Intubation zvinodhaka: Varwere vasina pulse uye apnea kana zvakanyanya kuoma kwekunzwa vanogona (uye vanofanira) kuiswa pasina rubatsiro rwemishonga. Vamwe varwere vanopihwa sedative uye mitezo yemishonga yekuderedza kusagadzikana uye kufambisa intubation (kukurumidza kutevedzana intubation nzira)

Pre-kurapwa pamberi intubation

Premedication inowanzo sanganisira

• 100% oksijeni
• Lidocaine
• Dzimwe nguva atropine, neuromuscular blocker, kana zvese zviri zviviri

Kana pane nguva, murwere anofanira kufema 100% oksijeni ye 3-5 min; muvarwere vaimbova vane hutano izvi zvinogona kuchengetedza oxygenation inogutsa kusvika ku8 min.

Non-invasive ventilation kana high-flow nasal cannula inogona kushandiswa kubatsira pre-oxygenation (1).

Kunyangwe muvarwere vane apnea, pre-oxygenation yakadai yakaratidzwa kuvandudza arterial oxygen saturation uye kuwedzera nguva yeapnea yakachengeteka (2).

Nekudaro, kudiwa kweokisijeni uye nguva yeapnea inotsamira zvakanyanya pakurova kwemoyo, kushanda kwemapapu, kuverenga kwemasero matsvuku eropa, uye zvimwe zvinhu zvakawanda zvemetabolism.

Laryngoscopy inokonzera kunzwira tsitsi-mediated pressor response nekuwedzera kwekurova kwemoyo, BP uye zvingangoita endocranial pressure.

Kuti vadzivise mhinduro iyi, kana nguva ichibvumira, vamwe vanachiremba vanopa lidocaine pachiyero che 1.5 mg / kg EV 1 kusvika 2 min isati yapera uye kupera simba.

Vana nevechiri kuyaruka vanowanzoita vagal reaction (yakaratidza bradycardia) mukupindura intubation uye panguva imwe chete kugamuchira 0.02 mg / kg EV yeatropine (zvishoma: 0.1 mg mucheche, 0.5 mg muvana nevechiri kuyaruka).

Vamwe vanachiremba vanobatanidza chirwere chiduku chevhavha yeuromuscular, yakadai sevecuronium pachiyero che 0.01 mg / kg EV, muvarwere> 4 yemakore ekudzivirira kusvibiswa kwemisumbu kunokonzerwa nehuwandu hwakazara hwe succinylcholine.

Fasciculations inogona kukonzera marwadzo emhasuru pakumuka uye zvakare kwenguva pfupi hyperkalemia; zvisinei, bhenefiti yechokwadi yekurapa kwakadaro haina kujeka.

Zvinodhaka: sedation uye analgesia ye intubation

Laryngoscopy uye intubation zvinokonzera kusagadzikana; muvarwere vakasvinura, EV kutonga kwemushonga wenguva pfupi une sedative kana kusanganiswa sedative uye analgesic properties inosungirwa.

Etomidate, isiri-barbiturate hypnotic, pachiyero che 0.3 mg / kg inogona kuva mushonga wekusarudza.

Fentanyl pachiyero che5 mcg/kg (2 kusvika 5 mcg/kg muvana; CHERECHEDZA: ichi chipimo chepamusoro pane chinoderedza marwadzo uye chinoda kuderedzwa kana chikashandiswa pamwe chete ne sedative-hypnotic, eg propofol kana etomidate) uyewo chisarudzo chakanaka uye hachikonzeri kuora mwoyo kwemwoyo.

Fentanyl iopioid uye saka ine analgesic pamwe nekunyaradza zvinhu.

Nekudaro, pazviyero zvakakwirira zvechipfuva kusimba kwemadziro kunogona kuitika.

Ketamine, pamadosi e1-2 mg/kg, idissociative anesthetic ine cardiostimulant properties.

Iyo inowanzochengeteka asi inogona kukonzera kufungidzira kana shanduko yemaitiro pakumuka.

Propofol, sedative uye amnesic, inowanzoshandiswa mukuderedzwa pamadhora e1.5 kusvika ku3 mg / kg EV asi inogona kukonzera kuora mwoyo kwemwoyo uye kunotevera hypotension.

Thiopental, 3-4 mg/kg, uye methohexital, 1-2 mg/kg, inoshanda asi inowanzokonzera hypotension uye inoshandiswa zvishoma.

Mishonga yekukonzeresa mitezo ye intubation

Kuzorora kwemaskeletal tsandanyama neEV neuromuscular blocker kunobatsira zvikuru intubation.

Succinylcholine (1.5 mg / kg EV, 2.0 mg / kg yevacheche), depolarising neuromuscular blocker, ine kukurumidza kukurumidza (30 seconds kusvika 1 min) uye nguva shoma yekuita (3 kusvika 5 min).

Inofanirwa kudziviswa kune varwere vane kupisa, kupwanya kukuvara kwe> 1-2 mazuva, Musipinha kukuvara kwetambo, neuromuscular disease, renal insufficiency, kana kukuvara kwemaziso kunogona kupinda.

Vanenge 1/15 000 vana (uye vashoma vakura) vane genetic predisposition to malignant hyperthermia nekuda kwe succinylcholine.

Succinylcholine inofanira kugara ichishandiswa neatropine muvana sezvo inogona kutungamirira ku bradycardia inokosha.

Neimwe nzira, non-depolarising neuromuscular blockers vane nguva yakareba yekuita (> 30 min) asi zvakare vane danho rinononoka rekuita kunze kwekunge rakashandiswa pamadhizi makuru anowedzera kurebesa mitezo.

Zvinodhaka zvinosanganisira atracurium pachiyero che 0.5 mg / kg, mivacurium 0.15 mg / kg, rocuronium 1.0 mg / kg uye vecuronium, 0.1-0.2 mg / kg, injected over 60 seconds.

Topical anesthesia zvinodhaka mune intubation

Intubation yemurwere anoziva (kazhinji isingashandisi muvana) inoda anesthesia yemhino uye pharynx.

Aerosol inotengeswa yebenzocaine, tetracaine, butylaminobenzoate (butamben) uye benzalkonium inowanzoshandiswa.

Neimwe nzira, 4% lidocaine inogona kuiswa nebulised uye kufemerwa kuburikidza nemaski kumeso.

Verenga Uyewo:

Tracheal Intubation: Rini, Sei Uye Sei Kugadzira Yakagadzirwa YeMhepo YeMurwere

Endotracheal Intubation Mune Vanachiremba Varwere: Midziyo Yeiyo Supraglottic Airways

Mukai Prone Positioning Kudzivirira Intubation Kana Rufu Mune Covid Varwere: Dzidza MuLancet Kufema Mushonga

UK / Emergency Kamuri, Pediatric Intubation: Maitiro NeMwana Ari Mamiriro Akakomba

Source:

Zvinyorwa zveMSD

Mareferensi emishonga yekufambisa intubation:

• 1. Higgs A, McGrath BA, Goddard C, et al: Nhungamiro dzehutungamiri hwetracheal intubation muvakuru vanorwara zvakanyanya. Br J Anaesth 120:323–352, 2018. doi: 10.1016/j.bja.2017.10.021
• 2. Mosier JM, Hypes CD, Sakles JC: Kunzwisisa preoxygenation uye apneic oxygenation panguva intubation mukurwara kwakanyanya. Intensive Care Med 43(2):226–228, 2017. doi: 10.1007/s00134-016-4426-0