清醒气管插管的药理学方法
Pharmacological approach to awake tracheal intubation.
摘要(中文译文)
本综述综合了关于清醒气管插管（ATI）药理策略的当前证据，该技术是应对预期困难气道的基石技术，尽管有指南推荐，但其应用仍然不足。目前已描述了30多种镇静方案，尚无单一方案显示出明显优势。右美托咪定显示出最完整的药理学特征，可提供抗焦虑、抗唾液分泌和咳嗽抑制效果，且呼吸抑制轻微。瑞芬太尼和瑞马唑仑等超短效药物可通过靶控输注实现精确滴定。联合方案可减少单个药物剂量及相关副作用。利多卡因仍是表面麻醉的金标准（最大剂量9 mg/kg瘦体重），各种给药途径在正确应用时显示出等效性。新兴证据支持视频喉镜作为特定病例中可弯曲支气管镜的替代方案。成功的ATI取决于充分的气道表面麻醉、维持自主呼吸的审慎镇静以及操作者专业技能。任何镇静方案均优于无镇静，但细致的剂量滴定和监测至关重要。标准化培训和机构方案对于优化安全性和提高使用率仍然至关重要。
Abstract
This review synthesizes current evidence on pharmacological strategies for awake tracheal intubation (ATI), a cornerstone technique for anticipated difficult airways that remains underutilized despite guideline recommendations. Over 30 sedation regimens have been described, with no single protocol demonstrating clear superiority. Dexmedetomidine shows the most complete pharmacological profile, providing anxiolysis, antisialagogue effects, and cough suppression with minimal respiratory depression. Ultra-short-acting agents such as remifentanil and remimazolam enable precise titration via target-controlled infusion. Combination regimens reduce individual drug dosing and associated side effects. Lidocaine remains the gold standard for topicalization (maximum 9 mg/kg lean body weight), with various administration routes showing equivalent efficacy when properly applied. Emerging evidence supports videolaryngoscopy as an alternative to flexible bronchoscopy for selected cases. Successful ATI depends on adequate airway topicalization, judicious sedation maintaining spontaneous ventilation, and operator expertise. Any sedation regimen proves superior to none, but meticulous dose titration and monitoring are essential. Standardized training and institutional protocols remain critical for optimizing safety and utilization.
如何引用
AMA
Daniele Salvatore Paternò, Luigi La Via, Emilia Concetta Lo Giudice, Massimiliano Sorbello. Pharmacological approach to awake tracheal intubation.. Current opinion in anaesthesiology. 2026; doi:10.1097/ACO.0000000000001670.
APA
Daniele Salvatore Paternò, Luigi La Via, Emilia Concetta Lo Giudice, Massimiliano Sorbello (2026). Pharmacological approach to awake tracheal intubation.. Current opinion in anaesthesiology. https://doi.org/10.1097/ACO.0000000000001670
GB/T 7714
Daniele Salvatore Paternò, Luigi La Via, Emilia Concetta Lo Giudice, Massimiliano Sorbello. Pharmacological approach to awake tracheal intubation.[J]. Current opinion in anaesthesiology, 2026 doi:10.1097/ACO.0000000000001670.
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