喉罩的使用麻醉（英文）课件

1、喉罩的使用麻醉（英文）Using the Laryngeal Mask AirwayNorman L. Goody, MD喉罩的使用麻醉（英文）ObjectiveuUsing the LMAuLMA and the Difficult AirwayuLMA and Pediatric AnesthesiauLMA and OB AnesthesiauAdvantages of Using the LMAuDisadvantages of the LMAuComplications Arising from Use of the LMA uContraindications to Using t

2、he LMA喉罩的使用麻醉（英文）History of the LMAdevelopment began in 1981 at Royal London Hospital by Dr. Archie Brainmodification of the Goldman Dental Maskavailable commercially in UK since 1988 and in the US since 1992now used in 50% of general anesthetics in some centers in UK (and probably US, too- especial

3、ly ambulatory surgery)喉罩的使用麻醉（英文）Characteristics of the LMAuLatex free, medical-grade siliconeuAperture barsuSizes#1 6.5 kg 2-5 ml#2 6.5-25 kg 7-10 ml #2 1/2 20-30 kg 14 ml#3 25-70 kg 15-20ml#4 70+ kg 25-30ml喉罩的使用麻醉（英文）Using the LMAuPreparation of the LMA Check patency of cuff Lubricate POSTERIOR su

4、rface only Surgilube v. lidocaine jellyuInductionuInsertion of the LMA Common Problems Cricoid PressureuSecuring the LMA喉罩的使用麻醉（英文）Using the LMAuMaintenance of AnesthesiauRemoval of the LMAuCleaning, Sterilization and Re-use喉罩的使用麻醉（英文）Determining Life Span of LMAuintended for 40-50 uses, but highly

5、over-manufactured tube remains translucent aperture bars remain intact cuff deflates correctly no valve leakage cuff remains symmetric pilot balloon retains shape connector remains tight/ not broken喉罩的使用麻醉（英文）THE LMA IS NOT DISPOSABLE喉罩的使用麻醉（英文）LMA and the Difficult AirwayuAwake IntubationuDifficult

6、 MASK AirwayuBlind IntubationuFailed IntubationuFiberoptic Bronchoscopy and the LMAuEmergent Intubation by an Unskilled Provider喉罩的使用麻醉（英文）LMA and Pediatric AnesthesiauDL&Butracheal stenosisudifficult airway喉罩的使用麻醉（英文）Accuracy of End-tidal CO2 in Pediatrics using LMA22 children, mechanically ven

7、tilated to a stable ETCO2ventilation via the LMA mean ETCO2 and PaCO2 obtained were 37.7 +/- 3.3 and 41.9 +/- 9.09, respectivelyventilation via ETTmean ETCO2 and PaCO2 obtained were 35.2 +/- 2.9 and 39.2 +/- 5.25, respectivelyLMA ETCO2 is as accurate an indicator of PaCO2 as when ventilated via ETTA

8、nesth Analg Feb;82 (2) :247-50喉罩的使用麻醉（英文）LMA and OB AnesthesiaQuestionnaire to 250 anesthesiologists in the UKLMA was available in 91.4% of obstetric units72% were in favor of using LMA for failed intubation with inadequate ventilation via face mask24 had experience with LMA in such a situation, 8 o

9、f which stated that LMA had proved to be a “lifesaver”Authors believed that we should use LMA before cricothyroidotomy for failed intubation/ventilationCan J Anaesth Gataure, et al. 1995 Feb;42(2):130-3喉罩的使用麻醉（英文）Advantages of Using the LMAMeta-analysis comparing advantages of the LMA over the trach

10、eal tube or face maskReviewed 858 LMA publications identified to December 1994, of which 52 met criteria for analysis32 different issues were testedCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23喉罩的使用麻醉（英文）Advantages of LMA over ETTuincreased speed and ease of placement by inexperienced personnelui

11、ncreased speed of placement by anesthetistsuimproved hemodynamic stability at induction and during emergenceuminimal increase in intraocular pressure following insertionCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23喉罩的使用麻醉（英文）Advantages of LMA over ETTureduced anesthetic requirements for airway to

12、leranceulower frequency of coughing during emergenceuimproved oxygen saturation during emergenceulower incidence of sore throats in adultsCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23喉罩的使用麻醉（英文）Advantages of LMA over Face Maskueasier placement by inexperienced personneluimproved oxygen saturation

13、uless hand fatigueuimproved operating conditions during minor pediatric otological surgeryCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23喉罩的使用麻醉（英文）Additional Advantages of Using the LMAuleaves providers hands freeupatient can produce effective coughuallows spontaneous ventilationueven malpositione

14、d can adequately ventilate喉罩的使用麻醉（英文）Disadvantages of LMA over the ETTulower seal pressureuhigher frequency of gastric insufflationCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23喉罩的使用麻醉（英文）Disadvantages of LMA over the FMuesophageal reflux more likelyCan J Anaesth Brimacombe 1995 Nov;42(11):1017-23

15、喉罩的使用麻醉（英文）Contraindications to Using the LMAuFull Stomach Non-fasted 34+ week pregnant trauma acute abdomen thoracic injury opiate premedication autonomic neuropathy patient unable to follow instructions any condition known to delay gastric emptying喉罩的使用麻醉（英文）Contraindications to Using the LMAuFull

16、 StomachuPatients with a history of GE reflux喉罩的使用麻醉（英文）Contraindications to Using the LMAuFull StomachuPatients with a history of GE refluxuPatients with low pulmonary compliance needing positive pressure ventilation喉罩的使用麻醉（英文）Complications Arising from Use of the LMAuAspiration喉罩的使用麻醉（英文）Passive R

17、egurgitation and the LMAStudy looked at gastric regurgitation during GA in different positions with the LMA15 minutes before induction, patients swallowed a 75 mg methylene blue capsule.supine, Trendelenburg and lithotomy positionspost-op, LMA and oropharynx were inspected for bluish discolorationNo

18、 blue dye was detected in the supine group but it was observed in one patient in each of the other two groupsAnaesthesia Strong, et al. 1995 Dec;50(12):1053-5喉罩的使用麻醉（英文）Passive Regurgitation: LMA v. ETTStudy at UT Dallas comparing incidence of reflux for spontaneously breathing anesthetized patients

19、 with either an ETT or LMA by continuous measurement of hypopharyngeal pH“Continuous monitoring.failed to detect evidence of pharyngeal regurgitation.”Anesth Anal Joshi, et al. 1996 Feb;82(2):254-7喉罩的使用麻醉（英文）Complications Arising from Use of the LMAuAspirationuCoughing喉罩的使用麻醉（英文）ComplicationsInciden

20、ce of airway complications following GA using either ETT or LMA Significantly greater incidence of coughing PRIOR to extubation, AT extubation and AFTER extubation in the ETT group than in the LMA groupNo airway complications were seen in either groupJR Soc Med Denny, et al. 1993 Sep;86(9):521-2喉罩的使

21、用麻醉（英文）Complications Arising from Use of the LMAuAspirationuCoughinguSore Throat喉罩的使用麻醉（英文）Sore Throatincidence of sore throat looked at in 327 patients who had GAmild/moderate soreness 7% of patients with LMA 10% who had FM and oral airway 47% of had ETT24 hours later, 3% of intubated group still c/o seve