ppt课件-difficultairwaymanagementprotocols-srm.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 2. Quick Look The patient may be sedated for an attempt at direct laryngoscopy WITHOUT muscle relaxation (“Quick Look”) There is some risk of failed laryngoscopy but There should be a low risk of failed mask ventilation. 3. Induction Paralysis The patient may be induced and paralyzed, In this case the patient is assessed as having a low risk of laryngoscopy and/or mask ventilation ? Pre-oxygenation: How Much Is Enough? Two techniques common in use: Tidal volume breathing (TVB) of oxygen for 3–5 min Deep breaths (DB) 4 times within 0.5 min Both are equally effective in increasing arterial oxygen tension (Pao2). Anesth Analg 1981; 60: 313–5 Each subject received 5 mg/kg thiopental and 1 mg/kg succinylcholine. Anesthesiology 2001, 95: 754-759 Spontaneous recovery from succinylcholine-induced apnea may not occur sufficiently quickly to prevent hemoglobin desaturation in subjects whose ventilation is not assisted. Pre-oxygenation What are we going to do if we don’t get the Tube? Plans “A”, “B” ,“C” and plan “D”. Know this answer before you tube. Failure -Why does it happens? No critical discussion with colleagues about proposed management plan No request for experienced help Exaggerated idea of personal ability Ill-conceived plan A and/or plan B Poorly executed plan A and/or plan B Persisting with plan A too long, starting the rescue plan too late Not involving, and preparing, surgical colleagues GALLERY OF TOOLS ILMA Video laryngoscopes Malleable video stillet- Levitan scope Fibreoptic bronchoscope ELECTIVE EMERGENCY  Old case of Hemi-mandibulectomy with forehead flap with trismus for block dissection of neck nodes ELECTIVE Anesthesia of choice - G.A. Intubating technique of choice  ? MANAGEMENT PLAN OF UNANTICIPATED DIFFICULT AIRWAY * * TheUnexpec