喉罩的使用麻醉(英文)-2课件

1、Using the Laryngeal Mask AirwayNorman L. Goody, MDObjectiveUsing the LMALMA and the Difficult AirwayLMA and Pediatric AnesthesiaLMA and OB AnesthesiaAdvantages of Using the LMADisadvantages of the LMAComplications Arising from Use of the LMA Contraindications to Using the LMAHistory of the LMAdevelo

2、pment 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- especially ambulatory surgery)Characteristics of

3、the LMALatex free, medical-grade siliconeAperture barsSizes#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 25-30mlUsing the LMAPreparation of the LMACheck patency of cuffLubricate POSTERIOR surface onlySurgilube v. lidocaine jellyInductionInsertion of the LMACo

4、mmon ProblemsCricoid PressureSecuring the LMAUsing the LMAMaintenance of AnesthesiaRemoval of the LMACleaning, Sterilization and Re-useDetermining Life Span of LMAintended for 40-50 uses, but highly over-manufacturedtube remains translucentaperture bars remain intactcuff deflates correctlyno valve l

5、eakagecuff remains symmetricpilot balloon retains shapeconnector remains tight/ not brokenTHE LMA IS NOT DISPOSABLELMA and the Difficult AirwayAwake IntubationDifficult MASK AirwayBlind IntubationFailed IntubationFiberoptic Bronchoscopy and the LMAEmergent Intubation by an Unskilled ProviderLMA and

6、Pediatric AnesthesiaDL&Btracheal stenosisdifficult airwayAccuracy of End-tidal CO2 in Pediatrics using LMA22 children, mechanically ventilated 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 PaC

7、O2 obtained were 35.2 +/- 2.9 and 39.2 +/- 5.25, respectivelyLMA ETCO2 is as accurate an indicator of PaCO2 as when ventilated via ETTAnesth Analg Feb;82 (2) :247-50LMA and OB AnesthesiaQuestionnaire to 250 anesthesiologists in the UKLMA was available in 91.4% of obstetric units72% were in favor of

8、using LMA for failed intubation with inadequate ventilation via face mask24 had experience with LMA in such a situation, 8 of 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, e

9、t al. 2019 Feb;42(2):130-3Advantages of Using the LMAMeta-analysis comparing advantages of the LMA over the tracheal 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 2019 Nov;42(11

10、):1017-23Advantages of LMA over ETTincreased speed and ease of placement by inexperienced personnelincreased speed of placement by anesthetistsimproved hemodynamic stability at induction and during emergenceminimal increase in intraocular pressure following insertionCan J Anaesth Brimacombe 2019 Nov

11、;42(11):1017-23Advantages of LMA over ETTreduced anesthetic requirements for airway tolerancelower frequency of coughing during emergenceimproved oxygen saturation during emergencelower incidence of sore throats in adultsCan J Anaesth Brimacombe 2019 Nov;42(11):1017-23Advantages of LMA over Face Mas

12、keasier placement by inexperienced personnelimproved oxygen saturationless hand fatigueimproved operating conditions during minor pediatric otological surgeryCan J Anaesth Brimacombe 2019 Nov;42(11):1017-23Additional Advantages of Using the LMAleaves providers hands freepatient can produce effective

13、 coughallows spontaneous ventilationeven malpositioned can adequately ventilateDisadvantages of LMA over the ETTlower seal pressurehigher frequency of gastric insufflationCan J Anaesth Brimacombe 2019 Nov;42(11):1017-23Disadvantages of LMA over the FMesophageal reflux more likelyCan J Anaesth Brimac

14、ombe 2019 Nov;42(11):1017-23Contraindications to Using the LMAFull StomachNon-fasted34+ week pregnanttraumaacute abdomenthoracic injuryopiate premedicationautonomic neuropathypatient unable to follow instructionsany condition known to delay gastric emptyingContraindications to Using the LMAFull Stom

15、achPatients with a history of GE refluxContraindications to Using the LMAFull StomachPatients with a history of GE refluxPatients with low pulmonary compliance needing positive pressure ventilationComplications Arising from Use of the LMAAspirationPassive Regurgitation and the LMAStudy looked at gas

16、tric 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 blue dye was detected in the supine group

17、but it was observed in one patient in each of the other two groupsAnaesthesia Strong, et al. 2019 Dec;50(12):1053-5Passive Regurgitation: LMA v. ETTStudy at UT Dallas comparing incidence of reflux for spontaneously breathing anesthetized patients with either an ETT or LMA by continuous measurement o

18、f hypopharyngeal pH“Continuous monitoring.failed to detect evidence of pharyngeal regurgitation.”Anesth Anal Joshi, et al. 2019 Feb;82(2):254-7Complications Arising from Use of the LMAAspirationCoughingComplicationsIncidence of airway complications following GA using either ETT or LMA Significantly

19、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):521-2Complications Arising from Use of the LMAAspirationCoughingSore ThroatSore Throatincidence of sore throat looked at in 327 patients who had GAmild/moderate soreness 7% of patients with LMA10% who had FM and oral airway47% of had ETT24 hours later, 3% of intubated group still c/o