喉罩的使用-麻醉（英文）.ppt

Using the Laryngeal Mask Airway Norman L. Goody, MD Objective Using the LMA LMA and the Difficult Airway LMA and Pediatric Anesthesia LMA and OB Anesthesia Advantages of Using the LMA Disadvantages of the LMA Complications Arising from Use of the LMA Contraindications to Using the LMA History of the LMA development began in 1981 at Royal London Hospital by Dr. Archie Brain modification of the Goldman Dental Mask available commercially in UK since 1988 and in the US since 1992 now used in 50% of general anesthetics in some centers in UK (and probably US, too- especially ambulatory surgery) Characteristics of the LMA Latex free, medical-grade silicone Aperture bars Sizes #1 6.5 kg 2-5 ml #2 6.5-25 kg 7-10 ml #2 1/2 20-30 kg 14 ml #3 25-70 kg 15-20ml #4 70+ kg 25-30ml Using the LMA Preparation of the LMA Check patency of cuff Lubricate POSTERIOR surface only Surgilube v. lidocaine jelly Induction Insertion of the LMA Common Problems Cricoid Pressure Securing the LMA Using the LMA Maintenance of Anesthesia Removal of the LMA Cleaning, Sterilization and Re-use Determining Life Span of LMA intended for 40-50 uses, but highly over-manufactured tube remains translucent aperture bars remain intact cuff deflates correctly no valve leakage cuff remains symmetric pilot balloon retains shape connector remains tight/ not broken THE LMA IS NOT DISPOSABLE LMA and the Difficult Airway Awake Intubation Difficult MASK Airway Blind Intubation Failed Intubation Fiberoptic Bronchoscopy and the LMA Emergent Intubation by an Unskilled Provider LMA and Pediatric Anesthesia DLB tracheal stenosis difficult airway Accuracy of End-tidal CO2 in Pediatrics using LMA 22 children, mechanically ventilated to a stable ETCO2 ventilation via the LMA mean ETCO2 and PaCO2 obtained were 37.7 +/- 3.3 and 41.9 +/- 9.09, respectively ventilation via ETT mean ETCO2 and PaCO2 obtained were 35.2 +/- 2.9 and 39.2 +/