Atemwegsmanagement – Videoassistierte Verfahren

Zusammenfassung

Die endotracheale Intubation stellt innerklinisch den sogenannten ”Goldstandard“ zur Sicherung der Atemwege dar. Lassen sich Probleme bei der Intubation durch konventionelle Maßnahmen nicht bewältigen, oder ist eine schwierige Intubation a priori zu erwarten, ist der Einsatz videoassistierter Verfahren zu bevorzugen. Diese ermöglichen eine indirekte Sicht auf die laryngealen Strukturen, das erfasste Bild wird per fiberoptischer oder Kamera-Chip-Technik auf einen Monitor geleitet. Bei erwartet schwieriger Intubation stellt die endoskopisch geführte Wachintubation mit einer flexiblen Fiberoptik immer noch die Methode der Wahl dar. Unter der Maßgabe, dass eine sichere Oxygenierung über Maskenbeatmung oder Einsatz einer supraglottischen Beatmungshilfe zu gewährleisten ist, können alternativ auch ein Intubationsendoskop oder ein Videolaryngoskop eingesetzt werden. Bei Beherrschung des Algorithmus für den unerwartet schwierigen Atemweg können letztgenannte Hilfsmittel auch als Notfallalternative zum Einsatz kommen.

Abstract

Endotracheal intubation remains the ”goldstandard“ in airway management. If with use of conventional techniques intubation of the patient fails, or if an anticipated difficult airway is present, video-assisted techniques may help to increase intubation success. Video-assisted techniques give the possibility to indirectly visualise the laryngeal structures with fibreoptical or camerachip-technique, and to display the videopicture on an external or integrated monitor. For the anticipated difficult airway, awake flexible fibreoptical intubation still is the first choice. However, if Oxygenation and Ventilation can be established with bag-mask ventilation or supraglottic airways, the use of an endoscopic optical stylet or a videolaryngoscope may be alternatives. If the algorithm for the unanticipated difficult airway can be safely administered, the latter techniques may also be used as emergency intubation devices.

Schlüsselwörter:

schwieriger Atemweg - Intubation - Fiberoptik - starre Endoskopie - Videolaryngoskopie

Key words:

difficult airway - laryngoscopy - videolaryngoscopy - fiberoptic - intubation

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