早产儿麻醉-2011-07PPT.pptVIP

气管异物取出术的麻醉（上周一晨课讲的病例） 中华医学会麻醉分会-----麻醉论坛------儿科麻醉学组专区 WWW. CSAOL.CN/BBS 欢迎大家上网参与讨论 一例早产儿麻醉的思考 左云霞 病例简介 患儿，男，产后2周，但系34周早产。当前体重1.45kg。 诊断：先天性十二指肠梗阻 术前造影 麻醉诱导过程 给予咪唑0.2mg, 芬太尼2ug，吸入1%七氟烷 发生呼吸抑制，不得不控制呼吸。 给予丙泊酚2mg, 实施局部喷1%利多卡因。发生喉痉挛，再次给予丙泊酚2mg ,喉痉挛缓解。 气管插管过程 1号镜片暴露，不能看见会厌 小儿直镜片暴露，仅见会厌，不见声门 怎么办？ 曾经发生的一个病例 新生儿，2.5kg, 急性坏死性肠炎。急诊拟行肠造瘘手术。遭遇没有预料到的气管插管困难，III级。放置入一软管芯后，导入2.5号气管导管，漏气显著。拟换为3号导管，退出2.5号气管导管保留管芯，但始终没能成功。多次饱和度降低和心率减慢。将病情与家长交代后，家长放弃治疗。 请看录像 引导气管探条、可通气管芯和导管交换器 各种技术的联合使用-气管插管探条联合LMA 逆行气管插管 穿刺导管针 注射器 引导钢丝 引导管 * Portex Venn Trachael Tube Introducer? (Smiths Medical ASD, Keene, NH, Hythe, Kent, England), known as the gum elastic bougie, is a 15 Fr, 60 cm in length stylet made from a woven polyester base that is angled 35° at its distal end。A new disposable version is also available called the Single Use Bougie? (Smiths Medical ASD) which is 15 Fr and 70 cm in length hollow and made from PVC. 4-6mm and 6-11mm sizes. Frova Intubating Introducer? (Cook Critical Care, Bloomington, IN) designed to facilitate endotracheal intubation and to allow simple ET exchange. Rapi-Fit? adapters that permit ventilation. Both adult (65cm; ETs 5.5 mm ID) and pediatric (35cm; ETs 3.0-5.0 mm ID)sizes are available. Aintree Intubation Catheter? (Cook Critical Care) can also be used to exchange LMAs and ETs ≥7.0 mm ID using a FOB. Like the Supkis airway exchange catheter (AEC), its hollow lumen allows insertion of a FOB directly through the catheter so that the airway can be visualized during its use.6 Although all of the family of Cook AECs have been designed to be used for jet ventilation, ventilation with the 15 mm adapter should be easier with this AEC because of its shorter length (56 cm) and larger lumen (4.7 mm), if necessary (i.e. jet ventilation system not available).