Anästhesiol Intensivmed Notfallmed Schmerzther 2006; 41(2): 93-118
DOI: 10.1055/s-2006-925031
Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Der schwierige Atemweg

Difficult Airway ManagementK.  Gerlach1 , V.  Dörges2 , T.  Uhlig3
  • 1 Klinik für Anästhesiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck (Direktor: Prof. Dr. med. P. Schmucker)
  • 2 Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel (Direktor: Prof. Dr. med. J. Scholz)
  • 3 Klinik für Anästhesiologie und Intensivmedizin, Dietrich Bonhoeffer Klinikum Neubrandenburg (Chefarzt: Priv.-Doz. Dr. phil. Dr. med. Th. Uhlig)
Further Information

Publication History

Publication Date:
22 February 2006 (online)

Weiterbildungsziele In diesem Beitrag sollen folgende Weiterbildungsziele vermittelt werden: Möglichkeiten und Grenzen der präoperativen Risikoeinschätzung Ausrüstung für das Atemwegsmanagement einschließlich der neueren supraglottischen Beatmungshilfen Vorgehen beim erwartet schwierigen Atemweg Management des unerwartet schwierigen Atemweges, einschließlich der „cannot intubate, cannot ventilate”-Situation Verstehen der strukturellen Voraussetzungen: Ausbildung, Training, Materialvorhaltung, Algorithmen Postoperatives Vorgehen

Literatur

  • 1 Benumof J L. Management of the difficult adult airway. With special emphasis on awake tracheal intubation.  Anesthesiology. 1991;  75 1087-1110
  • 2 Hagberg C. Handbook of difficult airway mangement. Churchill Livingstone 2000
  • 3 Manser T, Thiele K, Wehner T. Soziotechnische Systemanalyse im Krankenhaus - Eine arbeitspsychologische Fallstudie in der Anästhesie. In: E. Ulich (Hrsg) Arbeitspsychologie für Krankenhaus und Arztpraxis. Arbeitsbedingungen, Belastungen, Ressourcen. Schriften zur Arbeitspsychologie 61. Bern; Huber 2003: 361-380
  • 4 Manser T, Wehner T, Dieckmann P, Rall M. Gründe, Mühen und Chancen einer interdisziplinären Forschungskooperation zwischen Arbeitspsychologie und Anästhesie. In: Manser T (Hrsg) Komplexes Handeln in der Anästhesie. Lengerich; Pabst Science Publishers 2003: 25-45
  • 5 Stoelting R. Results of APSF survey regarding anesthesia patient safety issues. Anesthesia Patient Safety Foundation.  Newsletter. 1999;  13 6-7
  • 6 Eindhoven G B, Dercksen B, Regtien J G, Borg P AJ, Wierda J MKH. A practical clinical approach to management of the difficult airway.  Eur J Anaesthesiol. 2001;  18 (Suppl. 23) 60-65
  • 7 Stringer K R, Bajenov S, Yentis S M. Training in airway management.  Anaesthesia. 2002;  57 967-983
  • 8 Caplan R A, Benumof J L, Berry F A, Blitt C D, Bode R H, Cheney F W, Connis R T, Guidry O F, Ovapassian A. Practice guidelines for management of the difficult airway: A report by the American Society of Anesthesiologists Task Force on Management of the difficult airway.  Anesthesiology. 1993;  78 597-602
  • 9 Caplan R A, Benumof J L, Berry F A, Blitt C D, Bode R H, Cheney F W, Connis R T, Guidry O F, Nickinovich D G, Ovassapian A. Practice guidelines for management of the difficult airway (amended version) 2002.  http://www.asahq.org/PublicationsAndServices/
  • 10 Crosby E T, Cooper R M, Douglas M J, Doyle D J, Hung O R, Labrecque P, Muir H, Murphy M F, Preston R P, Rose D K, Roy L. The unanticipated difficult airway with recommendations for management.  Can J Anaesth. 1998;  45 757-776
  • 11 Boisson-Bertrand D, Bourgain J L, Camboulives J, Crinquette V, Cros A M, Dubreuil M, Eurin B, Haberer J P, Pottecher T, Thorin D, Ravussin P, Riou B. Intubation difficile. Société francaise d'anesthésie et de réanimation (Expertise collective).  Ann Fr Anesth Réanim. 1996;  15 207-214
  • 12 Frova G. The difficult intubation and the problem of monitoring the adult airway. Italian Society of Anesthesia, Resuscitation, and Intensive Therapy (SIAARTI).  Minerva Anestesiol. 1998;  64 361-371
  • 13 Braun U, Goldmann K, Hempel V, Krier C. Airway Management. Leitlinien der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin.  Anästh Intensivmed. 2004;  45 302-306
  • 14 Georgi R, Pothmann W, Krier C. Sicherung des schwierigen Atemweges. In: Kochs E, Krier C, Buzello W, Adams HA (Hrsg) Anästhesiologie. Stuttgart; Thieme 2001
  • 15 Samsoon G L, Young J R. Difficult tracheal intubation: a retrospective study.  Anaesthesia. 1987;  42 487-490
  • 16 Rocke D A, Murray W B, Rout C C, Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia.  Anesthesiology. 1992;  77 67-73
  • 17 Lyons G. Failed Intubation. Six years experience in a teaching maternity unit.  Anaesthesia. 1985;  40 759-762
  • 18 Holland R. Anaesthesia-related mortality in Australia.  Int Anaesthesiol Clin. 1984;  22 61-71
  • 19 Caplan R A, Posner K L, Ward R J, Cheney F W. Adverse respiratory events in anesthesia; a closed claims analysis.  Anesthesiology. 1990;  72 828-833
  • 20 Cheney F W, Posner K L, Caplan R A. Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis.  Anesthesiology. 1991;  75 932-939
  • 21 Currie M. A prospective survey of anesthetic critical events in a teaching hospital.  Anaesth Intensive Care. 1989;  17 403-411
  • 22 Adnet F, Borron S W, Racine S X, Clemessy J L, Fournier J L, Plaisance P, Lapandry C. The intubation difficulty scale (IDS). Proposal and evaluation of a new score characterizing the complexity of endotracheal intubation.  Anesthesiology. 1997;  87 1290-1297
  • 23 Janssens M, Lamy M. Quantification of intubation difficulty: comparison of subjective assessment of the anesthesiologist and the Intubation Difficulty Scale (IDS).  Eur J Anaesthesiol. 2000;  17 (Suppl. 35) A112
  • 24 Frerk C M, Till C B, Bradley A J. Difficult intubation: thyromental distance and the atlanto-occipital gap.  Anaesthesia. 1996;  51 738-740
  • 25 Savva D. Prediction of difficult tracheal intubation.  Br J Anaesth. 1994;  73 149-153
  • 26 Nath G, Sekar M. Predicting difficult intubation - a comprehensive scoring system.  Anaesth Intens Care. 1997;  25 482-486
  • 27 Tse J C, Rimm E B, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study.  Anesth Analg. 1995;  81 254-258
  • 28 Wilson M E, Spiegelhalter D, Robertson J A, Lesser P. Predicting difficult intubation.  Br J Anaesth. 1988;  61 211-216
  • 29 Mallampati S R, Gatt S P, Gugino L D, Desai S P, Waraksa B, Freiberger D, Liu P L. A clinical sign to predict difficult tracheal intubation: a prospective study.  Can Anaesth Soc J. 1985;  32 429-434
  • 30 Oates J D, MacLeod A D, Oates P D, Pearsall F J, Howie J C, Murray G D. Comparison of two methods for predicting difficult intubation.  Br J Anaesth. 1991;  66 305-309
  • 31 Randell T. Prediction of difficult intubation.  Acta Anaesthesiol Scand. 1996;  40 1016-1023
  • 32 Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, Duvaldestin P, Dhonneur G. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm.  Anesthesiology. 2004;  100 1146-1150
  • 33 Patil V, Stehling L, Zauder H. Fiberoptic endoscopy in anesthesia. Chicago, London; Year book medical publishers, Inc 1983
  • 34 Al Ramadhani S, Mohamed L A, Rocke D A, Gouws E. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia.  Br J Anaesth. 1996;  77 312-316
  • 35 Rose D K, Cohen M M. The airway: problems and predictions in 18.500 patients.  Can J Anaesth. 1994;  41 372-383
  • 36 Parmet J L, Colonna-Romano P, Horrow J C, Miller F, Gonzales J, Rosenberg H. The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation.  Anesth Analg. 1998;  87 661-665
  • 37 Mertzlufft F, Krier C. Präoxygenierung - ein Muss! Aber wie?.  Anästhesiol Intensivmed Notfallmed Schmerzther. 2001;  36 451-453
  • 38 Zander R, Mertzlufft F. Therapeutische Grenzwerte der akuten, arteriellen Hypoxie.  Anästhesiol Intensivmed Notfallmed Schmerzther. 1996;  31 372-374
  • 39 Zander R. Spezielle Physiologie der Atmung. In: Krier C, Georgi R, (Hrsg) Airway Management - Die Sicherung der Atemwege. Stuttgart; Thieme 2000: 50-55
  • 40 Heck Z, Stegmann J U, Lorenz C, Heck M, Schlack W. Akzeptanz der Präoxygenierung in der klinischen Routine.  Anästhesiol Intensivmed Notfallmed Schmerzther. 2001;  36 471-475
  • 41 Benumof J L. Preoxygenation: best method for both efficacy and efficiency.  Anesthesiology. 1999;  91 603-605
  • 42 Lawes E G, Baskett P J. Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation.  Intensive Care Med. 1987;  13 379-382
  • 43 Landsman I. Cricoid pressure: indications and complications.  Paediatr Anaesth. 2004;  14 43-47
  • 44 Benumof J L. Difficult laryngoscopy: obtaining the best view.  Can J Anaesth. 1994;  41 361-365
  • 45 Benumof J L, Cooper S D. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation.  J Clin Anest. 1996;  8 136-140
  • 46 Knill R L. Difficult laryngoscopy made easy with a „BURP”.  Can J Anaesth. 1993;  40 279-282
  • 47 Takahata O, Kubota M, Mamiya K, Akama Y, Nozaka T, Matsumoto H, Ogawa H. The efficacy of the „BURP” maneuver during a difficult laryngoscopy.  Anesth Analg. 1997;  84 419-421
  • 48 Miller R A. A new laryngoscope.  Anesthesiology. 1941;  2 318-320
  • 49 Henderson J J. The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation.  Anaesthesia. 1997;  52 552-560
  • 50 McCoy E P, Mirakhur R K, Rafferty C, Bunting H, Austin B A. A Comparison of the forces exerted during laryngoscopy. The Macintosh versus the McCoy blade.  Br J Anaesth. 1996;  51 912-915
  • 51 Gabbott D A. Laryngoscopy using the McCoy laryngoscope after application of a cervical collar.  Anaesthesia. 1996;  51 812-814
  • 52 Gerlach K, Wenzel V, Knobelsdorff G, Steinfath M, Dörges V. A new universal laryngoscope blade: a preliminary comparison with Macintosh laryngoscope blades.  Resuscitation. 2003;  57 63-67
  • 53 Lim T J, Lim Y, Liu E H. Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngosopy.  Anaesthesia. 2005;  60 180-183
  • 54 Ezri T, Szmuk P, Warters R D, Katz J, Hagberg C A. Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?.  J Clin Anesth. 2003;  15 418-422
  • 55 Bein B, Yan M, Tonner P H, Scholz J, Steinfath M, Dorges V. Tracheal intubation using the Bonfils intubation fibrescope after failed direct laryngoscopy.  Anaesthesia. 2004;  59 1207-1209
  • 56 Bein B, Worthmann F, Scholz J, Brinkmann F, Tonner P H, Steinfath M, Dorges V. A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways.  Anaesthesia. 2004;  59 668-674
  • 57 Combes X, Dumerat M, Dhonneur G. Emergency gum elastic bougie-assisted tracheal intubation in four patients with upper airway distortion.  Can J Anaesth. 2004;  51 1022-1024
  • 58 Baum J A, Sachs G, Stanke H G. Der unerwartet schwierige Atemweg - Ein Plädoyer für den Oxford-Non-Kinking-Tubus.  Anästhesiol Intensivmed Notfallmed Schmerther. 2004;  39 610-615
  • 59 Mort T C. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts.  Anesth Analg. 2004;  99 607-613
  • 60 Peterson G N, Domino K B, Caplan R A, Posner K L, Lee L A, Cheney F W. Management of the Difficult Airway - A Closed Claims Analysis.  Anesthesiology. 2005;  103 33-39
  • 61 Brain A I, McGhee T D, McAteer E J, Thomas A, Abu-Saad M A, Bushman J A. The laryngeal mask airway. Development and preliminary trials of a new type of airway.  Anaesthesia. 1985;  40 356-361
  • 62 Verghese C, Brimacombe J. Survey of laryngeal mask usage in 11 910 patients - safety and efficacy for conventional and nonconventional usage.  Anesth Analg. 1996;  82 129-133
  • 63 Brain A I. Three cases of difficult intubation overcome by the laryngeal mask airway.  Anaesthesia. 1985;  40 353-355
  • 64 Grayling M, Wilson I H, Thomas B. The use of the laryngeal mask airway and Combitube in cardiopulmonary resuscitation; a national survey.  Resuscitation. 2002;  52 183-186
  • 65 Deakin C D. Prehospital management of the traumatized airway.  Eur J Emerg Med. 1996;  3 233-243
  • 66 Brain A I, Verghese C, Addy E V, Kapila A. The intubating laryngeal mask I. Development of a new device for intubation of the trachea.  Br J Anaesth. 1997;  79 699-703
  • 67 Brain A I, Verghese C, Addy E V, Kapila A, Brimacombe J. The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea.  Br J Anaesth. 1997;  79 704-709
  • 68 Baskett P J, Parr M J, Nolan J P. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases.  Anaesthesia. 1998;  53 1174-1179
  • 69 Frass M, Frenzer R, Rauscha F, Weber H, Pacher R, Leithner C. Evaluation of the esophageal tracheal combitube in cardiopulmonary resuscitation.  Crit Care Med. 1987;  15 609-611
  • 70 Bozeman W P, Hexter D, Liang H K, Kelen G D. Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.  Ann Emerg Med. 1996;  27 595-599
  • 71 Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Adjuncts for Oxygenation, Ventilation and Airway Control.  Circulation. 2000;  102 I-95-104
  • 72 Bein B, Carstensen S, Gleim M, Claus L, Tonner P H, Steinfath M, Scholz J, Dörges V. A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures.  Eur J Anaesthesiol. 2005;  22 341-346
  • 73 Thierbach A R, Piepho T, Maybauer M O. A new device for emergency airway management: The EasyTube.  Resuscitation. 2004;  60 347
  • 74 Dörges V, Ocker H, Wenzel V, Schmucker P. The laryngeal tube: a new simple airway device.  Anesth Analg. 2000;  90 1220-1222
  • 75 Dorges V, Wenzel V, Neubert E, Schmucker P. Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube.  Crit Care. 2000;  4 369-376
  • 76 Asai T, Murao K, Shingu K. Efficacy of the laryngeal tube during intermittend positive-pressure ventilation.  Anaesthesia. 2000;  55 1099-1102
  • 77 Matioc A A, Olson J. Use of the laryngeal tube in two unexpected difficult airway situations: lingual tonsillar hyperplasia and morbid obesity.  Can J Anaesth. 2004;  51 1018-1021
  • 78 Ocker H, Wenzel V, Schmucker P, Steinfath M, Dörges V. A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures.  Anesth Analg. 2002;  95 1094-1097
  • 79 Asai T, Moriyama S, Nishita Y, Kawachi S. Use of the Laryngeal tube during cardiopulmonary resuscitation by paramedical staff.  Anaesthesia. 2003;  58 393-394
  • 80 Dörges V, Wenzel V, Schumann T, Neubert E, Ocker H, Gerlach K. Intubating laryngeal mask airway, laryngeal tube, 1100 ml self-inflating bag alternatives for basic life support?.  Resuscitation. 2001;  51 185-191
  • 81 Dörges V, Ocker H, Wenzel V, Steinfath M, Gerlach K. The Laryngeal Tube S. A modified simple airway device?.  Anesth Analg. 2003;  96 618-621
  • 82 Ravussin P, Freeman J. A new transtracheal catheter for ventilation and resuscitation.  Can Anaesth Soc J. 1985;  32 60-64
  • 83 Frei F J, Meier P Y, Lang F J, Fasel J H. Krikothyreotomie mit dem Quicktrach-Koniotomiebesteck.  Anaesth Intensivther Notfallmed. 1990;  25 (Suppl. 1) 44-49
  • 84 Enk D, Busse H, Meissner A, Van Aken H. A new device for oxygenation and drug administration by transtracheal jet ventilation.  Anesth Analg. 1998;  86 (2S) S203
  • 85 Eisenburger P, Laczika K, List M, Wilfing A, Losert H, Hofbauer R, Burgmann H, Bankl H, Pikula B, Benumof J L, Frass M. Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians.  Anesthesiology. 2000;  92 687-690
  • 86 Chan T C, Vilke G M, Bramwell K J, Davis D P, Hamilton R S, Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique.  J Emerg Med. 1999;  17 957-962
  • 87 Brofeldt B T, Panacek E A, Richards J R. An easy cricothyrotomy approach: the rapid four-step technique.  Acad Emerg Med. 1996;  3 1060-1063
  • 88 Parry K, Owen H. Small simulators for teaching procedural skills in a difficult airway algorithm.  Anaesth Intensive Care. 2004;  32 401-409
  • 89 Fletcher G C, McGeorge P, Flin R H, Glavin R J, Maran N J. The role of non-technical skills in anaesthesia: a review of current literature.  Br J Anaesth. 2002;  88 418-429
  • 90 Heidegger T, Gerig H J, Keller C. Vergleich von Algorithmen für das Management des schwierigen Atemweges.  Anästhesist. 2003;  52 381-392
  • 91 Engoren M. Evaluation of the cuff-leak test in a cardiac surgery population.  Chest. 1999;  116 1029-1031
  • 92 Miller K A, Harkin C P, Bailey P L. Postoperative Tracheal Extubation.  Anesth Analg. 1995;  80 149-172
  • 93 Hawkins J L, Koonin L M, Palmer S K, Gibbs C P. Anaesthesia-related deaths during obstetric delivery in the United States.  Anesthesiology. 1997;  86 277-284

Priv.-Doz. Dr. med. Klaus Gerlach, D.E.A.A.

Klinik für Anästhesiologie

Universitätsklinikum Schleswig-Holstein · Campus Lübeck · Ratzeburger Allee 160 · 23538 Lübeck

Email: klaus.gerlach@faehling.com

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