緊急（CICV時）の外科的気道確保─麻酔科医の立場から
気管挿管もマスク換気も不可能ないわゆるcannot intubate，cannot ventilate（以下，CICV）の場合，最終的には外科的気道確保の適応となる．その頻度は低いものの，日々気道確保に従事する麻酔科医が習熟しておくべき手技といえる．特に緊急の際に有用な輪状甲状膜穿刺・切開は重要である．輪状甲状膜経由でのアプローチ法には外科的手法と経皮的手法がある．また経皮的手法には直接穿刺法とセルジンガー法があるが，手術麻酔に専念する麻酔科医が輪状甲状膜穿刺・切開を学習，実施する機会は多くはない．今後CICVに備えたシミュレーショントレーニングや臨床研修のあり方を模索し，実践していく必要があ...
Saved in:
| Published in | 日本臨床麻酔学会誌 Vol. 30; no. 4; pp. 593 - 602 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2010
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.30.593 |
Cover
| Abstract | 気管挿管もマスク換気も不可能ないわゆるcannot intubate，cannot ventilate（以下，CICV）の場合，最終的には外科的気道確保の適応となる．その頻度は低いものの，日々気道確保に従事する麻酔科医が習熟しておくべき手技といえる．特に緊急の際に有用な輪状甲状膜穿刺・切開は重要である．輪状甲状膜経由でのアプローチ法には外科的手法と経皮的手法がある．また経皮的手法には直接穿刺法とセルジンガー法があるが，手術麻酔に専念する麻酔科医が輪状甲状膜穿刺・切開を学習，実施する機会は多くはない．今後CICVに備えたシミュレーショントレーニングや臨床研修のあり方を模索し，実践していく必要がある． |
|---|---|
| AbstractList | 気管挿管もマスク換気も不可能ないわゆるcannot intubate，cannot ventilate（以下，CICV）の場合，最終的には外科的気道確保の適応となる．その頻度は低いものの，日々気道確保に従事する麻酔科医が習熟しておくべき手技といえる．特に緊急の際に有用な輪状甲状膜穿刺・切開は重要である．輪状甲状膜経由でのアプローチ法には外科的手法と経皮的手法がある．また経皮的手法には直接穿刺法とセルジンガー法があるが，手術麻酔に専念する麻酔科医が輪状甲状膜穿刺・切開を学習，実施する機会は多くはない．今後CICVに備えたシミュレーショントレーニングや臨床研修のあり方を模索し，実践していく必要がある． |
| Author | 内野, 哲哉 |
| Author_xml | – sequence: 1 fullname: 内野, 哲哉 organization: 大分大学医学部麻酔科学講座 |
| BookMark | eNo9kE9LAkEYxocwyMxbX2NtZmfG3fcoS38EoYt0XV5nx3Ixi10v3VQKMrtEUhQEEUWHIDoEgQp9l2x38eRXSDK6PM_h9_Acfssk1ThoaEJWGc2ZDGDN90OFOU5zEvgCSTMuwAAmIEXS1LSlIUDIJZINw1qFUgmU2XmZJsXk4yxuPU1Hp07R2YlvOtNRd9x-jR6vkueL5PY4fruetC-Th8H3591XvzUZDCcn_RmKzoezWfLSi-7fx-3euNNdIYtVrIc6-9cZUt5YLztbRml7s-gUSobPbIZGXmKego1SCwuU8iQDUbUE85TwEISlNeMVZVJtUYXMtAVKZLZgmnoauMczpDC_9cMm7mr3MKjtY3DkYtCsqbp2fzW4nLpiHjMb_0ztYeD6yH8AA6hzQg |
| ContentType | Journal Article |
| Copyright | 2010 日本臨床麻酔学会 |
| Copyright_xml | – notice: 2010 日本臨床麻酔学会 |
| DOI | 10.2199/jjsca.30.593 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 1349-9149 |
| EndPage | 602 |
| ExternalDocumentID | article_jjsca_30_4_30_4_593_article_char_ja |
| GroupedDBID | 123 ALMA_UNASSIGNED_HOLDINGS CS3 DIK JSF KQ8 MOJWN OK1 RJT |
| ID | FETCH-LOGICAL-j181a-65a6098a5e479ccd5194f741dc4da947ee13bc20e70ca1284a5a1841e0de93d3 |
| ISSN | 0285-4945 |
| IngestDate | Wed Sep 03 06:22:32 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 4 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j181a-65a6098a5e479ccd5194f741dc4da947ee13bc20e70ca1284a5a1841e0de93d3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jjsca/30/4/30_4_593/_article/-char/ja |
| PageCount | 10 |
| ParticipantIDs | jstage_primary_article_jjsca_30_4_30_4_593_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2010 |
| PublicationDateYYYYMMDD | 2010-01-01 |
| PublicationDate_xml | – year: 2010 text: 2010 |
| PublicationDecade | 2010 |
| PublicationTitle | 日本臨床麻酔学会誌 |
| PublicationTitleAlternate | 日臨麻会誌 |
| PublicationYear | 2010 |
| Publisher | 日本臨床麻酔学会 |
| Publisher_xml | – name: 日本臨床麻酔学会 |
| References | 13) Mori M, Kira S, Noguchi T: Tracheal tube position during percutaneous tracheostomy. Anaesth Intensive Care 36: 911, 2008 7) 森正和：外科的気道確保，麻酔科学レクチャー1（1） 麻酔の現況と展望─研修医と指導医のための質問317─．「麻酔科学レクチャー」編集委員会編．総合医学社，東京，2009，78-84 6) Hayden SR, Panacek EA: Procedural competency in emergency medicine: the current range of resident experience. Acad Emerg Med 6: 728-735, 1999 2) Henderson JJ, Popat MT, Latto IP, et al.: Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59: 675-694, 2004 14) ネオパーク添付文書．2009年3月19日改訂（第7版）．タイコヘルスケアジャパン株式会社 11) 平野隆，上村尚樹，渡辺哲生ほか：気道確保における経皮的気管切開術と外科的気管切開術の比較検討～耳鼻咽喉科医の観点から～．日気食会報 58：472-477，2007 23) Eisenburger P, Laczika K, List M, et al.: Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians. Anesthesiology 92: 687-690, 2000 18) Bourreli B, Bigot A, Wesoluch M, et al.: Pneumomediastinum and subcutaneous emphysema after translaryngeal jet ventilation. Ann Fr Anesth Reanim 3: 377-379, 1984 17) Mammel MC, Ophoven JP, Lewallen PK, et al.: High-frequency ventilation and tracheal injuries. Pediatrics 77: 608-613, 1986 22) Chan TC, Vilke GM, Bramwell KJ, et al.: Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med 17: 957-962, 1999 26) Salah N, El Saigh I, Hayes N, et al.: Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites. Anesth Analg 109: 1901-1907, 2009 21) Fikkers BG, van Vugt S, van der Hoeven JG, et al.: Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques. Anaesthesia 59: 1008-1011, 2004 12) Kollig E, Heydenreich U, Roetman B, et al.: Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU. Injury 31: 663-668, 2000 5) Randall G: Difficult airway: Cannot ventilate, cannot intubate, Complications in Anesthesia, 2nd ed. Edited by Atlee JL. Saunders Elsevier, Philadelphia, 2007, 159-173 20) Vadodaria BS, Gandhi SD, McIndoe AK: Comparison of four different emergency airway access equipment sets on a human patient simulator. Anaesthesia 59: 73-79, 2004 16) Rade B, Grenvik A, Lindholm CE: Surgical airway, cricothyroidotomy, and tracheostomy: procedures, complications, and outcome, Textbook of Critical Care, 3rd ed. Edited by Grenvik A, Ayres SM, Holbrook PR, et al. WB Saunders, Pennsillvania, 2000, 724-734 1) American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 98: 1269-1277, 2003 10) Mori M, Fujimoto J, Iwasaka H, et al.: Emergency percutaneous dilatational cricothyroidotomy after failed intubation. Anaesth Intensive Care 30: 101-102, 2002 27) Randell T, Kalli I, Lindgren L: Minitracheotomy: complications and follow-up with fiberoptic tracheoscopy. Anaesthesia 45: 875-879, 1990 19) 森正和：経皮的外科的気道確保，ここがポイント麻酔手技上達のコツ．岩崎寛，野口隆之，福田和彦編．南江堂，東京，2006，337-342 4) Nagaro T, Yorozuya T, Sotani M, et al.: Survey of patients whose lungs could not be ventilated and whose trachea could not be intubated in university hospitals in Japan. J Anesth 17: 232-240, 2003 28) Silk JM, Marsh AM: Pneumothorax caused by minitracheotomy. Anaesthesia 44: 663-664, 1989 25) Schaumann N, Lorenz V, Schellongowski P, et al.: Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers. Anesthesiology 102: 7-11, 2005 3) （社）日本麻酔科学会教育委員会：麻酔科医のための教育ガイドライン（改訂第2版）．（社）日本麻酔科学会，2008 24) Schober P, Hegemann MC, Schwarte LA, et al.: Emergency cricothyrotomy--a comparative study of different techniques in human cadavers. Resuscitation 80: 204-209, 2009 8) Holdgaard HO, Pedersen J, Jensen RH, et al.: Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. A clinical randomised study. Acta Anaesthesiol Scand 42: 545-550, 1998 9) Stoeckli SJ, Breitbach T, Schmid S: A clinical and histologic comparison of percutaneous dilational versus conventional surgical tracheostomy. Laryngoscope 107: 1643-1646, 1997 30) 中尾博之，上農喜朗，中川雅史ほか：豚を用いた輪状甲状膜切開法のトレーニング．日臨麻会誌 29：848-854，2009 15) ウルトラパーク添付文書．2008年9月24日（第1版）．スミスメディカル・ジャパン株式会社 29) Sulaiman L, Tighe SQ, Nelson RA: Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion. Anaesthesia 61: 565-570, 2006 |
| References_xml | – reference: 3) （社）日本麻酔科学会教育委員会：麻酔科医のための教育ガイドライン（改訂第2版）．（社）日本麻酔科学会，2008 – reference: 10) Mori M, Fujimoto J, Iwasaka H, et al.: Emergency percutaneous dilatational cricothyroidotomy after failed intubation. Anaesth Intensive Care 30: 101-102, 2002 – reference: 13) Mori M, Kira S, Noguchi T: Tracheal tube position during percutaneous tracheostomy. Anaesth Intensive Care 36: 911, 2008 – reference: 16) Rade B, Grenvik A, Lindholm CE: Surgical airway, cricothyroidotomy, and tracheostomy: procedures, complications, and outcome, Textbook of Critical Care, 3rd ed. Edited by Grenvik A, Ayres SM, Holbrook PR, et al. WB Saunders, Pennsillvania, 2000, 724-734 – reference: 15) ウルトラパーク添付文書．2008年9月24日（第1版）．スミスメディカル・ジャパン株式会社 – reference: 12) Kollig E, Heydenreich U, Roetman B, et al.: Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU. Injury 31: 663-668, 2000 – reference: 30) 中尾博之，上農喜朗，中川雅史ほか：豚を用いた輪状甲状膜切開法のトレーニング．日臨麻会誌 29：848-854，2009 – reference: 9) Stoeckli SJ, Breitbach T, Schmid S: A clinical and histologic comparison of percutaneous dilational versus conventional surgical tracheostomy. Laryngoscope 107: 1643-1646, 1997 – reference: 21) Fikkers BG, van Vugt S, van der Hoeven JG, et al.: Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques. Anaesthesia 59: 1008-1011, 2004 – reference: 14) ネオパーク添付文書．2009年3月19日改訂（第7版）．タイコヘルスケアジャパン株式会社 – reference: 23) Eisenburger P, Laczika K, List M, et al.: Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians. Anesthesiology 92: 687-690, 2000 – reference: 2) 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: 4) Nagaro T, Yorozuya T, Sotani M, et al.: Survey of patients whose lungs could not be ventilated and whose trachea could not be intubated in university hospitals in Japan. J Anesth 17: 232-240, 2003 – reference: 29) Sulaiman L, Tighe SQ, Nelson RA: Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion. Anaesthesia 61: 565-570, 2006 – reference: 18) Bourreli B, Bigot A, Wesoluch M, et al.: Pneumomediastinum and subcutaneous emphysema after translaryngeal jet ventilation. Ann Fr Anesth Reanim 3: 377-379, 1984 – reference: 5) Randall G: Difficult airway: Cannot ventilate, cannot intubate, Complications in Anesthesia, 2nd ed. Edited by Atlee JL. Saunders Elsevier, Philadelphia, 2007, 159-173 – reference: 19) 森正和：経皮的外科的気道確保，ここがポイント麻酔手技上達のコツ．岩崎寛，野口隆之，福田和彦編．南江堂，東京，2006，337-342 – reference: 28) Silk JM, Marsh AM: Pneumothorax caused by minitracheotomy. Anaesthesia 44: 663-664, 1989 – reference: 27) Randell T, Kalli I, Lindgren L: Minitracheotomy: complications and follow-up with fiberoptic tracheoscopy. Anaesthesia 45: 875-879, 1990 – reference: 7) 森正和：外科的気道確保，麻酔科学レクチャー1（1） 麻酔の現況と展望─研修医と指導医のための質問317─．「麻酔科学レクチャー」編集委員会編．総合医学社，東京，2009，78-84 – reference: 24) Schober P, Hegemann MC, Schwarte LA, et al.: Emergency cricothyrotomy--a comparative study of different techniques in human cadavers. Resuscitation 80: 204-209, 2009 – reference: 6) Hayden SR, Panacek EA: Procedural competency in emergency medicine: the current range of resident experience. Acad Emerg Med 6: 728-735, 1999 – reference: 25) Schaumann N, Lorenz V, Schellongowski P, et al.: Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers. Anesthesiology 102: 7-11, 2005 – reference: 22) Chan TC, Vilke GM, Bramwell KJ, et al.: Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med 17: 957-962, 1999 – reference: 8) Holdgaard HO, Pedersen J, Jensen RH, et al.: Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. A clinical randomised study. Acta Anaesthesiol Scand 42: 545-550, 1998 – reference: 1) American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 98: 1269-1277, 2003 – reference: 26) Salah N, El Saigh I, Hayes N, et al.: Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites. Anesth Analg 109: 1901-1907, 2009 – reference: 11) 平野隆，上村尚樹，渡辺哲生ほか：気道確保における経皮的気管切開術と外科的気管切開術の比較検討～耳鼻咽喉科医の観点から～．日気食会報 58：472-477，2007 – reference: 17) Mammel MC, Ophoven JP, Lewallen PK, et al.: High-frequency ventilation and tracheal injuries. Pediatrics 77: 608-613, 1986 – reference: 20) Vadodaria BS, Gandhi SD, McIndoe AK: Comparison of four different emergency airway access equipment sets on a human patient simulator. Anaesthesia 59: 73-79, 2004 |
| SSID | ssib005901865 ssib003115890 ssib002484396 ssib000961604 ssib058493879 ssj0036822 |
| Score | 1.8120481 |
| Snippet | 気管挿管もマスク換気も不可能ないわゆるcannot intubate，cannot ventilate（以下，CICV）の場合，最終的には外科的気道確保の適応となる．その頻度は低いものの，日々気... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 593 |
| SubjectTerms | CICV Difficult airway 外科的気道確保 輪状甲状膜穿刺・切開 |
| Title | 緊急（CICV時）の外科的気道確保─麻酔科医の立場から |
| URI | https://www.jstage.jst.go.jp/article/jjsca/30/4/30_4_593/_article/-char/ja |
| Volume | 30 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 日本臨床麻酔学会誌, 2010, Vol.30(4), pp.593-602 |
| journalDatabaseRights | – providerCode: PRVAFT databaseName: Open Access Digital Library customDbUrl: eissn: 1349-9149 dateEnd: 99991231 omitProxy: true ssIdentifier: ssj0036822 issn: 0285-4945 databaseCode: KQ8 dateStart: 19810101 isFulltext: true titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html providerName: Colorado Alliance of Research Libraries – providerCode: PRVBFR databaseName: Free Medical Journals - Free Access to All customDbUrl: eissn: 1349-9149 dateEnd: 99991231 omitProxy: true ssIdentifier: ssj0036822 issn: 0285-4945 databaseCode: DIK dateStart: 19810101 isFulltext: true titleUrlDefault: http://www.freemedicaljournals.com providerName: Flying Publisher |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3Na9VAEA-1XryIouI3PTjHPJPNbrLrLUlTWkFRqNJbyNcD36GKvl489RUFa72IRVEQRBQPgngQhLbg_2JtH-_Uf8GZ3bzXSD1Y9RKW2dndmUyS_e3uzMSyLqh2EfDSze3SLRlt3XA7dyrXZl7gZm2EHCygQOErV_3pG_zynJgbO3Ct4bW00M1bxf3fxpX8jVWRhnalKNl9WHbUKRKwjPbFK1oYr39kY0gCiAKQISQ-uSyEApIpiGKQMp6JbxJVKZBsSFWQeAgdIUwgERByUD51EQagXCqoECSnVpEDKoBEEbPyNA-DCIfhEE2BmiQXCcVpSORBehRpZkHE3Q4FyFhXjQbFqghkpEd3IOJ1lTQ8DMx_foZgWcsfaK2wEEMYQyJBIkVSDzguab5XAOx8EkJfSxuTUtgqRObRhrAWzSd2aoQ3ULuEEhWVjVhdqIWpt0Rqt1h6fP-XXI2PMJPC5sqkvGxVZpLwuMJJwqRaHc4i9enSreYWiZ4ShPkDZI0ufB1fvmfiwnmD8r52OveKrOU5rVGjX1KB1w9aqtlSz0m5uSB3OqyjYL20gyuGg4x2qMhN4XoDcCvfbWbjYVwiIvUbX3hXNCOjKTJZ7p6DI1pVnqRzXYN1PF-ac7rhXTKhJaTNxaYuCO86uNgZOkpq7DZ7xDpcL7omQiP8UWuskx2zZvpfH28vvt_ZeETvyvbLpZ2N5c3ep613z_sfnvZfPdj-_GLQe9Z_u_bj2-vvq4uDtfXBw1Ws2nqyjmz9jytbb75s9lY2l5aPW7NTyWw8bdc_FrE7CGgz2xeZ7yiZiQo_TkVR4iqGtxFalwUvM8WDqnK9vGBOFThFRgAuE5kruVs5ZaW80jthjc_fnq9OWhOiVEEpKSUSqxCKu7nri9JTPGfUkrNT1iWjeHrHJI9J92HD0__S-Ix1yDi60G7hWWu8e3ehOof4uZuf14_ET26-oyo |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E7%B7%8A%E6%80%A5%EF%BC%88CICV%E6%99%82%EF%BC%89%E3%81%AE%E5%A4%96%E7%A7%91%E7%9A%84%E6%B0%97%E9%81%93%E7%A2%BA%E4%BF%9D%E2%94%80%E9%BA%BB%E9%85%94%E7%A7%91%E5%8C%BB%E3%81%AE%E7%AB%8B%E5%A0%B4%E3%81%8B%E3%82%89&rft.jtitle=%E6%97%A5%E6%9C%AC%E8%87%A8%E5%BA%8A%E9%BA%BB%E9%85%94%E5%AD%A6%E4%BC%9A%E8%AA%8C&rft.au=%E5%86%85%E9%87%8E%2C+%E5%93%B2%E5%93%89&rft.date=2010&rft.pub=%E6%97%A5%E6%9C%AC%E8%87%A8%E5%BA%8A%E9%BA%BB%E9%85%94%E5%AD%A6%E4%BC%9A&rft.issn=0285-4945&rft.eissn=1349-9149&rft.volume=30&rft.issue=4&rft.spage=593&rft.epage=602&rft_id=info:doi/10.2199%2Fjjsca.30.593&rft.externalDocID=article_jjsca_30_4_30_4_593_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0285-4945&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0285-4945&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0285-4945&client=summon |