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Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(11/12): 656-663
DOI: 10.1055/s-0042-102798
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Wache Videolaryngoskopie

Eine Alternative zur Fiberoptik?Awake video laryngoscopy - an alternative to awake fiberoptic intubation?
Jana Lohse
1   Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
,
Rüdiger Noppens
2   Department of Anesthesia & Peri-operative Medicine, Western University, London, Ontario, Canada
› Author Affiliations
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Publication History

Publication Date:
24 November 2016 (online)

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Zusammenfassung

Einleitung: Derzeit rückt eine neue, faszinierende Technik als Alternative zur wachen flexiblen Intubationsendoskopie in den Fokus der klinischen Anästhesie: Wache Videolaryngoskopie.

Hauptthemen: Die Intubation unter Erhaltung der Spontanatmung ist das Verfahren mit dem geringsten Risiko für Patienten mit erwartet schwierigem Atemweg. Im direkten Vergleich zur wachen, flexiblen Intubationsendoskopie erreicht die wache Videolaryngoskopie akzeptable Intubationszeiten bei gleichzeitig hoher Akzeptanz durch Patient und Anästhesist. In speziellen Fällen, insbesondere bei stark limitierter Mundöffnung und einer veränderten Anatomie des Halses, hervorgerufen durch Strahlentherapie, chirurgische Eingriffe und große Tumormassen, ist die Durchführung einer wachen Videolaryngoskopie schwierig oder unmöglich. Obligatorisch für die Umsetzung einer erfolgreichen, wachen Videolaryngoskopie sind suffiziente topische Anästhesie und eine differenzierte Sedierung. Die Herausforderung hier ist die Balance zwischen dem Erhalt der Spontanatmung und dem Erreichen möglichst optimaler Intubationsbedingungen ohne den Verlust der Kontaktfähigkeit des Patienten.

Fazit: Wache Videolaryngoskopie kann die flexible Intubationsendoskopie nicht ersetzen. Nicht jeder Patient (und jeder Atemweg!) ist für eine wache Videolaryngoskopie geeignet. Eine sorgfältige Planung, die richtige Wahl des Spatels und genügend Expertise sind für den Erfolg einer wachen Videolaryngoskopie entscheidend.

Abstract

Introduction: Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.

Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Specific cases, in particular very limited mouth opening or sub-glottic masses, require awake flexible endoscopic intubation. Sufficient topical anesthesia and a sophisticated sedation protocol are prerequisites for successful awake video laryngoscopy.

Conclusion: Awake video laryngoscopy cannot fully replace flexible endoscopic intubation. It is a useful option, but it must be considered that this technique is not suitable for all types of airways, patients or even anesthesiologists. Expertise and adequate practice is mandatory for both techniques. Careful planning, an appropriate blade design and a high expertise in video laryngoscopy are crucial for a successful intubation.

Kernaussagen

  • Bei erwartet schwierigem Atemweg empfiehlt die S1-Leitlinie der DGAI die Atemwegssicherung unter Erhaltung der Spontanatmung um unerwünschten Ereignissen vorzubeugen.

  • Flexible endoskopische Intubation ist einfach zu erlernen. Die Erfolgsrate der endoskopischen Wachintubation liegt bei > 98 %.

  • Die flexible Intubationsendoskopie und die wache Videolaryngoskopie unterscheiden sich kaum bezüglich Intubationszeit, -erfolg und Schweregrad.

  • Für die wache Videolaryngoskopie ist eine suffiziente Anästhesie der Glottis, der Trachea und des Zungengrunds entscheidend.

  • Bei pathologischer Anatomie des Halses, z. B. bei großen, obstruktiven Tumoren, sollte der flexiblen endoskopischen Intubation der Vorzug gegeben werden.

Schlüsselwörter:

endoskopische Wachintubation - Videolaryngoskopie - flexible Intubationsendoskopie - schwieriger Atemweg - topische Anästhesie

Keywords:

awake endoscopic intubation - video laryngoscopy - flexible endoscopy - difficult arway management - topic anesthesia
 

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