全麻喉罩通气9例并发症原因分析和护理

喉罩因操作简便、快捷,正确到位率高,通气可靠,插喉罩时不需要过深的麻醉,对咽喉剌激轻[1]。插喉罩时不需要借助喉镜等器械,被广泛应用于临床麻醉、急救复苏等领域[1],特别是困难插管病人也可应用喉罩。喉罩是一种声门上的通气装置,头部位置变动可能使喉罩发生改变,需要一定麻醉深度,患者才能耐受喉罩,因此喉罩使用有一定的适     

喉罩通气在急诊心肺复苏中的应用

目的：探讨喉罩在急诊心肺复苏中的优越性及安全性。方法：将心搏、呼吸骤停患者70例按随机原则选取复苏程序,分为对照组和观察组。对照组采用传统的面罩加压给氧,待麻醉师到场后改用气管内插管,而观察组选用第三代便捷盲插喉罩（LMA-ProSeal喉罩）建立人工气道。结果：SpO2上升时间观察组为（128.8±36.7）s,对照组为（260.1±41.6）s,观察组明显短于对照组（P〈0.05）;喉罩一次置入成功率观察组为98.9%,对照组为71.4%,观察组高于对照组的气管内插管,且置入所花费时间明显较对照组短（P〈0.05）;观察组的复苏成功率与对照组相似（P〉0.05）。结论：喉罩通气在重建人工气道时,具有置入快捷方便、连接准确可靠的优势,值得在急诊急救中推广使用。     

喉罩在急救中的应用32例分析

目的探讨喉罩在急救中建立紧急通气道的方法和作用及其适应证与禁忌证。方法插管型喉罩应用于32例患者,其中28例为心跳呼吸骤停者,4例为肺心病并严重呼吸衰竭者。结果 28例心跳呼吸骤停者复苏成功1例,4例肺心病并严重呼吸衰竭者症状明显好转。结论 LMA用于复苏的优点是容易快速插入喉部进行有效通气,且插入喉罩不影响心脏按压,为进一步抢救赢得时间。喉罩使用的方法简单易行、操作迅速,能进行有效的人工呼吸,气道管理方便、快捷,值得广泛应用于院前,院内急救中紧急气道救援。     

压力模式下新生儿应用喉罩和气管插管时通气有效性的实验研究

喉罩是近年来广泛使用的一种维持病人呼吸道通畅的装置。与喉镜下气管插管相比,喉罩属于一种无创的套囊声门外气道装置。在新生儿1mm的水肿能减少65%的喉部横截面积[1]。1号经典型喉罩已经广泛使用于新生儿手术,困难气道管理与复苏治疗[2]。对于新生儿来说,胸廓短,肺血量丰富而     

喉罩在急救复苏和危重患者中的应用

喉罩通气道（LMA）是由英国医生Dr．ArchieBrain根据解剖成人咽喉结构所研制的一种人工气道,自1981年用于临床以来．应用范围越来越广．1987年以后应用于急救复苏患者,亦被临床医生所认可。欧洲复苏学会、美国心脏学会相继于1996年、2000年批准喉罩用于新生儿、小儿及成人复苏。LMA用于复苏的优点是容易快速插入喉部进行有效通气,且插入喉罩不影响心脏按压．为进一步抢救赢得时间。     

插管型喉罩与常规复苏面罩在院前急救中应用的效果比较

目的探讨2种不同气道建立方式对院前心搏骤停患者通气效果的影响。方法将60例院前急救心搏骤停患者按使用喉罩通气、面罩通气分为两组。A组30例在心脏按压的同时予喉罩置入辅助通气,B组30例给予心脏按压的同时予常规复苏面罩辅助通气。比较两组患者气道装置放置成功时间、呼末二氧化碳值、自主循环恢复率等指标。结果面罩通气建立气道用时短,喉罩通气建立气道用时较长;心脏按压2min、5min呼末二氧化碳值A组高于B组;自主循环恢复率A组高于B组。结论在院前心肺复苏时,早期盲插喉罩通气有利于提高气道通气质量。     

翻转法置入PLMA在小儿心肺复苏中的应用

目的:翻转法置入小儿ProSeal喉罩在心肺复苏中的应用效果。方法:80例CPR过程中需插入食管引流型喉罩(PLMA)的小儿随机分为翻转组(R组)和标准组(S组)两组,对成功置入喉罩时间、置入次数、变换置入方法次数及喉罩漏气,喉罩反折,罩体带血,操作者手指痛感等不良反应和CPR成功率进行比较。结果:R组喉罩置入时间明显短于S组(P<0.05),置入一次成功率明显高于S组(P<0.05),R组操作者手指痛感明显少于S组(P<0.05),CPR成功率R组心肺复苏成功23例(57.5%)明显高于S组15例(37.5%)(P<0.05)。结论:小儿ProSeal喉罩翻转置入法操作快速安全有效,提高抢救成功率。     

喉罩在心肺复苏中的应用

从 1995～ 1998年我们在心肺复苏中应用喉罩建立气道抢救病人取得较好效果 ,现报告如下。1　临床资料与方法1 1　病例选择　成功地应用喉罩建立气道抢救的心肺复苏病人 14例 ,均为住院或急诊科病人 ,其中男 9例 ,女 5例 ,年龄 2 3～ 78岁 ,平均 44 2岁。1 2　方法　根据性别选择喉罩的型号 ,一般男性选择 4号 ,女性选择 3号。将喉罩的罩囊充气 5～ 10ｍｌ,并用生理盐水将喉罩湿润以减少喉罩插入口腔时的阻力。将病人的口张开 ,然后左手牵拉舌头 (或用喉镜推开舌体 ) ,再用右手将喉罩顺势插入直至前端受阻 ,左手固定喉罩之导管 ,右手用空注…     

喉罩的简介与临床应用及护理

英国麻醉师Dr. Archie Brain作为喉罩(LM)的发明人于1983年成功地对1例施行腹腔镜手术插管困难的男性患者应用了喉罩,经过多次试验和改良以后,喉罩于1988年正式应用于临床,它作为一种新型通气道,既可以让患者自主呼吸,又能施行正压通气,属介入气管插管与面罩之间的通气工具,因喉罩使用操作简便,效果可靠,在全球范围的临床麻醉、急救复苏和困难气道处理中被广泛应用,现报道如下:     

喉罩替代气管插管在心肺复苏中的临床应用

目的探讨心肺复苏(CPR)时盲插喉罩通气对复苏成功率的影响。方法将我科2003-06~2007-05所接诊的心跳骤停患者51例作为观察组,应用盲插喉罩通气;另选同期所接诊的心跳骤停患者46例作为对照组,应用气管内插管通气。结果插管所需时间:观察组(28.1±12.6)s;对照组(130±56)s,两组比较差异有统计学意义(P<0.001)。一次插管成功率:观察组盲探下插入喉罩一次成功47例(成功率92%);对照组气管内插管一次成功19例(成功率41.3%),两组比较差异有统计学意义(P<0.01)。复苏成功率:观察组复苏成功25例(成功率49%);对照组复苏成功12例(成功率26%),两组比较差异有统计学意义(P<0.01)。结论在CPR时,盲插喉罩通气具有操作简便、迅速、复苏成功率高的优点,可以代替气管内插管。     

Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing?

OBJECTIVE: To evaluate the impact of the laryngeal mask airway (LMA) on neonatal resuscitation policy. DESIGN: We analyzed retrospectively the records of neonates requiring positive pressure ventilation (PPV) at birth before (1996) and after (2000) the introduction of the LMA into our delivery suites. In addition, the outcome of neonates treated with the LMA was compared with that of neonates matched for gestational age and mode of delivery who were resuscitated using a face mask. RESULTS: During the year 2000, 95 out of 380 (25%) resuscitated neonates were treated with the LMA. The LMA was effective in 94 out of 95 (99%) of these infants. Over the same period, the percentage of neonates receiving tracheal intubation (TI) at birth (34%) was significantly reduced compared with the figure for 1996 (67%). There were no reported complications associated with the use of the LMA. Seventy-four out of the 95 neonates treated with the LMA were considered suitable for matching for gestational age and mode of delivery with 74 neonates treated with a face mask. No differences were found between the two groups for birth weight, Apgar scores, need for tracheal intubation, need for admission to the Neonatal Intensive Care Unit (NICU), primary diagnosis at discharge and primary outcomes. The LMA provided effective ventilation in four neonates in whom the face mask failed. CONCLUSIONS: The LMA is changing neonatal resuscitation practice in our Institution. Our data suggest that it is a safe and useful alternative method for respiratory support in neonates requiring PPV at birth, which merits further study.     

Use of the LMA classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report

In addition to managing the most challenging of airways within the operating room environment, anesthesia providers are frequently consulted or requested to participate in emergency airway control in various areas of the hospital, often after other providers have failed. The following is a case report of a premature infant born with multiple and life threatening congenital anomalies in a rural facility. The current recommendations of the American Heart Association for neonatal resuscitation were followed; however, the resuscitating team was unable to secure the airway using standard intubating techniques. Consultation with the anesthetist on duty resulted in the successful placement of the laryngeal mask airway (LMA) size 1. The pediatrician involved in the care of the patient had minimal experience with using the LMA; however, with verbal instruction was able to successfully place the LMA. With a patent airway established, the patient stabilized and was transferred to a tertiary facility for aggressive care. Although currently not part of the American Heart Association neonatal resuscitation algorithm, consideration of the LMA as a tool to manage an airway after failed attempts at intubation may be appropriate.     

Laryngeal mask airway in neonatal resuscitation: a survey of current practice and perceived role by anaesthesiologists and paediatricians

Objectives: To survey current practice and to compare the opinion of paediatricians and anaesthesiologists regarding laryngeal mask airway (LMA) in neonatal resuscitation. Design: A structured postal questionnaire on the use of the laryngeal mask airway in neonatal resuscitation was sent to the heads of department of the paediatric and anaesthesiology services. Setting: Forty-three hospitals in the Veneto Region, Italy. Results: During the year 2000, 1526 out of 33708 (4.5%) neonates in our region needed resuscitation. Of these cases, 101 (6.6%) were ventilated using the LMA. Laryngeal mask airway availability was significantly greater in the anaesthesiology department compared to the paediatric department (90% versus 50%; P=0.002). However, 52% of anaesthesiologists and 72% of paediatricians had never used the laryngeal mask airway in their practice. The laryngeal mask airway was considered as an essential device more frequently by the anaesthesiologists than by the paediatricians (27% versus 5%; P=0.015); both groups considered the laryngeal mask airway particularly useful in specific situations. Interestingly, while 16% of the paediatricians described the laryngeal mask airway as having no value, none of the anaesthesiologists did (P=0.002). Staff competence was considered low by 70% of anaesthesiology heads of department compared with 90% of their pediatric colleagues. In both specialties, use of the laryngeal mask airway was limited to medical staff. With regard to training, 35% of anaesthesiologists and 22.5% of paediatricians had attended a course on laryngeal mask airway use. Conclusions: Laryngeal mask airway availability and perceived value were higher amongst anaesthesiologists than their paediatric colleagues. However, educational level, competence and utilization rates of the LMA in neonatal resuscitation were low in both groups.     

A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation

Objective

To study the feasibility, efficacy and safety of using the laryngeal mask airway (LMA) in neonatal resuscitation.

Methods

In total, 369 neonates (gestational age ≥34 weeks, expected birth weight ≥2.0 kg) requiring positive pressure ventilation at birth were quasi-randomised to resuscitation by LMA (205 neonates) or bag-mask ventilation (164 neonates).

Results

(1) Successful resuscitation rate was higher with the LMA compared with bag-mask ventilation (P < 0.001) and the total ventilation time was shorter with the LMA than with bag-mask ventilation (P < 0.001). Seven of nine neonates with an Apgar score of 2 or 3 at 1 min after birth were successfully resuscitated in the LMA group, while in the BMV group all six neonates with an Apgar score of 2 or 3 at 1 min required tracheal intubation and ventilation. In neonates with an Apgar score of 4 or 5 at 1 min after birth, successful resuscitation rate with the LMA was higher than with bag-mask ventilation (P < 0.01). (2) Successful insertion rate of the LMA at the first attempt was 98.5% and the insertion time was 7.8 s ± 2.2 s. There were few adverse events (vomiting and aspiration) in the LMA group.

Conclusion

The LMA is safe, effective and easy to implement for the resuscitation of neonates with a gestational age of 34 or, more weeks.     

Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Aim

This observational study aims to describe: (1) the use of positive pressure ventilation (PPV) for resuscitation in the delivery room among newly born near-term infants; (2) the methods used for PPV resuscitation [e.g., bag-facial mask (BFM), laryngeal mask airway (LMA), endotracheal tube (ETT)]; and (3) the association of each device with short-term neonatal outcomes.

Methods

We identified near-term (34 0/7-36 6/7 weeks) infants delivered at the Padua University Hospital (Padua, Italy) during the years 2002-2006. The mode of delivery, gestational age, birth weight, Apgar scores, methods of resuscitation and respiratory outcome after NICU admission were analysed.

Results

During the 5-year study period, 921 (4.9%) near-term infants were identified from a total of 18,641 live births. PPV was provided in the delivery room to 86 (9.3%) of these infants. Among them, 36 (41.8%) were managed by LMA, 34 (39.5%) by BFM and 16 (18.6%) by ETT. Thirty-four (39.5%) resuscitated near-term infants were admitted to the Neonatal Intensive Care Unit (NICU): 15 (44.1%) after BFM, 12 (75%) after ETT and seven (19.4%) after LMA. Resuscitation with an ETT was associated with an increased rate of respiratory distress syndrome when compared with either BFM or LMA. Resuscitation with an LMA was associated with a lower rate of NICU admission and shorter length of stay when compared with either BFM or ETT.

Conclusion

The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation.     

T-cell responsiveness to specific group A streptococcus antigens in patients with recurrent erysipelas

Peripheral blood leukocytic migratory activity (LMA) was studied in 51 patients with recurrent erysipelas versus 63 patients with primary erysipelas. To reveal LMA, the authors employed in vitro a screening cell migration test as an indicator of the cooperation of T and B lymphocytes and macrophages, by stimulating with polysaccharide A, surface proteins, L-antigen, hyaluronidase, streptolysine-O, and a complete set of Grasse S. pyogenes. In patients with recurrent erysipelas, undulating LMA changes were found in the course of the disease in response to the stimulation with partial specific S. pyogenes antigens. There were differences in the time course of LMA changes, when stimulated with specific surface streptococcus antigens and with components of streptococcus with toxic activity. Significant LMA differences were found in relation to the pattern of a local process: active LMA changes from acceleration to suppression in the erythematous-hemorrhagic form and hyperergic reactions of LMA acceleration in the bullous-hemorrhagic one.     

Feasibility of Laryngeal Mask Airway Use by Prehospital Personnel in Simulated Pediatric Respiratory Arrest

Introduction. Pediatric respiratory arrest is a technically challenging scenario infrequently faced by prehospital providers. Prehospital endotracheal intubation (ETI) is a complex procedure, andone study showed that it may result in worse neurological outcome in these patients. Alternatives to ETI include bag-valve-mask (BVM) ventilation andthe laryngeal mask airway (LMA). Although the LMA has been used successfully for pediatric resuscitation in the hospital setting, there is no data describing its use in the prehospital setting. Hypothesis. Prehospital providers can successfully place andventilate the pediatric LMA in a simulated pediatric respiratory arrest. Methods. Paramedic students received a 1-hour training session covering the use of the pediatric LMA. Subjects performed airway management of a simulator manikin using both the LMA andthe BVM. Rate of successful LMA placement, time to first ventilation, tidal volume by weight, andventilations per minute were recorded. A generalized estimating equation analysis was completed to determine the effects of time andventilation technique. Results. All 13 subjects (100%) successfully ventilated the mannequin with both techniques. The median number of attempts required to successfully place the LMA was one. Median time from the start of the scenario to BVM ventilation was 4 seconds (IQR 3, 5), andthe median for LMA ventilation was 30 seconds (IQR 25, 52). Tidal volumes were significantly greater with BVM ventilation (5.07 mL/kg [IQR 4.47, 5.43]) than with LMA ventilation (2.88 mL/kg [IQR 2.17, 4.04]). An obvious air leak was present in all LMA cases, potentially resulting in reduced tidal volume delivery. Excessive ventilatory rates were noted in both BVM (42 ventilations per minute [IQR 33, 46]) andLMA (37 ventilations per minute [IQR 31, 39]) groups. Conclusions. Prehospital providers were able to place andventilate a simulated pediatric respiratory arrest patient using the LMA after a brief educational intervention. Obvious air leakage was noted when ventilating with the LMA andlikely represents one technical limitation of using a simulator.     

Choosing the correct laryngeal mask airway sizes and cuff inflation volumes in pediatric patients

The laryngeal mask airway (LMA) is now standard airway management equipment in prehospital and Emergency Department (ED) care. Most providers may not be able to match the pediatric LMA sizes to the appropriate weights of pediatric patients. The exact inflation volumes are also difficult to memorize. To overcome this problem, we propose the following equations: Weight (kg) of patient = 2(2 x LMA), where LMA is the size; cuff inflation volume (mL) = 5 x LMA.     

Insertion of a folded laryngeal mask airway around a palatal torus

The laryngeal mask airway (LMA) is an airway management device that is used to establish and maintain a patent airway for the patient. A palatal torus is a common benign bony exostosis, usually located in the midline of the palate, beneath the palatal mucosa. It should be recognized by the CRNA during the preoperative anesthetic assessment. A palatal torus can hinder insertion of the LMA when using the standard LMA insertion technique. Therefore, modification must be made to the operator's insertion technique with a folded LMA around a palatal torus.