喉罩的使用-麻醉（英文.ppt

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1、UsingtheLaryngealMaskAirwayNormanL.Goody,MDObjectiveUsingtheLMALMAandtheDifficultAirwayLMAandPediatricAnesthesiaLMAandOBAnesthesiaAdvantagesofUsingtheLMADisadvantagesoftheLMAComplicationsArisingfromUseoftheLMAContraindicationstoUsingtheLMAHistoryoftheLMAdevelopmentbeganin1981atRoyalLondonHospitalby

2、Dr.ArchieBrainmodificationoftheGoldmanDentalMaskavailablecommerciallyinUKsince1988andintheUSsince1992nowusedin>50%ofgeneralanestheticsinsomecentersinUK(andprobablyUS,too-especiallyambulatorysurgery)CharacteristicsoftheLMALatexfree,medical-gradesiliconeAperturebarsSizes#1<6.5kg2-5ml#26.5-25kg7-10ml#

3、21/220-30kg14ml#325-70kg15-20ml#470+kg25-30mlUsingtheLMAPreparationoftheLMACheckpatencyofcuffLubricatePOSTERIORsurfaceonlySurgilubev.lidocainejellyInductionInsertionoftheLMACommonProblemsCricoidPressureSecuringtheLMAUsingtheLMAMaintenanceofAnesthesiaRemovaloftheLMACleaning,SterilizationandRe-useDet

4、erminingLifeSpanofLMAintendedfor40-50uses,buthighlyover-manufacturedtuberemainstranslucentaperturebarsremainintactcuffdeflatescorrectlynovalveleakagecuffremainssymmetricpilotballoonretainsshapeconnectorremainstight/notbrokenTHELMAISNOTDISPOSABLELMAandtheDifficultAirwayAwakeIntubationDifficultMASKAi

5、rwayBlindIntubationFailedIntubationFiberopticBronchoscopyandtheLMAEmergentIntubationbyanUnskilledProviderLMAandPediatricAnesthesiaDL&BtrachealstenosisdifficultairwayAccuracyofEnd-tidalCO2inPediatricsusingLMA22children,mechanicallyventilatedtoastableETCO2ventilationviatheLMAmeanETCO2andPaCO2obtained

6、were37.7+/-3.3and41.9+/-9.09,respectivelyventilationviaETTmeanETCO2andPaCO2obtainedwere35.2+/-2.9and39.2+/-5.25,respectivelyLMAETCO2isasaccurateanindicatorofPaCO2aswhenventilatedviaETTAnesthAnalgFeb;82(2):247-50LMAandOBAnesthesiaQuestionnaireto250anesthesiologistsintheUKLMAwasavailablein91.4%ofobst

7、etricunits72%wereinfavorofusingLMAforfailedintubationwithinadequateventilationviafacemask24hadexperiencewithLMAinsuchasituation,8ofwhichstatedthatLMAhadprovedtobea“lifesaver”AuthorsbelievedthatweshoulduseLM