1、1ppt课件New Extratracheal Airway New Extratracheal Airway-LMA&COPA-LMA&COPA-2ppt课件Airway Management3ppt课件Laryngeal Mask Airway(LMA)Laryngeal Mask Airway(LMA)Dr A.I.J.Brain(1981)UK(1988),US(1991)Types of LMA Classic LMA Reinforced flexible LMA(RLMA)Intubating LMA(ILMA)Gastric LMA4ppt课件5ppt课件Sizes of Cl
2、assic LMASizes of Classic LMA6ppt课件Induction for LMA InsertionInduction for LMA InsertionAdequate level to obtund laryngeal reflex -propofol 2-2.5 mg/kg thiopental (CJA 1993;40:816)-inhalational agents(sevoflurane)Muscle relaxant are unnecessaryInsertion techniques7ppt课件Standard Insertion TechniqueS
3、tandard Insertion Technique8ppt课件Failure of LMA InsertionFailure of LMA Insertion9ppt课件AdvantagesAdvantagesCompared to face mask -better airway,free hands,reduce fatigueCompared to ETT -e a s i l y p l a c e d (e v e n i n inexperienced personnel)-not require laryngoscopy or NMB-prevent Cx -hemodyna
4、mic and IOP stability -well tolerated at light plane-clear airway -lower incidence of sore throat(7-12%)-useful in difficult intubation Meta-analysis:Brimacombe CJA 1995;42:101710ppt课件ProblemsProblemsAirway leak Positive pressure ventilation?Regurgitation Risk of aspiration?Gastric insufflationFaile
5、d insertion Pharyngeal/laryngeal traumaNerve palsiesLaryngospasm/bronchospasm11ppt课件LMA-Positive Pressure VentilationLMA-Positive Pressure VentilationDevitt JH et al;Anesthesiology 1994;80:550 12ppt课件Airway Sealing Pressure-Mucosal PressureBrimacombe J et al Anesth Analg 1998;:87:1379-8213ppt课件Rules
6、 for Positive PressureRules for Positive PressureLargest size of LMA possible Standard insertion techniqueTidal volume:6-8 ml/kgAirway pressure:15-20 cmH20Inflate to only 60 cm H2O intracuff pressureAuscultation of neckReverse nm block while still deepRemoval only when fully awake14ppt课件Airway Press
7、ure in LMA&ETT Berry A et al Anesthesiology 1999:90;395-715ppt课件Influence of Head/Neck PositionInfluence of Head/Neck Position Leak pressure Fiberoptic score A d u l t C h i l d r e n Adult Children Neutral 20.1 21 5/9/4/2 7/11/5/1 Flexion 25.1 26 3/10/4/3 2/10/5/7 Rotation 21.6 22 3/10/5/2 6/12/4/2
8、 Extension 17.2 18 3/10/5/2 10/10/3/1 Keller et al;Anesth Analg 1999;88:913-6 Okuda et al;Anesth Analg 2000;90:S226 16ppt课件Aspiration Related to LMA Aspiration Related to LMA Brimacombe&Berry(1995);J Clin A 7:297 -LMA Meta-analysis;3/12,901 -ETT:0.026%(Warner MA et al;A 1993:78:65-62)Cho DK et al;KJ
9、A1997;32:377-83-2 hr,PPV,methylene blue&pH 20 cmH20).Whenever access to patients airway is difficult or ETT cannot readily accomplished(prone,lateral,Jackknife position)28ppt课件Intubating LMAIntubating LMAA new concept in intubationDesigned for the difficult airwayNo head or neck movementSingle-hande
10、d insertionApproach patient from any anglePermits ventilation between attemptsSize:No.3,4,5(LMA-TastrachTM)29ppt课件Blind Intubation through ILMABlind Intubation through ILMA Up to ID 8 mm ETT Not require neck and head manipulation 99.3%success rate for blind intubation Brain AIJ et al;BJA 1997:79;704
11、 Helpful in cervical spine operation Nakazawa K et al;Anesth Analg 89:1319 36/40:blind,4/40 fiberoptic Asai T et al CJA 1999,46,2:182-184 interdental gap 1-2cm30ppt课件Tips for Use of LMATips for Use of LMA31ppt课件Gastric LMAGastric LMALopez-gil M et al BJA 1999;82:132-432ppt课件Cuffed Oropharyngeal Airw
12、ay(COPA)Cuffed Oropharyngeal Airway(COPA)1992 Greenberg and Toung Modifed Guedel airway with distal cuff and proximal 15 mm connector 4 sizes(8,9,10,11)33ppt课件InIn Spontaneous Breathing Spontaneous Breathing AnesthesiaAnesthesia COPA LMA (n=302)(n=151)First insertion 81%89%No of airway manipulation
13、1.1(1.6)0.1(0.2)Continuous airway support 30%0%Blood on device 5.8%15.3%Sore throat 4.7%21.9%Greenberg RS et al;Anesthesiology 1998;88:970-734ppt课件Adjuvant to fiberoptic tracheal Adjuvant to fiberoptic tracheal intubationintubationUezono S et al;Anesthesiology 1998;88:1677Greenberg&Kay;BJA 82;39535ppt课件For Ambulatory AnesthesiaWhich One?LMACOPAMAC36ppt课件Thank you!For better airway management37ppt课件
