緊急気道確保：器具と外科的処置 (2)輪状甲状膜穿刺（切開）

緊急時の外科的気道確保としての輪状甲状膜穿刺・切開は種々の気道管理ガイドラインの最後の手段の一つである．手技自体は喀痰吸引などを目的に計画的に行う輪状甲状膜切開と同じであるが，施行する環境は大きく異なる．SpO2モニターが低音調で頻脈，不整脈，あるいは徐脈を告げ，アラーム音が鳴り響く中での手技である．時間的余裕はなく，数分で心停止となる．このような状況下での緊急輪状甲状膜切開はやはり手技自体の成功率が下がる．そのため換気不可能となった場合は人員を集め，生理学的状態を考えながら換気不可能に対処するタスクチームを編成する必要がある．確実な輪状甲状膜切開と同様に，二人法のマスク換気，薬剤の投与，除細...

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Published in日本臨床麻酔学会誌 Vol. 34; no. 4; pp. 613 - 621
Main Author 野村, 岳志
Format Journal Article
LanguageJapanese
Published 日本臨床麻酔学会 2014
Subjects
タスクチーム
無呼吸許容時間
緊急輪状甲状膜穿刺・切開
Online AccessGet full text
ISSN0285-4945
1349-9149
DOI10.2199/jjsca.34.613

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Abstract 緊急時の外科的気道確保としての輪状甲状膜穿刺・切開は種々の気道管理ガイドラインの最後の手段の一つである．手技自体は喀痰吸引などを目的に計画的に行う輪状甲状膜切開と同じであるが，施行する環境は大きく異なる．SpO2モニターが低音調で頻脈，不整脈，あるいは徐脈を告げ，アラーム音が鳴り響く中での手技である．時間的余裕はなく，数分で心停止となる．このような状況下での緊急輪状甲状膜切開はやはり手技自体の成功率が下がる．そのため換気不可能となった場合は人員を集め，生理学的状態を考えながら換気不可能に対処するタスクチームを編成する必要がある．確実な輪状甲状膜切開と同様に，二人法のマスク換気，薬剤の投与，除細動器・救急カートの準備，確実な記録記載などを行うことも重要で，タスクチームとしての対処が患者の生命予後を左右する．
AbstractList 緊急時の外科的気道確保としての輪状甲状膜穿刺・切開は種々の気道管理ガイドラインの最後の手段の一つである．手技自体は喀痰吸引などを目的に計画的に行う輪状甲状膜切開と同じであるが，施行する環境は大きく異なる．SpO2モニターが低音調で頻脈，不整脈，あるいは徐脈を告げ，アラーム音が鳴り響く中での手技である．時間的余裕はなく，数分で心停止となる．このような状況下での緊急輪状甲状膜切開はやはり手技自体の成功率が下がる．そのため換気不可能となった場合は人員を集め，生理学的状態を考えながら換気不可能に対処するタスクチームを編成する必要がある．確実な輪状甲状膜切開と同様に，二人法のマスク換気，薬剤の投与，除細動器・救急カートの準備，確実な記録記載などを行うことも重要で，タスクチームとしての対処が患者の生命予後を左右する．
Author 野村, 岳志
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References 16) Prithishkumar IJ, David SS: Morphometric analysis and clinilcal application of the working dimensions of cricothyroid membrane in south Indian adults: with special relevance to surgical cricothyroidotomy. Emerg Med Australas 22: 13-20, 2010
5) 野村岳志：侵襲的気道確保─輪状甲状膜穿刺・切開．Anet 9：15-18，2005
10) Granholm T, Farmer DL: The surgical airway. Respir Care Clin N Am 7: 13-23, 2001
2) Long N, Ng S, Donnelly G, et al.: Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography. Int J Obstet Anesth 23: 29-34, 2014
11) Esses BA, Jafek BW: Cricothyroidotomy: a decade of experience in Denver. Ann Otol Rhinol Laryngol 96: 519-524, 1987
8) Hsiao J, Pacheco-Fowler V: Videos in clinical medicine. Cricothyroidotomy. N Engl J Med 358: e25, 2008
9) Sise MJ, Shackford SR, Cruickshank JC, et al.: Cricothyroidotomy for long-term tracheal access. A prospective analysis of morbidity and mortality in 76 patients. Ann Surg 200: 13-17, 1984
17) Wong DT, Prabhu AJ, Coloma M, et al.: What is the minimum training required for successful cricothyroidotomy?: a study in mannequins. Anesthesiology 98: 349-353, 2003
14) Dimitriadis JC, Paoloni R: Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 63: 1204-1208, 2008
6) Tanoubi I, Drolet P, Donati F: Optimizing preoxygenation in adults. Can J Anaesth 56: 449-466, 2009
12) Gillespie MB, Eisele DW: Outcomes of emergency surgical airway procedures in a hospital-wide setting. Laryngoscope 109: 1766-1769, 1999
13) Jaquet Y, Monnier P, Van Melle G, et al.: Complications of different ventilation strategies in endoscopic laryngeal surgery: a 10-year review. Anesthesiology 104: 52-59, 2006
3) Goumas P, Kokkinis K, Petrocheilos J, et al.: Cricothyroidotomy and the anatomy of the cricothyroid space. An autopsy study. J Laryngol Otol 111: 354-356, 1997
15) Vadodaria BS, Gandhi SD, Mclndoe AK: Comparison of four different emergency airway access equipment sets on a human patient simulator. Anaesthesia 59: 73-79, 2004
1) Apfelbaum JL, Hagberg CA, Caplan RA, et al.: Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118: 251-270, 2013
7) Henderson JJ, Popat MT, Latto IP, et al.: Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59: 675-694, 2004
4) Shono A, Nomura T, Mihara T, et al.: The ultrasound scanning of the anterior neck for percutaneous dilational tracheostomy (PDT): possibility of routine use of ultrasound for PDT. Intensive Care Med 33 (Suppl 2): S86, 2007
References_xml – reference: 6) Tanoubi I, Drolet P, Donati F: Optimizing preoxygenation in adults. Can J Anaesth 56: 449-466, 2009
– reference: 13) Jaquet Y, Monnier P, Van Melle G, et al.: Complications of different ventilation strategies in endoscopic laryngeal surgery: a 10-year review. Anesthesiology 104: 52-59, 2006
– reference: 7) Henderson JJ, Popat MT, Latto IP, et al.: Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59: 675-694, 2004
– reference: 15) Vadodaria BS, Gandhi SD, Mclndoe AK: Comparison of four different emergency airway access equipment sets on a human patient simulator. Anaesthesia 59: 73-79, 2004
– reference: 16) Prithishkumar IJ, David SS: Morphometric analysis and clinilcal application of the working dimensions of cricothyroid membrane in south Indian adults: with special relevance to surgical cricothyroidotomy. Emerg Med Australas 22: 13-20, 2010
– reference: 5) 野村岳志：侵襲的気道確保─輪状甲状膜穿刺・切開．Anet 9：15-18，2005
– reference: 11) Esses BA, Jafek BW: Cricothyroidotomy: a decade of experience in Denver. Ann Otol Rhinol Laryngol 96: 519-524, 1987
– reference: 9) Sise MJ, Shackford SR, Cruickshank JC, et al.: Cricothyroidotomy for long-term tracheal access. A prospective analysis of morbidity and mortality in 76 patients. Ann Surg 200: 13-17, 1984
– reference: 10) Granholm T, Farmer DL: The surgical airway. Respir Care Clin N Am 7: 13-23, 2001
– reference: 1) Apfelbaum JL, Hagberg CA, Caplan RA, et al.: Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118: 251-270, 2013
– reference: 4) Shono A, Nomura T, Mihara T, et al.: The ultrasound scanning of the anterior neck for percutaneous dilational tracheostomy (PDT): possibility of routine use of ultrasound for PDT. Intensive Care Med 33 (Suppl 2): S86, 2007
– reference: 3) Goumas P, Kokkinis K, Petrocheilos J, et al.: Cricothyroidotomy and the anatomy of the cricothyroid space. An autopsy study. J Laryngol Otol 111: 354-356, 1997
– reference: 8) Hsiao J, Pacheco-Fowler V: Videos in clinical medicine. Cricothyroidotomy. N Engl J Med 358: e25, 2008
– reference: 2) Long N, Ng S, Donnelly G, et al.: Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography. Int J Obstet Anesth 23: 29-34, 2014
– reference: 14) Dimitriadis JC, Paoloni R: Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 63: 1204-1208, 2008
– reference: 12) Gillespie MB, Eisele DW: Outcomes of emergency surgical airway procedures in a hospital-wide setting. Laryngoscope 109: 1766-1769, 1999
– reference: 17) Wong DT, Prabhu AJ, Coloma M, et al.: What is the minimum training required for successful cricothyroidotomy?: a study in mannequins. Anesthesiology 98: 349-353, 2003
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無呼吸許容時間
緊急輪状甲状膜穿刺・切開
Title 緊急気道確保：器具と外科的処置 (2)輪状甲状膜穿刺（切開）
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