医学课件-超声在气道管理中的应用课件

1、超声在气道管理中的应用超声在气道管理中的应用颈部气道解剖颈部气道解剖定位喉上神经The thyrohyoid membrane as a target for ultrasonography-guided block of the internal branch of the superior laryngeal nerveStopar-Pintaric T, Vlassakov K, Azman J.J Clin Anesth.2015 Nov ; 27(7): 548-52.In conclusion, we are proposing an anatomical concept for

2、a new, simpler, consistently reproducible US-guided iSLN block technique using the thyrohyoid membrane to define the target plane for low-volume local anesthetic injection.定位喉上神经The thyrohyoid membrane 外侧舌骨外侧舌骨超声影像舌骨、喉上神经外侧过拱桥，甲舌膜里寻喉上外侧舌骨外侧舌骨超声影像舌骨、喉上神经外侧过拱桥，甲舌膜定位环甲膜The conventional method, inspecti

3、on and palpation, has a low success rate, especially in women (2435%).Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010; 65: 88994 Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by anes

4、thesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495503定位环甲膜The conventional method, Barbe N,Martin P,Pascal J,et al. Ann Fr Anesth Reanim.2014 Mar;33(3):163-6.定位环甲膜Locating the cricothyroid membrane in learning phase: Value of ultrasonography ? The CTM was accurately ide

5、ntified by palpation and ultrasound by 46% and 100% of residents respectively (P 0.05). Barbe N,Martin P,Pascal J,et aKristensen MS, Teoh WH, Rudolph SS,et al.Br J Anaesth. 2015 Jun;114(6):1003-4.定位环甲膜Structured approach to ultrasound-guided identification of thecricothyroid membrane: a randomized c

6、omparison with the palpation method in the morbidly obeseWhen using the conventional digital palpation method, 13 of 35 anaesthetists (37%) were able to locate the cricothyroid membrane successfully within 2 min, whereas the success rate was 29 of 35 (83%) when the structured stepwise ultrasonograph

7、y method was applied (P=0.0008, McNemars test).Kristensen MS, Teoh WH, RudolpSiddiqui N, Arzola C, Friedman Z, et al.Anesthesiology.2015 Nov;123(5):1033-41.定位环甲膜Ultrasound Improves Cricothyrotomy Success inCadavers with Poorly Defined Neck AnatomyUltrasound guidance significantly decreased the incid

8、ence of injuries to the larynx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation.Siddiqui N, Arzola C, Friedman外侧甲状软骨声带声带环甲膜外侧超声影像甲状软骨、环甲膜外侧越尖峰，缺口伪影环甲膜甲状软骨声带声带伪影外侧甲状软骨声带声带环甲膜外侧超声影像甲状软骨、环甲膜外超声影像环状软骨外侧气管软骨甲状腺峡部外侧气管软骨外侧超

9、声影像环状软骨外侧气管软骨甲状腺峡部外侧气管软骨外侧Ultrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessIida T,Suzuki A, Kunisawa T,et al. J Anesth (2013) 27:309310临床应用1清醒插管Ultrasound-guided superior larSonographically Guided Superior Lary

10、ngeal Nerve Block During Awake Fiberoptic IntubationSawka A, Tang R, Vaghadia H.A A Case Rep.2015 Apr 15; 4(8): 107-10.Sonographically guided superior laryngeal nerve block may be useful in patients where identification of landmarks in the neck is difficult as a result of patient anatomy临床应用1清醒插管Son

11、ographically Guided Superio临床应用1清醒插管Ultrasound-guided Cannula CricothyroidotomySuzuki A,Iida T, kunisawa T,et al.Anesthesiology 2012 Nov;117(5):1128Ultrasound-assisted translaryngeal block for awake fibreoptic intubationDe Oliveira GSJr, Fitzgerald P, Kendall M.Can J Anesth. 2011 58:664665临床应用1清醒插管U

12、ltrasound-guided Ca临床应用1清醒插管病态肥胖 BMI 60临床应用1清醒插管病态肥胖 BMI 60临床应用1清醒插管临床应用1清醒插管临床应用1清醒插管临床应用1清醒插管临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺Wu J,Dong J,Ding Y,et al.Med Sci Monit, 2014; 20: 2343-2350Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyAnterior neck soft tis

13、sue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy.Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy.临床应用2判断喉镜显露困难

14、气管软骨外侧食管甲状腺Wu J,临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺Ultrasonographic measurement of the minimal transverse diameter of the subglottic airway in the transverse plane, typically at the caudal outlet of the cricoid ring临床应用3选择适合气管导管Ultrasonographic measurement o临床应用4判断气管导管位置气管软骨外侧食管甲状腺排除食管内

15、插管证实气管导管在气管内临床应用4判断气管导管位置气管软骨外侧食管甲状腺排除食管内临床应用4判断气管导管位置THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL TUBE PLACEMENT IN A CADAVER MODELDynamic assessment resulted in 97% sensitivity and 100% specificity for detecting esophageal ET placement. Static assess

16、ment resulted in only 51% sensitivity and 91% specificity.Ma G,Davis DP, Schmitt J, et al.J Emerg Med.2007 May;32(4):405-7.临床应用4判断气管导管位置THE SENSITIVITY 气管插管过程中环甲膜改变气管插管过程中环甲膜改变气管导管气囊充气表现气管导管气囊充气表现临床应用5判断喉罩位置Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airw

17、ay placementSonographic upper airway assessment emerges as a rapid and easily available method to predict difficult intubation, to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ.Wojtczak JA,Cattano D.Journal of Ultrasonography 2014; 14: 3

18、62366临床应用5判断喉罩位置Laryngo-tracheal u临床应用5判断喉罩位置蝴蝶征Unique喉罩的位置ESupreme喉罩的位置E临床应用5判断喉罩位置蝴蝶征Unique喉罩的位置ESup临床应用6定位气管切开Real-time ultrasound-guided percutaneousdilatational tracheostomy: a feasibility studyPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears accur

19、ate and safe, including in patients with morbid obesity and cervical spine precautions. Venkatakrishna Rajajee, Jeffrey J Fletcher, Lauryn R Rochlen, et al.Critical Care 2011, 15:R67临床应用6定位气管切开Real-time ultrasou临床应用6定位气管切开Traditional landmark versus ultrasound guided tracheal puncture during percuta

20、neous dilatational tracheostomy in adult intensive care patients: a randomised controlled trialUltrasound guidance significantly improved the rate of first-pass puncture and puncture accuracy. Fewer procedural complications were observed; however, this did not reach statistical significance. These r

21、esults support wider general use of real-time ultrasound guidance as an additional tool to improve PDT.Mt Rudas, Ian Seppelt, Robert Herkes,et al.Critical Care 2014, 18:514临床应用6定位气管切开Traditional landma临床应用6定位气管切开可视化操作才能有意识避开血管临床应用6定位气管切开可视化操作才能临床应用6定位气管切开临床应用6定位气管切开其他的临床应用1迅速准确建立通气Mallin M, Curtis K, Dawson M,et al.Am J Emerg Med 2014 Jan;32(1):61-3.Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubationUltrasound marking of the CTM o