一般常見呼吸道插管評估因素的因子分析（ppt33）课件

The factor analyzing on predictors of tracheal intubation 一般常見呼吸道插管評估因素的因子分析 嘉義基督教醫院 麻醉科 吳玉雪 Airway Assessment and Evaluation nHistory elements and physical examination nVariable predictive methods and scores for 1. unanticipated difficult mask ventilation- (1) “OBESE” (Langeron et al): The Obese (body mass index 26 kg/m2)/ The Bearded / The Elderly (older than 55 y)/ The Snorers / The Edentulous (2) others: mandibular protrusion test; Sleep apnea; Thick/obese neck anatomy; Mallampati classification Airway Assessment and Evaluation nVariable predictive methods and scores 2. unanticipated difficult intubation- (1) the LEMON or the MELON scale: Look externally, Evaluate the 3-3-2 rule, Mallampati, Obstruction, Neck mobility (2) the LM MAP (Laryngeal Mask MAP) Rule : L = Look for External face Deformities; M = Mallampati; M = Measurements 3-3-2-1 OR 1-2-3-3 Fingers; A = A- O Extension (Atlanto- Occipital); P = Pathological obstructive Conditions, Edema / Glottic Trauma Airway Assessment and Evaluation (3) the 4 Ds : Dentition (prominent upper incisors, receding chin); Distortion (edema, blood, vomits, tumor, infection); Disproportion (short chin-to-larynx distance, bull neck, large tongue, small mouth); Dysmobility (TMJ and cervical spine) (4) the Wilson Risk Score: weight, head and neck movement, jaw movement, receding mandible, and buck teeth Airway Assessment and Evaluation (5) Arn model score : A 103:42937 n2. Sachin Kheterpal, Richard Han, Kevin K. Tremper, Amy Shanks, Alan R. Tait, Michael OReilly, Thomas A. Ludwig.: Incidence and Predictors of Difficult and Impossible Mask Ventilation. Anesthesiology 2006; 105:88591 n3. Mohamed Naguib, Franklin L. Scamman, Cormac OSullivan, John Aker, Alan F. Ross, Steven Kosmach, and Joe E. Ensor :Predictive Performance of Three Multivariate DifficultTracheal Intubation Models: A Double-Blind, Case- Controlled Study. ANESTH ANALG 2006;102:81824 n4. M. M. Ali Magboul : The Dilemma of Airway Assessment and Evaluation . The Internet Journal of Anesthesiology. 2005 Volume 10 Number 1 n5. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Tse JC - Anesth Analg - 01-AUG-1995; 81(2): 254-8 Reference n6. Ezri T, Medalion B, Weisenberg M, Szmuk P, Warters RD, Charuzi I:Increased body mass index per se is not a predictor of difficult laryngoscopy. Can J Anaesth 2003; 50:17983 n7. Gupta S, Pareek S, Dulara SC: Comparison of two methods for predicting difficult intubation in obstetric patients. Middle East J Anesthesiol 2003; 17: 27585 n8. Iohom G, Ronayne M, Cunningham AJ: Prediction of difficult tracheal intubation. Eur J Anaesthesiol 2003; 20:316 n9. Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL, Desmonts JM: Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97:595600 n10. Khan ZH, Kashfi A, Ebrahimkhani E: A comparison of the upper lip bite test (a simple new technique) with modified Mal