ReinforcedLMAsforpaediatrictonsillectomy增强小儿扁桃体切除术昆布多糖硫酸酯.pptxVIP

会计学1ReinforcedLMAsforpaediatrictonsillectomy增强小儿扁桃体切除术昆布多糖硫酸酯 第1页/共35页 Day-case tonsillectomy in Epsom98% Day-case discharge rateBenefitscost – effectiveLess pressure on inpatient bedsLess psychological trauma for parents and childrenAnaesthesia 2006, 61, 116 - 122第2页/共35页 Epsom children’s ENT day-case anaesthesia protocolClear fluids up to 2hrs pre-opEMLA or ametopPropofol inductionIV ondansetronOxygen/air/sevofluranerLMA in children aged 3 or olderSpontaneous ventilationIV dexamethasonePR diclofenacPR paracetamolIM codeineIV crystalloids 10ml/kg第3页/共35页 Continued (Post-op)Free fluids and food on demandNursing observations for 6hrs post-opPost-op consultant-led ward roundNurse-led discharge 6hrs post-op第4页/共35页 Theoretical advantages of LMAAvoids neuromuscular blockadeMinimises pharyngeal laryngeal traumaNo endobronchial/oesophageal intubationLess airway soilingAvoids extubation risks DeepAwakeAirway protection until awake第5页/共35页 EvidenceCanadian paeds study (1993)English adult paeds study (1993)Meta-analysis (1996)第6页/共35页 UK practiceClarke et al, BJA 99 (3): 425-8 (2007)Airway management3yrs3-16AdultETT87%79%73%Reusable LMA0.60.61Single-use LMA127Reusable flexi LMA696Single use flexi LMA698第7页/共35页 Ninewells?Prospective survey of LMA use3 critical stages:1. Insertion2. Opening of BD gag3. recovery第8页/共35页 MethodsSimple formAll NW paeds anaesthetists with regular ENT listsMay 2007 – January 200864 patients第9页/共35页 AgeAgen第10页/共35页 WeightWeight in Kg第11页/共35页 LMA size第12页/共35页 Number of insertion attempts第13页/共35页 Quality of fit5761第14页/共35页 Tolerance of Boyle-Davis Gag5623第15页/共35页 Reposition after BD gag insertion?558第16页/共35页 Reposition success?2 successfully repositioned3 converted to ETT第17页/共35页 Conversion to ETTAirway not acceptable with BD gag openSuboptimal fit (? Better with smaller LMA) and “chunky” childLMA obstructed completely with BD gag第18页/共35页 Overall airway quality5652第19页/共35页 RecoveryAll smooth第20页/共35页 ProblemsUnsatisfactory fit – 2Airway c