Ọgwụ intubation: Ndị ọrịa na-enweghị mkpụkọ na apnea ma ọ bụ mmetụta uche siri ike nwere ike (ma kwesịrị) etinye ya na-enweghị enyemaka ọgwụ. A na-enye ndị ọrịa ndị ọzọ ọgwụ na-akụda mmụọ na nke ahụ mkpọnwụ iji belata ahụ erughị ala ma kwado nbata (usoro intubation ngwa ngwa)

Tupu ọgwụgwọ tupu intubation

Ọgwụ ọgwụ na-agụnyekarị

• 100% oxygen
• Lidocaine
• Mgbe ụfọdụ atropine, neuromuscular blocker, ma ọ bụ abụọ

Ọ bụrụ na enwere oge, onye ọrịa kwesịrị iku ume 100% oxygen maka 3-5 min; N'ime ndị ọrịa nwere ahụike mbụ nke a nwere ike idowe ikuku oxygen na-eju afọ ruo nkeji 8.

Enwere ike iji ikuku ikuku na-adịghị emerụ ahụ ma ọ bụ cannula imi na-eru eru iji nyere aka tupu ikuku oxygenation (1).

Ọbụlagodi na ndị na-arịa ọrịa apnea, egosipụtara tupu oxygenation dị otú ahụ iji meziwanye saturation oxygen na akwara na-agbatị ogologo oge nke apnea dị mma (2).

Otú ọ dị, ọchịchọ oxygen na oge apnea na-adabere chiri anya na ọnụọgụ obi, ọrụ ngụgụ, ọnụ ọgụgụ ọbara ọbara uhie, na ọtụtụ ihe ndị ọzọ na-akpata metabolic.

Laryngoscopy na-eme ka nzaghachi onye nta akụkọ na-enwe ọmịiko na-enwe mmetụta ọmịiko na mmụba nke ọnụọgụ obi, ọbara mgbali elu na nrụgide endocranial.

Iji belata nzaghachi a, mgbe oge na-enye ohere, ụfọdụ ndị dọkịta na-enye lidocaine na dose nke 1.5 mg / kg EV 1 ruo 2 min tupu nkwụsịtụ na ahụ mkpọnwụ.

Ụmụaka na ndị nọ n'afọ iri na ụma na-enwekarị mmeghachi omume vagal (akara bradycardia) na nzaghachi na intubation ma na-enweta 0.02 mg / kg EV nke atropine (opekempe: 0.1 mg na ụmụ ọhụrụ, 0.5 mg na ụmụaka na ndị nọ n'afọ iri na ụma).

Ụfọdụ ndị dọkịta na-ejikọta obere dose nke ihe mgbochi neuromuscular, dị ka vecuronium na dose nke 0.01 mg / kg EV, na ndị ọrịa> 4 afọ iji gbochie mkpali akwara nke na-akpata site na oke dose nke succinylcholine.

Ọkpụkpụ ahụ nwere ike ịkpata mgbu anụ ahụ na edemede yana hyperkalemia na-agafe agafe; Otú ọ dị, ezigbo uru nke ọgwụgwọ dị otú ahụ adịghị edozi.

Ọgwụ: sedation na analgesia maka intubation

Laryngoscopy na intubation na-akpata ahụ erughị ala; N'ime ndị ọrịa na-amụ anya, nchịkwa EV nke ọgwụ na-eme mkpụmkpụ nke nwere ihe na-eme ka ahụ dị jụụ ma ọ bụ ngwakọta na-edozi ahụ na analgesic bụ iwu.

Etomidate, hypnotic na-abụghị barbiturate, na dose nke 0.3 mg/kg nwere ike ịbụ ọgwụ nhọrọ.

Fentanyl na dose nke 5 mcg / kg (2 ruo 5 mcg / kg n'ime ụmụaka; IHE: dose a dị elu karịa ọgwụ analgesic na ọ dị mkpa ka e belata ma ọ bụrụ na ejiri ya na ọgwụ mgbochi-hypnotic, dịka propofol ma ọ bụ etomidate). bụkwa ezigbo nhọrọ na ọ dịghị akpata ịda mbà n'obi nke obi.

Fentanyl bụ opioid ya mere ọ nwere ihe analgesic yana ihe na-eme ka ahụ sie ike.

Agbanyeghị, n'ọ̀tụ̀tụ̀ dị elu nke mgbidi obi nwere ike ime.

Ketamine, na doses nke 1-2 mg / kg, bụ ihe anestetiiki dissociative nwere akụrụngwa cardiostimulant.

Ọ dị mma n'ozuzu mana ọ nwere ike ịkpata ihunanya ma ọ bụ mgbanwe omume na edemede.

A na-ejikarị Propofol, ọgwụ na-eme ka ahụ sie ike na amnesic, na ntinye nke 1.5 ruo 3 mg / kg EV mana ọ nwere ike ịkpata ịda mbà n'obi nke obi na obi mgbawa na hypotension na-esote.

Thiopental, 3-4 mg/kg, na methohexital, 1-2 mg/kg, dị irè ma na-ebute hypotension ma na-eji obere oge.

Ọgwụ na-eme ka ahụ mkpọnwụ maka intubation

Ntụrụndụ nke mọzụlụ skeletal na EV neuromuscular blocker na-eme ka intubation dịkwuo mfe.

Succinylcholine (1.5 mg / kg EV, 2.0 mg / kg maka ụmụ ọhụrụ), onye na-egbochi neuromuscular na-emebi emebi, nwere mmalite kachasị ngwa ngwa (sekọnd 30 ruo 1 min) na oge kachasị dị mkpirikpi (3 ruo 5 min).

Ekwesịrị ịzere ya na ndị ọrịa nwere ọkụ, zọpịa mmerụ ahụ nke> 1-2 ụbọchị, spinal mmerụ ahụ ụdọ, ọrịa neuromuscular, ụkọ akụrụ, ma ọ bụ enwere ike ịbanye n'ime mmerụ ahụ anya.

Ihe dị ka 1/15 000 ụmụaka (na ndị okenye ole na ole) nwere ọdịdị mkpụrụ ndụ ihe nketa maka hyperthermia dị njọ n'ihi succinylcholine.

Ekwesịrị iji atropine na-enye Succinylcholine mgbe niile n'ime ụmụaka n'ihi na ọ nwere ike ibute bradycardia dị ịrịba ama.

N'aka nke ọzọ, ndị na-egbochi neuromuscular ndị na-adịghị emebi emebi nwere ogologo oge nke ime ihe (> 30 min) ma na-enwekwa mmalite nke nwayọọ nwayọọ ma ọ bụrụ na ejiri ya na nnukwu doses nke na-eme ka ahụ mkpọnwụ ahụ dịkwuo ogologo.

Ọgwụ gụnyere atracurium na dose nke 0.5 mg/kg, mivacurium 0.15 mg/kg, rocuronium 1.0 mg/kg na vecuronium, 0.1-0.2 mg/kg, ịgbanye ihe karịrị 60 sekọnd.

Ọgwụ ọnyà dị n'elu n'ime intubation

Ntinye nke onye ọrịa maara nke ọma (anaghị eji ụmụaka eme ihe) chọrọ nkụnwụ nke imi na pharynx.

A na-ejikarị aerosol nke benzocaine, tetracaine, butylaminobenzoate (butamben) na benzalkonium eme ihe.

N'aka nke ọzọ, 4% lidocaine nwere ike nebulized wee kukuo ya site na nkpuchi ihu.

Gụọ kwa:

Mkparịta ụka tracheal: mgbe, olee otu na ihe kpatara iji mepụta ikuku ụgbọelu maka onye ọrịa

Ọgwụgwụ Endotracheal Na Ndị Ọrịa edimụaka: Ngwaọrụ Maka Supraglottic Airways

Ọnọdụ Awake Prone iji gbochie mbubata ma ọ bụ ọnwụ na ndị ọrịa Covid: Ọmụmụ na Ọgwụ Lancet Respiratory.

UK / Ụlọ ihe mberede, ntinye ụmụaka: Usoro a na nwatakịrị nọ n'ọnọdụ siri ike

Isi Iyi:

Akwụkwọ ntuziaka MSD

Ntuziaka maka ọgwụ iji kwado intubation:

• 1. Higgs A, McGrath BA, Goddard C, et al: Ntuziaka maka njikwa nke intubation tracheal na ndị okenye na-arịa ọrịa siri ike. Br J Anaesth 120:323–352, 2018. doi: 10.1016/j.bja.2017.10.021
• 2. Mosier JM, Hypes CD, Sakles JC: Ịghọta preoxygenation na apneic oxygenation n'oge intubation na ọrịa siri ike. Nlekọta kpụ ọkụ n'ọnụ Med 43 (2): 226-228, 2017. doi: 10.1007/s00134-016-4426-0