青年医师读书会第一期：气道管理

yabg183

想请版主讲讲喷射呼吸机的原理及其类型和用法，我见过几种类型，厂家不一样，使用也好像不一样，按道理不应该这样，应该原则上差不多啊

mzsj

上图:

When face mask ventilation is inadequate to provide necessary airway support, or when long term positive pressure ventilation is required, an endotracheal tube (ETT) should be placed. In most circumstances, direct laryngoscopy is the simplest and most readily applied means of placing the ETT. Indications for direct laryngoscopy and endotracheal intubation are summarized below.
During direct laryngoscopy the provider must bring his/her line of sight into alignment with the glottic opening in order to facilitate visualization of ETT placement. Most sources recommend that the oral, pharyngeal, and laryngeal axes be aligned by the process of patient positioning and direct laryngoscopy, to guarantee the best view of the glottic opening. However, even if one cannot peer down the laryngeal axis into the trachea, placement of the endotracheal tube is usually readily accomplished if the laryngeal inlet is visible. Evaluation of the alignment of the oral, pharyngeal, and laryngeal axes utilizing magnetic resonance imaging when the head and neck are in neutral position, in simple extension, or in “sniffing position,” reveals that these three lines seldom, if ever, become well-aligned (Fig. 3.1)



The forces brought to bear on the soft tissues of the oral cavity and pharynx in direct laryngoscopy must be appropriately directed. Whether a curved or straight laryngoscope blade is utilized, the operator should lift upward and away from himself/herself, a stressful maneuver that requires practice, and when prolonged, causes fatigue. When the laryngoscopist pulls towards himself/herself to create mechanical advantage, he/she is creating leverage, but the upper teeth are often contacted and in danger of injury. This maneuver is common among trainees learning laryngoscopy and must be actively discouraged.

mzsj

1.  Upper airway anatomy: A. Inferior  turbinate, B. Major nasal airway, C. Vallecula,D. Epiglottis, E. Hyoid bone, F. Hyoepiglottic ligament, G. Thyroid (laryngeal) cartilage,  H. Cricoid cartilage.

2.  CORMACK-LEHANE12 AND COOK MODIFICATION13 GRADING OF LARYNGEAL INLET STRUCTURES VISIBLE AT  LARYNGOSCOPY

3.The Cormack-Lehane (C-L) classification of glottic visualization

xyz-cn99

2.国内专家推荐的困难气道处理流程
　　麻醉前评估，至少在给病人实施麻醉前（手术室内）要对是否存在困难气道进行评估。麻醉前准备好气道管理工具，检查麻醉机、呼吸回路、面罩、通气道以及喉镜、气管导管、插管探条、喉罩等，确保其随手可得。

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雪山海子

1  除了常用的经口明视气管插管外，其他的插管方法还有 ： 经鼻气管插管，纤支镜引导下的气管插管，可视喉镜下气管插管，喉罩引导下气管插管，光杖引导下气管插管，逆行气管插管

lwlinwei

医生的基本功 还是非常重要的。

shenzhen

曾经得到一片综述，内容不少，值得一读。

liuliu87

今天把整个内容重新看了一遍，感觉意犹未尽，补充点内容

新型喉上通气装置——SLIPA™通气道----许亚超 薛富善
中国医学科学院 整形外科医院麻醉科

wms

气道评估是一个重点，也是麻醉中重要的一个环节。术前一定要问病史，是否有困难插管历史，在就要进行 Mallampati分级，估计插管的难易度。估计困难插管最好采用清醒慢诱导，一定要保证病人安全。遇到2不可预料的困难插管，要积极寻求帮助，不能盲目插管

3dfs

　　逆行插管是否可以用硬膜外穿刺针和导管来进行呢，科室没有丁卡因，能否用2%利多漱口，环甲膜喷，再喷声门附近那样还需要静脉需要推点利多吗，还是给点艾洛、0.1mg的芬太尼和1mg左右的咪唑？
　　如果清醒插管，环甲膜喷局麻药会不会导致痉挛。若发生了，加压面罩吸氧缓解后，还可以继续清醒插管吗？？