声门上通气道喉罩

声门上通气道喉罩,声门上通气道的概述喉罩临床使用中的问题喉罩并发症的防治,Summary applications of SLAs,SpontaneousVentilation,Positive Pressure Ventilation,Facemask,Laryngeal mask,Laryngeal tube,SLIPA, ProSeal,Combitube, SLT,Tracheal tube,i-Gel,分类（根据机制）,1st Generation (mechanism) Air inflation of shaped balloons Combitube (Base of Tongue) 1979 Laryngeal Mask (Perilaryngeal)19802nd GenerationWedge sealing mechanisms SLIPA airway (Base of Tongue) 2002iGel (Perilaryngeal) 2005,Copyright D M Miller,Scoring SGA performance,Only looking at the positive aspects,Combining all the best features,Single useHigh seal pressure and reliable sealMinimal or no risk of serious side effectsEasy insertion and simple to useOesophageal access and GI separationBlind intubation possibleMany aspiration prevention mechanismsSimple structure,喉罩临床使用中常见问题,麻醉诱导喉罩置入,影响喉罩的主要因素：张口度，咽喉反射喉罩置入时机的把握：下颌松弛麻醉诱导药物的选择：肌松剂的应用?喉罩置入手法的选择：充气？喉镜辅助？,麻醉维持,麻醉监测：喉罩对位及通气情况(呼气末CO2)通气模式的选择：自主呼吸 VS 机械通气，压力/容量控制，吸呼比，呼吸频率, PEEP麻醉深度的调控： 满足手术需求，耐受喉罩,麻醉苏醒喉罩拔除,喉罩拔除时机的选择： 麻醉 vs 清醒例：小儿平稳拔除喉罩时七氟烷半数有效浓度为1.49 %（0.6 MAC）。,喉罩并发症的防治,喉罩常见并发症,胃胀气 反流 误吸咽喉疼痛、吞咽困难声音嘶哑通气不足,Aspiration prevention,ObstructionCombitube, LT LMA, ProSeal, Supreme SLIPA, i-gelDrainage (Separation of GI & Resp. tracts)Combitube, LTSProSeal, Supreme i-gelStorageSLIPA 15x LMA, i-Gel; 3 x LT,Aspiration prevention,喉罩使用的适应症 患者情况、手术部位及类型、仪器设备喉罩的管理与监测,Insertion problems and Trauma prevention,喉罩置入手法粗暴、不当。喉罩套囊压力高低及持续时间。喉罩本身设计类型、材质决定。,SLIPA喉罩置入示意图,Manual insertion of the ProSeal LMA,喉罩套囊的管理,有效地控制和监测喉罩套囊压力。套囊压力与喉罩密封性。套囊压力与局部组织血流。损伤的严重程度取决于插管的时间和作用于气管壁压力的乘积 。,50%N2O下LMA囊