插管探条临床应用.pptVIP

插管探条之临床应用 陳昭良主任 彰化基督教醫院麻醉科 If this is a Difficult Intubation situation. What are our back-up plans ??? What other gadgets do we have ??? From Below the Glottis (Invasive) Transtracheal Jet Ventilation (TTJV) Retrograde Intubation Percutaneous dilational tracheal entry Surgical Airway From Above the Glottis Laryngoscope ± Gum Elastic Bougie Blind Oral/Nasal Intubation Fiberoptic Bronchoscopy Intubating LMA (Fastrach?) GlideScope? Lighted Stylet (Trachlight?) Optical Stylet Eschmann tracheal tube introducer “Gum Elastic Bougie” History of Gum Elastic Bougie The Eschmann tracheal tube introducer (gum elastic bougie) was marketed in the United Kingdom (UK) in the early 1970s. It differs from previous introducers in its greater length (60 cm), angled tip, and the combination of flexibility and malleability. Lighted Stylet (Lightwand)光棒 History of Lighted Stylet The first reported use of a lighted stylet used to facilitate intubation came in 1957. Macintosh described an 18-inch illuminated tracheal tube introducer, which was designed to stiffen the tube and better illuminate the cords by supplementing the light of the laryngoscope. Anaesthesia 1957; 12:223–5 History of Lighted Stylet Yamamura et al. described a light bulb-tipped wire that was inserted into the tracheal tube before blind nasal intubation in awake patients. The tube position was then determined by the medial transillumination of the external throat and neck. Anesthesiology 1959; 20:221 History of Lighted Stylet In 1977, Foster used a transilluminating fiberoptic bundle to facilitate tracheal intubation in a young child with trismus. Anaesthesia 1977; 32:1038 Ducrow used a Flexi-lum? to achieve the same end by first passing a guide into the trachea followed by passage of the tracheal tube over the guide. Anaesthesia 1978; 33:827–9 History of Lighted Stylet Rayburn commented that the Flexi-lum? (flexible surgical light) could be positioned inside the tracheal tube, thereby shortening the