超声在气道管理中应用

上 海 交 通 大 学 附 属 第 六 人 民 医 院 麻 醉 科 赵达强 超声在气道管理中的应用 2016-5-27 上海市第六人民医院 Shanghai Sixth Peoples Hospital 颈部气道解剖 上海市第六人民医院 Shanghai Sixth Peoples Hospital 定位喉上神经 The thyrohyoid membrane as a target for ultrasonography-guidedultrasonography-guided block of the internal branch of the superior laryngeal nerve Stopar-Pintaric T, Vlassakov K, Azman J. J Clin Anesth.2015 Nov ; 27(7): 548-52. In conclusion, we are proposing an anatomical concept for a new, new, simpler, consistently reproduciblesimpler, consistently reproducible US-guided iSLN block technique using the thyrohyoid membrane to define the target plane for low- volume local anesthetic injection. 上海市第六人民医院 Shanghai Sixth Peoples Hospital 外侧 舌骨 外侧 舌骨 超声影像舌骨、喉上神经 外侧 过拱桥，甲舌膜里寻喉上 上海市第六人民医院 Shanghai Sixth Peoples Hospital定位环甲膜 The conventional method, inspection and palpation, has a low success rate, especially in women (2435%). Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010; 65: 88994 Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495503 上海市第六人民医院 Shanghai Sixth Peoples Hospital Barbe N,Martin P,Pascal J,et al. Ann Fr Anesth Reanim.2014 Mar;33(3):163-6. 定位环甲膜 Locating the cricothyroid membrane in learning phase: Value of ultrasonography ? The CTM was accurately identified by palpation and ultrasound by 46% and 100% 46% and 100% of residents respectively (P 0.05). 上海市第六人民医院 Shanghai Sixth Peoples Hospital Kristensen MS, Teoh WH, Rudolph SS,et al. Br J Anaesth. 2015 Jun;114(6):1003-4. 定位环甲膜 Structured approach to ultrasound-guidedultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly obesemorbidly obese When using the conventional digital palpation method, 13 of 35 anaesthetists (37%) were able to locate the cricothyroid membrane successfully within 2 min, whereas the success rate was 29 of 35 (83%) when the structured stepwise ultrasonography method was applied (P=0.0008, McNemars test). 上海市第六人民医院 Shanghai Sixth Peoples Hospital Siddiqui N, Arzola C, Friedman Z, et al. Anesthesiology.2015 Nov;123(5):1033-41. 定位环甲膜 Ultrasound Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy Ultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation. 上海市第六人民医院 Shanghai Sixth Peoples Hospital 外侧 甲状软骨 声带 声带 环甲膜 外侧 超声影像甲状软骨、环甲膜 外侧 越尖峰，缺口伪影环甲膜 甲状软骨 声带 声带 伪影 上海市第六人民医院 Shanghai Sixth Peoples Hospital超声影像 环状软骨 外侧 气管软骨 甲状腺峡部 外侧 气管软骨 外侧 上海市第六人民医院 Shanghai Sixth Peoples Hospital Ultrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscess Iida T,Suzuki A, Kunisawa T,et al. J Anesth (2013) 27:309310 临床应用1清醒插管 上海市第六人民医院 Shanghai Sixth Peoples Hospital Sonographically Sonographically Guided Superior Laryngeal Nerve Block During Awake Fiberoptic Intubation Sawka A, Tang R, Vaghadia H. A A Case Rep.2015 Apr 15; 4(8): 107-10. Sonographically guided superior laryngeal nerve block may be usefuluseful in patients where identification of landmarks in the neck is difficultdifficult as a result of patient anatomy 临床应用1清醒插管 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用1清醒插管 Ultrasound-guided Cannula Cricothyroidotomy Suzuki A,Iida T, kunisawa T,et al. Anesthesiology 2012 Nov;117(5):1128 Ultrasound-assisted translaryngeal block for awake fibreoptic intubation De Oliveira GSJr, Fitzgerald P, Kendall M. Can J Anesth. 2011 58:664665 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用1清醒插管 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用1清醒插管 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用1清醒插管 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用2判断喉镜显露困难 气管软骨 外侧 食管 甲状腺 Wu J,Dong J, Ding Y, et al. Med Sci Monit, 2014; 20: 2343-2350 Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopy Anterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy. 上海市第六人民医院 Shanghai Sixth Peoples Hospital 临床应用2判断喉镜显露困难 气管软骨 外侧 食管 甲状腺 上海市第六人民医院 Shanghai Sixth Peoples Hospital Ultrasonographic measurement of the minimal transverse diameter of the subglottic airway in the transverse plane, typically at the caudal outlet of the cricoid ring 临床应用3选择适合气管导管 上海市第六人民医院 Shanghai Sixth Peoples Hospital临床应用4判断气管导管位置 气管软骨 外侧 食管 甲状腺 上海市第六人民医院 Shanghai Sixth Peoples Hospital临床应用4判断气管导管位置 THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOT