超聲在氣道管理中的應(yīng)用ppt課件

1、上 海 交 通 大 學(xué) 附 屬 第 六 人 民 醫(yī) 院 麻 醉 科趙達強 超聲在氣道管理中的應(yīng)用2019-5-27上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital頸部氣道解剖上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital定位喉上神經(jīng)The thyrohyoid membrane as a target for block of the internal branch of the superior laryngeal nerveStopar-Pintaric T, Vlassakov K, Azman J.J Clin Anes

2、th.2019 Nov ; 27(7): 548-52.In conclusion, we are proposing an anatomical concept for a US-guided iSLN block technique using the thyrohyoid membrane to define the target plane for low-volume local anesthetic injection.上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital外側(cè)外側(cè)舌骨舌骨外側(cè)外側(cè)舌骨舌骨超聲影像舌骨、喉上神經(jīng)外側(cè)外側(cè)過拱橋，甲舌膜里尋喉上

3、上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital定位環(huán)甲膜The conventional method, inspection and palpation, has a low success rate, especially in women (2435%).Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannula Elliott DS, Baker PA, Scott MR, et al. Accuracy of surfac

4、e landmark identification for cannula cricothyroidotomy.Anaesthesia 2019; 65: 88994cricothyroidotomy.Anaesthesia 2019; 65: 88994 Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by a

5、nesthesia trainees and staff in a Canadian institution. Can J Anaesth 2019; 62: 495503anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2019; 62: 495503上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院Shanghai Sixth Peoples HospitalSiddiqu

6、i N, Arzola C, Friedman Z, et al.Anesthesiology.2019 Nov;123(5):1033-41. 定位環(huán)甲膜 Improves Cricothyrotomy Success inCadavers with Poorly Defined Neck AnatomyUltrasound guidance significantly decreased the incidence of injuries to the larynx and trachea Increased the probability of correct insertion by

7、5.6 times in cadavers with difficult and impossible landmark palpation.上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital外側(cè)外側(cè)甲狀軟骨甲狀軟骨聲帶聲帶聲帶聲帶環(huán)甲膜環(huán)甲膜外側(cè)外側(cè)超聲影像甲狀軟骨、環(huán)甲膜外側(cè)外側(cè)越尖峰，缺口越尖峰，缺口偽影偽影環(huán)甲膜環(huán)甲膜甲狀軟骨甲狀軟骨聲帶聲帶聲帶聲帶偽影偽影上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital超聲影像環(huán)狀軟骨環(huán)狀軟骨外側(cè)外側(cè)氣管軟骨氣管軟骨甲狀腺峽部甲狀腺峽部外側(cè)外側(cè)氣管軟骨氣管軟骨外側(cè)外側(cè)上海市第六人民醫(yī)院Sh

8、anghai Sixth Peoples HospitalUltrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessIida T,Suzuki A, Kunisawa T,et al. J Anesth (2019) 27:309310臨床應(yīng)用1清醒插管上海市第六人民醫(yī)院Shanghai Sixth Peoples HospitalGuided Superior Larynge

9、al Nerve Block During Awake Fiberoptic IntubationSawka A, Tang R, Vaghadia H.A A Case Rep.2019 Apr 15; 4(8): 107-10.Sonographically guided superior laryngeal nerve block may be in patients where identification of landmarks in the neck is as a result of patient anatomy臨床應(yīng)用1清醒插管上海市第六人民醫(yī)院Shanghai Sixth

10、 Peoples Hospital臨床應(yīng)用1清醒插管Ultrasound-guided Cannula CricothyroidotomySuzuki A,Iida T, kunisawa T,et al.Anesthesiology 2019 Nov;117(5):1128Ultrasound-assisted translaryngeal block for awake fibreoptic intubationDe Oliveira GSJr, Fitzgerald P, Kendall M.Can J Anesth. 2019 58:664665上海市第六人民醫(yī)院Shanghai Si

11、xth Peoples Hospital臨床應(yīng)用1清醒插管病態(tài)肥胖病態(tài)肥胖 BMI 60BMI 60上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用1清醒插管上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用1清醒插管上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用2判斷喉鏡顯露困難氣管軟骨氣管軟骨外側(cè)外側(cè)食管食管甲狀腺甲狀腺Wu J,Dong J, Ding Y, et al.Med Sci Monit, 2019; 20: 2343-2350Role of anterior

12、 neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyAnterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy.Combinations of those screening tests or ri

13、sk factors with US measurements might increase the ability to predict difficult laryngoscopy.上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用2判斷喉鏡顯露困難氣管軟骨氣管軟骨外側(cè)外側(cè)食管食管甲狀腺甲狀腺上海市第六人民醫(yī)院Shanghai Sixth Peoples HospitalUltrasonographic measurement of the minimal transverse diameter of the subglottic airway in

14、the transverse plane, typically at the caudal outlet of the cricoid ring臨床應(yīng)用3選擇適合氣管導(dǎo)管上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用4判斷氣管導(dǎo)管位置氣管軟骨氣管軟骨外側(cè)外側(cè)食管食管甲狀腺甲狀腺上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用4判斷氣管導(dǎo)管位置THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOTRA

15、CHEAL TUBE PLACEMENT IN A CADAVER MODELDynamic assessment resulted in sensitivity and specificity for detecting esophageal ET placement. Static assessment resulted in only sensitivity and specificity.Ma G,Davis DP, Schmitt J, et al.J Emerg Med.2019 May;32(4):405-7. 上海市第六人民醫(yī)院Shanghai Sixth Peoples Ho

16、spital氣管插管過程中環(huán)甲膜改變上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital氣管導(dǎo)管氣囊充氣表現(xiàn)上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用5判斷喉罩位置Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placementSonographic upper airway assessment emerges as a to predict difficult intuba

17、tion, to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ.Wojtczak JA,Cattano D.Journal of Ultrasonography 2019; 14: 362366上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用5判斷喉罩位置Unique喉罩的位置ESupreme喉罩的位置E上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨

18、床應(yīng)用6定位氣管切開Real-time ultrasound-guided percutaneousdilatational tracheostomy: a feasibility studyPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears , including in patients with . Venkatakrishna Rajajee, Jeffrey J Fletcher, Lauryn R Rochlen, et al.Critical

19、Care 2019, 15:R67上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用6定位氣管切開Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trialUltrasound guidance significantly improved the rate of firs

20、t-pass puncture and puncture accuracy. Fewer procedural complications were observed; however, this did not reach statistical significance. These results support wider general use of real-time ultrasound guidance as an additional tool to improve PDT.Mt Rudas, Ian Seppelt, Robert Herkes,et al.Critical Care 2019, 18:514上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用6定位氣管切開上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臨床應(yīng)用6定位氣管切開上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital其他的臨床應(yīng)用1迅速準(zhǔn)確建立通氣Mallin M, Curtis K, Dawson M,et al.Am J Emerg Med 2019 Jan;32(1):61-3.Accuracy of ultrasound-guided marking of