三种方法建立麻醉通气道对血流动力学影响的比较

目的 探讨全麻手术患者术前建立通气道的最佳方式.方法 90例全麻手术病人根据术前建立通气道方式不同随机分成3组:喉镜直视下气管插管组、盲探插管组和使用喉罩组,比较使用3种通气道方法对手术病人所诱发的心血管反应,观察3组患者的动脉压和心率变化.结果 使用喉镜插管组患者心率加快、血压升高程度最大;盲探插管组病人血压和心率增幅明显小于使用喉镜组;喉罩组病人心血管反应轻微,血压、心率增幅小,且1 min左右即可恢复.结论 对于全麻手术病人通气道采用盲探下气管插管或使用喉罩均可作为手术病人术前建立通气道的适宜首选方法.     

喉罩通气道在俯卧位腰椎后路手术麻醉中的应用

目的探讨俯卧位下安全使用喉罩通气道进行全麻呼吸管理的方法。方法将49例俯卧位下胸、腰椎后路择期手术分为喉罩组(喉罩通气道,n=28)和经口插管组(气管插管,n=21)进行呼吸管理,比较插管(喉罩)前后、拔管(喉罩)即时循环改变以及体位改变对气道通气压力、气道密封压的影响;应用C臂机X线影像学技术比较体位改变对气管插管或喉罩通气道位置的影响。结果两组患者插管(喉罩)前、后血压、心率,组间比较无统计学差异(P>0.05)。经口插管组拔管后即刻血压高于喉罩组,有统计学差异(P<0.05);经口插管组面罩通气压力、插管后及俯卧位气道通气压力较喉罩组均明显升高,有统计学差异(均P<0.01);喉罩组俯卧位气道密封压较仰卧位时明显升高[(23.8±2.6)cm H_2O vs.(22.4±2.38)cm H_2O],有统计学差异(P<0.05)。C臂机X线显示:俯卧位后,喉罩罩杯上极下移,但是喉罩罩杯下极无明显位移;俯卧位后,气管导管末端向气管远端(气管隆凸)移位。结论俯卧位下使用喉罩通气,只要管理得当可能是一种安全有效的方法。     

喉罩在院前急救中的应用

目的 探讨喉罩(LMA)在院前急救中应用的简易性和有效性.方法 对院前发生心跳呼吸骤停的患者84例,根据CPR时对患者建立人工气道的不同措施,将其分为2组进行回顾性对比.A组47例,常规CPR时即盲插喉罩通气;B组37例,常规CPR时即行气管内插管.结果 一次插管成功率:A组盲探下插入喉罩全部一次成功,成功率100%;B组插管,一次成功26例,两次成功8例,三次以上成功4例,一次插管成功率70%.两组相比有显著性差异(P＜0.01).插管时间:A组(10.4±7.5)s,B组(96±25.7)s,两组相比有显著性差异(P＜0.01).有效通气效果评定:两组比较无显著性差异(P＞0.05).结论 在院前心肺复苏时,早期盲插喉罩通气具有操作快捷、可盲探插管且成功率高、能够保证有效通气和提高抢救成功率的优点,值得在院前急救中推广使用.     

喉罩通气在院前心肺复苏中的临床研究

目的:探讨院前心肺复苏(CPR)时早期盲插喉罩通气对复苏成功率的影响。方法:对院前发生心跳呼吸骤停患者460例,根据CPR时对患者建立人工气道的不同措施将其分为3组,A组210例,常规CPR时即盲插喉罩通气;B组40例,常规CPR时即行气管内插管;C组210例,常规CPR时以球囊面罩装置通气,转送至急诊科再行气管内插管,插管延迟时间5～15min。结果:插管所需时间:A组10.4±7.5s;B组96±25.7s;C组52±27.5s;3组相比差异有显著性(P<0.001)。一次插管成功率:A组盲探下插入喉罩全部1次成功,成功率100%;B组插管1次成功28例,2次成功9例,3次以上3例,一次插管成功率70%;C组插管1次成功200例,2次成功10例,一次插管成功率95.2%;3组相比差异有显著性(P<0.01)。复苏成功率:A组复苏成功41例,成功率19.5%;B组复苏成功1例,成功率2.5.%;C组复苏成功8例,成功率3.8%;A组与B、C组复苏成功率比较差异有显著性(P<0.01),B组与C组复苏成功率比较差异无显著性(P>0.05)。结论:在院前心肺复苏时,早期盲插喉罩通气具有操作快捷,可盲探插管且成功率高,能明显提高抢救成功率,而早期气管插管需时长,一次插管成功率较低,不能提高CPR成功率。     

SLIPA喉罩通气全身麻醉在腹腔镜胆囊切除术中的应用

目的 探讨SLIPA喉罩通气全身麻醉在腹腔镜胆囊切除术中临床应用的可行性和安全性.方法 120例行腹腔镜胆囊切除术患者,随机分成两组:SLIPA喉罩组(SLIPA组,60例)和气管插管组(TT组,60例).人工气腹后SLIPA喉罩组选择相对低潮气量和较快的呼吸频率进行机械通气,TT组常规机械通气.监测平均动脉压(MAP)、脉搏氧饱和度(SP02)、心率(HR)、气道峰压(P(peak)、肺顺应性(COMPl)、呼气末二氧化碳分压(P(et)CO2).观察有无反流误吸情况,记录拔管(喉罩)时躁动、呛咳、咽喉痛、声音嘶哑、喉罩或气管导管沾染血迹等发生情况.结果 SLIPA组喉罩置入成功率98.33%,气腹后相对低潮气量和较快呼吸频率通气未发生低氧血症和二氧化碳蓄积,各监测时间点SPO2、P(et)CO2均在正常范围,两组间差异无显著性(P>0.05).气管插管(喉罩)和拔管(喉罩)时,TT组MAP增高、HR加快变化明显(P<0.05),而SLIPA组则较为平稳(P>0.05).SLIPA组躁动、呛咳、咽喉痛、声音嘶哑、喉罩或气管导管沾染血迹等发生率也低于TT组(P<0.05).结论 SLIPA喉罩通气全身麻醉用于腹腔镜胆囊切除术,可减轻插管时对咽喉及气道的刺激,维持血流动力学相对稳定,确保气道通畅和有效通气.     

喷射通气辅助下经喉罩行困难气道气管插管临床研究

目的探讨在喷射通气辅助下经喉罩行困难气道气管插管的方法和可行性。方法选择麻醉前被评估为困难气道、麻醉诱导中发生气管插管困难的择期手术患者68例,随机分为2组:A组(n=34),喷射通气辅助下经LMA气管插管;B组(n=34),经ILMA盲探气管插管。观察两组患者气管导管置入情况及MAP、HR、SPO2、EtCO2、PaO2、PaCO2变化情况。结果两组患者置入LMA或ILMA情况相似,无统计学差异,但和B组相比,A组首次插管成功率明显高于B组,差异有统计学意义(P0.01);麻醉诱导前后各组MAP、HR明显下降而PaO2明显升高,差异显著(P0.05);气管插管操作完成后,B组患者MAP、HR、EtCO2、PaCO2显著升高(P0.05),PaO2显著降低(P0.05);插入导管后,A组MAP、HR、EtCO2、PaCO2明显低于B组(P0.05),PaO2明显高于B组(P0.05)。结论在存在自主呼吸条件下,应用喷射通气辅助下经喉罩行困难气道气管插管安全、有效。     

喉罩在院前急救中的应用

目的探讨喉罩（LMA）在院前急救中应用的简易性和有效性。方法对院前发生心跳呼吸骤停的患者84例,根据CPR时对患者建立人工气道的不同措施,将其分为2组进行回顾性对比。A组47例,常规CPR时即盲插喉罩通气;B组37例,常规CPR时即行气管内插管。结果一次插管成功率：A组盲探下插入喉罩全部一次成功,成功率100％;B组插管,一次成功26例,两次成功8例,三次以上成功4例,一次插管成功率70％。两组相比有显著性差异（P〈0．01）。插管时间：A组（10．4±7．5）s,B组（96±25．7）s,两组相比有显著性差异（P〈0．01）。有效通气效果评定：两组比较元显著性差异（P〉0．05）。结论在院前心肺复苏时,早期盲插喉罩通气具有操作快捷、可盲探插管且成功率高、能够保证有效通气和提高抢救成功率的优点,值得在院前急救中推广使用。     

乳房手术中喉罩通气压力与容量控制呼吸模式的比较

目的:比较乳房手术喉罩通气压力控制呼吸(PCV)与容量控制呼吸(VCV)模式对心血管、气道压力与漏气率的影响。方法:30 例全麻下行乳房手术患者,年龄46．05±4．32岁,ASA Ⅰ-Ⅱ级,静脉麻醉诱导后置入喉罩,按随机顺序接受PCV和VCV两种通气方式,通气期间保持相同的呼气末二氧化碳分压(PetCO2)达到30-40mmHg,并稳定15min后分别记录呼吸循环参数。结果:两种通气方式SBP、DBP、HR、PetCO2、SPO2比较无显著差异,P>0．05。PCV时气道峰压和漏气率明显低于VCV,P<0．05,VCV期间有6例气道峰压大于20cmH2O,而PCV期间有3例为20cmH2O,15min后P-V环的密闭性PCV通气方式优于VCV期间。结论:全麻喉罩通气期间PCV较VCV方式能在较低的压力下提供有效的肺通气,是较为理想和安全的通气模式。     

面罩复合鼻咽通气道与喉罩通气道在小儿手术中的应用比较

目的:比较两种声门上通气道在小儿手术中的应用效果及两者对患儿血流动力学的影响。方法:选择3-6岁,ASAI-Ⅱ级的拟行腹股沟斜疝手术的患儿78例,并随机分配到面罩复合鼻咽通气道组(面罩组)和喉罩通气道组(喉罩组)。观察并记录麻醉诱导前(T_0)、置入声门上气道即刻(T_1)及拔出声门上气道即刻(T_2)患儿的SBP、NBP、MAP、HR、PetCO_2、SpO_2、麻醉复苏清醒时间及拔除后声门上气道表面带有血迹的例数。结果:两组T_1时SBP、DBP、MAP、HR均明显低于T_0及T_2时(P0.05)。与喉罩组相比,面罩组T_2时SBP、DBP、MAP较低(P0.05),HR、SpO_2及其余时点观察值无明显差异(P0.05)。喉罩组通气道拔出后表面带有血迹的例数明显高于面罩组(P0.05)。结论:在小儿短小手术中,两种声门上气道均安全有效,但面罩复合鼻咽通气道较喉罩通气道对血流动力学波动更小,拔除后粘膜损伤发生率更低,总体优于喉罩通气道。     

紧急气管插管在特殊情况心肺复苏中的临床应用

目的:探讨紧急气管插管在重型颅脑外伤、中毒、淹溺、自缢、异物窒息等特殊情况下院前心肺复苏(CPR)中临床应用的必要性、可行性,以提高急救水平.方法:对院前因重型颅脑外伤、中毒、淹溺、自缢、异物窒息等特殊情况导致心跳呼吸骤停患者48例根据CPR时先行建立人工气道的不同措施将其分为两组,院前CPR时先行紧急气管插管(A组,n=40);院前CPR时先行肓探置人喉罩(B组,n=8).结果:A组现场发现不同程度气道阻塞31例,全部插管成功,插管时间均少于2 min,通气良好,复苏成功28例;B组现场先行盲探置入喉罩,但通气不良,均改行紧急气管插管,发现8例均有不同程度气道阻塞,全部插管成功,插管时间均少于2 min,通气良好,复苏成功2例;A组复苏成功率明显高于B组(P<0.05).结论:在重型颅脑外伤、中毒、淹溺、自缢、异物窒息等特殊情况下院前心肺复苏抢救中,紧急气管插管仍是无可替代的建立人工气道首选方法.     

喉罩与气管插管通气在小儿腹腔镜手术麻醉中对血流动力学的影响比较

目的观察全身麻醉诱导后管入喉罩通气与气管插管通气在小儿腹腔镜手术麻醉中对血流动力学的影响。方法选择择期行腹腔镜手术的小儿40例,年龄3～10岁,ASAⅠ～Ⅱ级,阑尾切除手术17例,斜疝修补术12例,精索静脉曲张血管结扎术5例,胆囊切除2例,Meckel憩室切除4例;根据建立通气方式不同将患儿随机分为两组：E组（气管插管）20例和L组（喉罩,LMA）20例。用PHILIPS多功能监护仪连续监测收缩压（SBP）、舒张压（DBP）、心率（HR）、心电图（ECG）和脉搏血氧饱和度（SpO2）。记录诱导前安静状态（T0）、麻醉诱导后（T1）、喉罩置入或插管即刻（T2）、拔管前（T3）及拔管后（T4）5个时点SBP、DBP及HR值。结果E组气管插管后各时间点SBP、DBP、HR均显著增高（P〈0．01）;L组喉罩置入后各时间点SBP、DBP、HR虽有所增高,但与基础值比较差异无显著性（P〉0．05）。结论小儿腹腔镜手术麻醉中,应用喉罩安全方便,较直接喉镜下气管插管对心血管的不良刺激小,值得推广。     

Comparative Study of Airway Management Techniques with Restricted Access to Patient Airway

Objective. To determine which airway endotracheal tube (ET), Combitube (CT), or Laryngeal Mask Airway (LMA) has the shortest time to successful ventilation in three nontraditional prehospital airway scenarios. Methods. Prospective randomized cohort study of emergency medicine (EM) residents, faculty EM physicians, andparamedics (EMT-P). Subjects were instructed to place an airway in a mannequin in three scenarios: mannequin supine under a table with head abutting a wall, mannequin sitting upright with access from behind, andmannequin lying on its side with access facing the mannequin. The number of airway placement attempts andtime to successful ventilation were recorded. Results. Twenty-five resident physicians, 9 faculty physicians, and22 EMT-Ps participated. No significant difference was found between the different airways in the number of attempts to successfully ventilate. EMT-Ps demonstrated significantly faster times to successful ventilation for all scenarios versus physicians (e.g., supine scenario with ET, EMT-P median time 57 seconds, physician median time 96 seconds) except for the mannequin lying on its side where there was no significant difference. The time to ventilation for all scenarios was less with the LMA versus ET or CT versus ET, except in the sitting scenario where ET andCT were comparable Conclusions. In this mannequin model of restricted airway access, LMA resulted in significantly faster times to ventilation versus ET andCT in all but one scenario. Further consideration andstudy using airways other than ET are warranted for situations with restricted access to the patient's airway.     

Successful Tracheal Intubation through an Intubating Laryngeal Airway in Pediatric Patients with Airway Hemorrhage

Background

This case report describes the use of the air-Q intubating laryngeal airway (air-Q ILA; Cookgas LLC, St. Louis, MO) for airway rescue and a conduit for blind tracheal intubation in two pediatric patients with failed rapid sequence intubation and difficult airways secondary to airway bleeding in the emergency department (ED).

Objectives

To describe the use of a new supraglottic rescue device in the management of the pediatric patient’s difficult airway in the emergency setting.

Case Report

Case 1 was a 5-year-old boy who presented to the ED for bleeding one day after his tonsillectomy. After a rapid sequence intubation, direct laryngoscopy was difficult, with copious bleeding in the oropharynx and inability to visualize the glottis. After two failed direct laryngoscopic attempts to intubate, a size-2 air-Q ILA was inserted. A cuffed 5.0-mm inner diameter (ID) endotracheal tube (ETT) was blindly inserted through the lumen of the air-Q ILA into the trachea successfully. Case 2 was a 13-year-old boy who presented to the ED with a large nasopharyngeal laceration from a motor vehicle accident. After a rapid sequence intubation, direct laryngoscopy showed copious blood with no glottic visualization. A size 3 Laryngeal Mask Airway Classic™ (cLMA; LMA North America Inc., San Diego, CA) was inserted with a large airway leak, and blind ETT insertion via the cLMA was unsuccessful. Subsequently, a size-2.5 air-Q ILA was inserted and adequate ventilation was restored. A cuffed 6.0-mm ID ETT was blindly inserted through the air-Q ILA into the trachea successfully.

Conclusion

Two cases of failed laryngoscopy in pediatric patients with blood in the airway are described. In each case, insertion of an air-Q ILA was followed by successful blind tracheal intubation via the lumen of the air-Q ILA.     

The laryngeal mask airway in emergency medicine

The Laryngeal Mask Airway (LMA) is an upper airway adjunct lying intermediate in function between the endotracheal tube and the oropharyngeal airway. It has gained wide acceptance since its introduction into United Kingdom anaesthetic practice in 1988. We review the principles of advanced airway management in the emergency department and examine the application of the LMA to this area. We conclude that the LMA may have a small role in pre-hospital and CPR airway management, and a very significant role in the management of difficult or failed endotracheal intubation.     

喉罩全麻在小儿侧卧位手术中的应用

目的比较喉罩全麻与气管插管全麻两种麻醉方法在小儿侧卧位短小手术中的优缺点。方法 2009年6月-2010年2月,将40例择期行侧卧位短小手术儿患,随机分为喉罩全麻（L）组与气管插管全麻（T）组,每组各20例。观察患儿术中心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、气道峰压（Pmax）,恶心呕吐、术后躁动等围术期不良反应。结果 T组插管后及拔管后即刻HR、MAP均高于L组患儿（P〈0.05）;SpO2、Pmax在两组之间比较差异无统计学意义（P〉0.05）,T组患儿术后躁动发生率明显高于L组（P〈0.05）。结论喉罩可以安全、有效地用于小儿侧卧位短小手术麻醉,且操作简便,插管期和拔管期心血管应激反应轻,术后躁动发生率低。     

The laryngeal mask airway: a comprehensive review for the Emergency Physician

The Laryngeal Mask Airway (LMA) was developed in the 1980s, but has only recently begun to be used in Emergency Medicine. The LMA affords effective assisted ventilation without requiring endotracheal intubation or visualization of the glottis. In doing so, it is more efficacious than a bag-valve-mask apparatus, although the risk of aspiration of gastric contents persists, particularly if the device is not properly placed. The LMA also has significant potential utility in management of the difficult airway. Most reported clinical experience with the LMA has come from the operating room. This article provides an overview of the extensive potential utility of the LMA in the Emergency Department and prehospital settings as well as a comprehensive review of the pertinent advantages, disadvantages, and complications associated with its use.     

喉罩应用于老年高血压患者腹腔镜胆囊切除术的麻醉效果与安全性评价

目的观察一次性喉罩（Laryngeal mask airway,LMA）应用于老年高血压患者的麻醉效果与安全性。方法选择择期行腹腔镜胆囊切除术的老年高血压患者80例,ASAⅠ~Ⅱ级,分为喉罩组（A组）和气管内插管组（B组）各40例,观察记录两组患者诱导前5分钟（T0）、插管或置入喉罩后即刻（T1）、插管或置入喉罩后5分钟（T2）、气腹后（T3）、拔管或拔出喉罩时（T4）、拔管或拔出喉罩后5分钟（T5）,6个时间点的心率（HR）、收缩压（SBP）、舒张压（DBP）、心率与收缩压的乘积（RPP）、脉搏血氧饱和度（SpO2）、并观察插管或置入喉罩时、拔除前后及术中相关并发症,记录术后口咽痛、痰多或呛咳发生率。结果 T0时点两组患者HR、SBP、DBP、RPP及SpO2比较差异无统计学意义（P〉0.05）,T1与T4时点B组循环系统应急反应强于A组;两组T2与T3时点的HR、SBP、DBP、RPP比较差异有统计学意义（P〈0.05）;围术期A组呛咳、喉痉挛、术后咽痛、痰多等并发症少于B组（P〈0.05）。结论喉罩较支气管内插管全麻围手术期循环功能更加稳定,插管及拔管时呛咳、喉痉挛、术后咽痛、多痰等并发症更低。     

INCIDENCE OF EMS CALLS REQUIRING BLS ADMINISTRATION OF EPINEPHRINE FOR ACUTE ALLERGIC REACTIONS AND ANAPHYLAXIS

Abstract

This review discusses the history, developments, benefits, and complications of supraglottic devices in prehospital care for adults and pediatrics. Evidence supporting their use as well as current controversies and developments in out-of-hospital cardiac arrest and rapid sequence airway management is discussed. Devices reviewed include the Laryngeal Mask Airway, Esophageal Tracheal Combitube, Laryngeal Tube, I-Gel, Air-Q, Laryngeal Mask Airway Fastrach, and the Supraglottic Airway Laryngopharyngeal Tube (SALT).     

七氟烷在小儿困难气管插管中的应用

【目的】观察七氟烷在小儿困难气管插管中的应用。【方法】选择2009年来我院行择期或急诊手术且存在困难气道的165例患儿为研究对象,采用面罩吸入8％七氟烷复合氧气（4～6L／min）诱导插管,观察在全麻诱导前（T1）、气管插管前（T2）、插管时（T3）、插管后3min（T4）及四个不同时段患儿平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）及不良事件发生率。【结果】全组惠儿麻醉诱导和气管插管期间均未发生明显低氧血症,麻醉诱导平稳,呼吸、心率、血压均能维持在正常范围。【结论】采用8％七氟烷吸入麻醉诱导可以减少小儿困难气管插管中气管插管的风险,且不良反应少。     

Management of ventricular dysrhythmia secondary to trazodone overdose

The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on laryngeal mask airways. Our objective was to assess the effect of altitude on the LMA in both fixed wing and rotary wing models. We performed an in vitro study of the effect of altitude on the LMA cuff. Infant and adult airway trainer mannequins with properly sized and inserted LMA-Classic laryngeal mask airways were monitored for cuff pressure changes while flown at altitudes commonly encountered during air medical transport. Both models demonstrated that LMA cuff pressures may exceed manufacturer recommended levels for safe use even at the relatively low altitudes experienced during rotor wing flight. Properly inserted and inflated laryngeal mask airways at ground level may result in overinflated LMA cuffs when flown to altitudes commonly used for rotor and fixed wing medical transport unless monitored and corrected.