trachlight®WandETTsizeSmall2.5#~4.0#Medium4.5#~5.5#Large6.0#~LightwandIntubation

◆Transilluminationofnecktissues◆Flexiblestyletcontainsadistallightbulb1.Jawliftedwithnon-dominanthand2.Observingthegl

owontheneckHelpfulManeuversforTrachlight◆Jawlift(Jawthrust)◆Hyperextensionoftheheadandneck◆Useofthethumbto

liftthetongue◆HavinganassistanttopullthetongueAnesthesiology2019;83:509-514IntubationwithTrachlight(I)IntubationwithTrachli

ght(II)AdvantagesofTrachlight◆Easytolearnanduse◆Lesstraumatic◆Suitableforpediatricpatients◆Mayuseinnasaltrachealintubation◆Mayuseinambientl

ightComplications◆Instrumentdisarticulation◆Traumatotheupperairway–bleeding–sorethroat–hoarseness–dysphagia◆ArytenoidcartilagedislocationInd

ications◆Difficultairway◆Unintubatablebydirectorfiberopticlaryngoscopy◆Neckmobilityislimitedorcontraindicated◆Prevent

ionofdentalinjuryContraindications◆Absolute–Upperairwayforeignbody,tumor,polyp,retropharyngealabscess.◆Relative–traumavictim

withlaryngealinjury–knowndifficultairwayEnvironmentforTrachlight◆Ambientlight--78.5%◆Dimmed--8.7%◆Dark--12.2%Anesthesiology2019;

83:509-514EffectofCricoidPressureonLightwandIntubation◆Timetosuccessfulintubationissignificantlyprolon

ged◆Thefailurerateforthefirstattemptis13%.Anesthesiology.94(2):259-262,2019IntubationwithTrachlight(I)Intub

ationwithTrachlight(II)IntubationwithTrachlight(III)HybridTechniques◆WithDirectLaryngoscopy◆Light-guidedNasalIntubatio

n◆WithLaryngealMaskAirway◆WithFiberopticScope◆AirwayIntroducer◆Light-guidedRetrogradeIntubationOpticalStylet可視光棒HistoryofOro

trachealIntubation◆Theearliestreportsofblindorotrachealintubation(BOI)inanaesthesiadatebackto1880.◆WilliamMacEwendescribedawakeBOIbyinternalpalp

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

xiblemetaltubeswhichweregenerallyintroducedintothetracheaunderdigitalcontrol.◆HesuggestedtheadvantageoususeofKirstein'sautoscope(aforerunnerofmo

dernlaryngoscopes)TechniquesforBOI1.Palpation2.Malleablestylet3.Dividedoropharyngealairway4.Williamsairwayintubato

r5.Lightwand6.LaryngealMaskAirway7.Endotroltubewithcapnography8.AugustineGuide9.Combitube10.Retrogradeintubation11.Fluo

roscopyAlternativeIntubationDevices◆Flexiblefiberopticbronchoscope(64%)◆Retrogradeintubationkit(45%)◆Lightedstylet(35%)◆Rigidfiberopticdevic

e(6%)–Bullard–Wu-scopeAnnalsofEmergencyMedicine.33(6):694-8,2019FlexibleFibreopticandIntubation◆In1967Murphyreportedsuccessfu

lnasalintubationusingaflexiblecholedochoscopeplacedthroughatrachealtube.Anaesthesia1967;22:489-91History

of“OpticalStylet”KatzandBercicoinedtheterm“OpticalStylet”in1979todescribeastraightrigidendoscopeusedasatrachealtubestyl

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