ʻO nā lāʻau lapaʻau intubation: ʻO nā maʻi me ka pulse ʻole a me ka apnea a i ʻole ka dulling sensory koʻikoʻi hiki ke hoʻokomo ʻia (a pono) ke hoʻokomo ʻia me ke kōkua ʻole o ka lāʻau lapaʻau. Hāʻawi ʻia nā mea maʻi ʻē aʻe i nā lāʻau sedative a me nā paralyzing e hōʻemi i ka ʻeha a hoʻomaʻamaʻa i ka intubation (rapid sequence intubation technique)

Hana mua ma mua o ka intubation

Hoʻokomo pinepine ʻia ka premedication

• 100% oxygen
• Lidocaine
• I kekahi manawa atropine, kahi neuromuscular blocker, a i ʻole ʻelua

Inā loaʻa ka manawa, pono ka mea maʻi e hanu i ka 100% oxygen no 3-5 min; i nā poʻe maʻi olakino ma mua e mālama paha kēia i ka oxygenation maikaʻi a hiki i 8 min.

Hiki ke hoʻohana ʻia ka ventila non-invasive a i ʻole kiʻekiʻe-flow nasal cannula e kōkua i ka pre-oxygenation (1).

ʻOiai i nā maʻi apnea, ua hōʻike ʻia kēlā pre-oxygenation e hoʻomaikaʻi i ka saturation oxygen arterial a hoʻolōʻihi i ka manawa o ka apnea palekana (2).

Eia nō naʻe, pili pono ka koi o ka oxygen a me nā manawa apnea i ka puʻuwai puʻuwai, ka hana o ka māmā, ka helu o ke koko ʻulaʻula, a me nā mea metabolic ʻē aʻe.

Hoʻokumu ka Laryngoscopy i kahi pane pressor me ka piʻi ʻana o ka puʻuwai, ke koko a me ke kaomi endocranial.

No ka ho'ēmiʻana i kēia pane, i ka wā e hiki ai ka manawa, hāʻawi kekahi mau kauka i ka lidocaine ma keʻano o 1.5 mg / kg EV 1 i ka 2 min ma mua o ka hoʻomaha a me ka maʻi lolo.

Loaʻa pinepine nā keiki a me nā ʻōpio i ka hopena vagal (marked bradycardia) i ka pane ʻana i ka intubation a loaʻa i ka manawa like 0.02 mg/kg EV o atropine (ka liʻiliʻi: 0.1 mg i nā pēpē, 0.5 mg i nā keiki a me nā ʻōpio).

Hoʻohui kekahi mau kauka i kahi maʻi liʻiliʻi o ka neuromuscular blocker, e like me ka vecuronium ma kahi ʻano o 0.01 mg/kg EV, i nā mea maʻi ma mua o 4 mau makahiki e pale ai i nā fasciculations muscle i hoʻokumu ʻia e ka nui o ka succinylcholine.

Hiki i nā fasciculations ke hoʻoulu i ka ʻeha o ka ʻiʻo i ke ala ʻana a me ka hyperkalemia transient; akā naʻe, ʻaʻole maopopo ka pōmaikaʻi maoli o ia ʻano hana mua.

Nā lāʻau lapaʻau: hoʻomaha a me analgesia no ka intubation

ʻO ka laryngoscopy a me ka intubation ke kumu o ka pilikia; i nā poʻe maʻi makaʻala, ʻo ka hoʻokele EV o kahi lāʻau pōkole me ka sedative a i ʻole hui pū ʻia a me nā waiwai analgesic he mea pono.

ʻO Etomidate, kahi hypnotic non-barbiturate, ma kahi maʻa o 0.3 mg / kg paha ka lāʻau i koho ʻia.

ʻO ka Fentanyl ma kahi maʻa o 5 mcg/kg (2 a 5 mcg/kg i nā keiki; KA MANAʻO: ʻoi aku ke kiʻekiʻe o kēia maʻa ma mua o ka analgesic a pono e hoʻemi ʻia inā hoʻohana pū ʻia me kahi mea hoʻomaha-hypnotic, e laʻa me propofol a i ʻole etomidate) He koho maikaʻi nō hoʻi a ʻaʻole kumu i ke kaumaha o ka cardiovascular.

ʻO ka Fentanyl he opioid a no laila he analgesic a me nā waiwai sedative.

Eia nō naʻe, i nā kau kiʻekiʻe e hiki mai ana ka paʻa o ka paia o ka umauma.

ʻO ka Ketamine, ma ka nui o 1-2 mg / kg, he anesthetic dissociative me nā waiwai cardiostimulant.

He palekana maʻamau akā hiki ke hoʻololi i ka noʻonoʻo a i ʻole ke ʻano o ke ʻano i ke ala ʻana.

Hoʻohana mau ʻia ʻo Propofol, kahi mea hoʻomaha a me ka amnesic, i ka hoʻokomo ʻana ma nā kumu o 1.5 a i 3 mg/kg EV akā hiki ke hoʻoulu i ka puʻuwai cardiovascular a me ka hypotension ma hope.

ʻO ka Thiopental, 3-4 mg/kg, a me ka methohexital, 1-2 mg/kg, ʻoi aku ka maikaʻi akā hiki ke kumu i ka hypotension a hoʻohana pinepine ʻia.

ʻO nā lāʻau lapaʻau e hoʻoulu ai i ka lolo no ka intubation

ʻO ka hoʻomaha ʻana o nā ʻiʻo iwi me kahi EV neuromuscular blocker e hoʻomaʻamaʻa nui i ka intubation.

ʻO Succinylcholine (1.5 mg / kg EV, 2.0 mg / kg no nā neonates), he neuromuscular blocker depolaring, loaʻa ka wikiwiki loa (30 kekona a 1 min) a me ka lōʻihi o ka hana (3 a 5 min).

Pono e pale ʻia i nā mea maʻi me nā kuni, nā hōʻeha ʻeha o> 1-2 mau lā, spinal ʻeha kaula, maʻi neuromuscular, lawa ʻole o ka renal, a i ʻole ʻeha maka komo.

Ma kahi o 1/15 000 keiki (a me ka liʻiliʻi o nā mākua) loaʻa kahi predisposition genetic i ka hyperthermia malignant ma muli o ka succinylcholine.

Pono e lawelawe mau ʻia ʻo Succinylcholine me ka atropine i nā keiki no ka mea hiki ke alakaʻi i ka bradycardia nui.

ʻO kahi ʻē aʻe, ʻoi aku ka lōʻihi o ka hana neuromuscular blockers non-depolaring (> 30 min) akā ʻoi aku ka lohi o ka hoʻomaka ʻana ke ʻole e hoʻohana ʻia i nā kau kiʻekiʻe e hoʻolōʻihi i ka maʻi maʻi.

ʻO nā lāʻau lapaʻau e pili ana i ka atracurium ma kahi maʻa o 0.5 mg / kg, mivacurium 0.15 mg / kg, rocuronium 1.0 mg / kg a me vecuronium, 0.1-0.2 mg / kg, injected ma luna o 60 kekona.

Nā lāʻau anestheia topical i ka intubation

ʻO ka hoʻokomo ʻana o ka mea maʻi noʻonoʻo (ʻaʻole i hoʻohana pinepine ʻia i nā keiki) pono ka anesthesia o ka ihu a me ka pharynx.

Hoʻohana maʻamau ʻia kahi aerosol o benzocaine, tetracaine, butylaminobenzoate (butamben) a me benzalkonium ma ke kūʻai aku.

ʻO kahi ʻē aʻe, 4% lidocaine hiki ke nebulised a inhaled ma o ka pale maka.

E heluhelu pū nō hoʻi:

Tracheal Intubation: I ka manawa, pehea a no ke aha e hana ai i kahi ala kaʻaima no ka mea maʻi

Hoʻopau Endotracheal i nā maʻi Pediatric: Pūnaewele No nā Alanui Supraglottic

ʻO Positioning Proneing e pale aku ai i ka hoʻoweliweli a i ʻole ka make i nā mea maʻi Covid: Ke aʻo i ka lāʻau Lancet Respiratory Medicine

UK / Keʻena ʻEpekema, Pediatric Intubation: ʻO ke kaʻina hana me kahi keiki i ke kūlana koʻikoʻi

Source:

Nā Manuahi MSD

Nā kuhikuhi no nā lāʻau lapaʻau e hoʻomaʻamaʻa i ka intubation:

• 1. Higgs A, McGrath BA, Goddard C, et al: Nā alakaʻi no ka mālama ʻana i ka intubation tracheal i nā pākeke maʻi koʻikoʻi. Br J Anaesth 120:323–352, 2018. doi: 10.1016/j.bja.2017.10.021
• 2. Mosier JM, Hypes CD, Sakles JC: Hoʻomaopopo i ka preoxygenation a me ka oxygenation apneic i ka wā o ka intubation i ka maʻi koʻikoʻi. ʻO ka mālama kino kino Med 43 (2): 226–228, 2017. doi: 10.1007/s00134-016-4426-0