麻醉相关资料：喉罩的使用.pdfVIP

New Extratracheal Airway -LMA COPA- Dong-A University Hospital Chanjong Chung M.D. Airway Management 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 LMA ~ Sizes of Classic LMA Induction for LMA Insertion • Adequate level to obtund laryngeal reflex - propofol 2-2.5 mg/kg thiopental (CJA 1993; 40 : 816) - inhalational agents (sevoflurane) • Muscle relaxant are unnecessary • Insertion techniques Standard Insertion Technique Failure of LMA Insertion Advantages • Compared to face mask - better airway, free hands, reduce fatigue • Compared to ETT - easily placed (even in inexperienced personnel) - not require laryngoscopy or NMB - prevent Cx - hemodynamic 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: 1017 Problems • Airway leak Positive pressure ventilation ? • Regurgitation Risk of aspiration ? • Gastric insufflation • Failed insertion • Pharyngeal /laryngeal trauma • Nerve palsies • Laryngospasm / bronchospasm LMA- Positive Pressure Ventilation Devitt JH et al; Anesthesiology 1994; 80:550 Airway Sealing Pressure-Mucosal Pressure Brimacombe J et al Anesth Analg 1998;:87:1379-82 Rules for Positive Pressure • Largest size of LMA possible • Standard insertion technique • Tidal volume : 6-8 ml/kg • Airway pressure : 15-20 cmH 0 2 • Inflate to only 60 cm H O intracuff pressure 2 • Auscultation of neck • Reverse nm bloc