第4章气管及支气管内插管.ppt

气管及支气管内插管 气道（airway） ：呼吸道 呼吸管理：保持呼吸道通畅和气体交换良好 呼吸管理是麻醉科最重要的业务工作之一，也是每一个麻醉科医师必须掌握的重点技能 在气道内根据具体情况置入不同类型的通气道（airway），包括口咽通气管、鼻咽通气管、喉罩通气管、气管内导管或支气管内导管等 可以主动掌握气道通畅，施行控制呼吸 第一节 插管前准备和麻醉 气道评估 插管器具准备 插管前麻醉 EVALUATION OF THE AIRWAY History Physical Examination Further Evaluation EVALUATION OF THE AIRWAY —— History A history of difficult airway management in the past may be the best predictor of a challenging airway Particular importance should also be placed on diseases that may affect the airway. EVALUATION OF THE AIRWAY —— History If old medical records are available, prior anesthetic records should be reviewed for the ease of intubation and ventilation number of intubation attempts ability to mask ventilate type of laryngoscope blade used use of stylet any other modifications of intubation technique EVALUATION OF THE AIRWAY —— History Arthritis or cervical disk disease —— decrease neck mobility → spinal cord injury Infections of the floor of the mouth, salivary glands , tonsils, or pharynx —— cause pain, edema, and trismus with limited mouth opening Tumors —— obstruct the airway extrinsic compression ，tracheal deviation Morbidly obese individuals —— have a history of obstructive sleep apnea from hypertrophied tonsils and adenoids, as well as a short neck or increased soft tissue at the neck and upper airway. EVALUATION OF THE AIRWAY —— History Trauma may be associated with airway injuries, cervical spine injury, basilar skull fracture, or intracranial injury Previous surgery, radiation, or burns may produce scarring , contractures, and limited tissue mobility Acromegaly肢端巨大症may cause mandibular hypertrophy and overgrowth and enlargement of the tongue and epiglottis The glottic opening may be narrowed because of enlargement of the vocal cords EVALUATION OF THE AIRWAY History Physical Examination Further Evaluation EVALUATION OF THE AIRWAY—— Physical Examination 1. Specific findings that may indicate a difficult air