Iziyobisi ze-Intubation: Izigulane ezingenayo i-pulse kunye ne-apnea okanye i-sensory dulling enzima (kwaye kufuneka) ifakwe ngaphandle koncedo lwe-pharmacological. Ezinye izigulana zinikwa amayeza okuthomalalisa kunye namachiza okukhubazeka ukuze anciphise ukungonwabi kunye nokuququzelela intubation (ubuchule bokulandelana ngokukhawuleza kwe-intubation)

Unyango lwangaphambili phambi kwe-intubation

Ukulungiselela kwangaphambili kubandakanya

• 100% oksijini
• Lidocaine
• Ngamanye amaxesha i-atropine, i-neuromuscular blocker, okanye zombini

Ukuba kukho ixesha, isigulane kufuneka siphefumle i-100% oksijini kwi-3-5 min; kwizigulane ezinempilo ngaphambili oku kunokugcina i-oxygenation eyanelisayo ukuya kuthi ga kwi-8 min.

Ukungena komoya okungangeni ndawo okanye i-high-flow nasal cannula ingasetyenziselwa ukunceda i-pre-oxygenation (1).

Nakwizigulane ze-apnea, i-pre-oxygenation enjalo ibonakaliswe ukuphucula i-arterial saturation kunye nokwandisa ixesha le-apnea ekhuselekileyo (2).

Nangona kunjalo, imfuno yeoksijini kunye namaxesha e-apnea axhomekeke ngokusondeleyo kwisantya sentliziyo, ukusebenza kwemiphunga, ukubalwa kweeseli ezibomvu zegazi, kunye nezinye izinto ezininzi ze-metabolic.

I-Laryngoscopy ibangela impendulo yovelwano-mediated pressor kunye nokunyuka kwesantya sentliziyo, uxinzelelo lwegazi kunye noxinzelelo olunokubakho lwe-endocranial.

Ukunciphisa le mpendulo, xa ixesha livumela, abanye oogqirha balawula i-lidocaine kwi-dose ye-1.5 mg / kg EV 1 ukuya kwi-2 min ngaphambi kokutshatyalaliswa kunye nokukhubazeka.

Abantwana kunye nabaselula bavame ukuba ne-vagal reaction (ephawulwe i-bradycardia) ekuphenduleni kwi-intubation kwaye ngexesha elifanayo bafumana i-0.02 mg / kg EV ye-atropine (ubuncinci: 0.1 mg kwiintsana, i-0.5 mg kubantwana nakwishumi elivisayo).

Abanye oogqirha badibanisa umthamo omncinci we-neuromuscular blocker, njenge-vecuronium kwi-dose ye-0.01 mg / kg EV, kwizigulane> iminyaka eyi-4 ubudala ukukhusela i-muscle fasciculations ebangelwa yi-dose epheleleyo ye-succinylcholine.

I-Fasciculations inokubangela intlungu ye-muscle ekuvukeni kunye ne-hyperkalemia yesikhashana; nangona kunjalo, inzuzo yokwenene yonyango olunjalo ayicacanga.

Iziyobisi: i-sedation kunye ne-analgesia ye-intubation

I-Laryngoscopy kunye ne-intubation kubangela ukungahambi kakuhle; kwizigulane eziqaphileyo, ukulawulwa kwe-EV yeyeza elifutshane kunye ne-sedative okanye i-completed sedative kunye ne-analgesic properties inyanzelekile.

I-Etomidate, i-hypnotic engeyona i-barbiturate, kwi-dose ye-0.3 mg / kg ingaba yiyeza elikhethiweyo.

I-Fentanyl kwidosi ye-5 mcg/kg (2 ukuya kwi-5 mcg/kg ebantwaneni; QAPHELA: le dose iphezulu kunethamo le-analgesic kwaye kufuneka incitshiswe xa isetyenziswe ngokudibanisa ne-sedative-hypnotic, umz. ipropofol okanye i-etomidate) kwakhona ukhetho olulungileyo kwaye alubangeli ukudakumba kwentliziyo.

I-Fentanyl yi-opioid kwaye ngenxa yoko ine-analgesic kunye neempawu zokuthomalalisa.

Nangona kunjalo, kwiidosi eziphezulu zesifuba ukuqina kodonga kunokwenzeka.

I-Ketamine, kwiidosi ze-1-2 mg / kg, i-anesthetic ye-dissociative eneempawu ze-cardiostimulant.

Ikhuselekile ngokubanzi kodwa inokubangela umbono okanye utshintsho lokuziphatha ekuvukeni.

I-Propofol, i-sedative kunye ne-amnesic, isetyenziswa ngokuqhelekileyo kwi-induction kwi-dose ye-1.5 ukuya kwi-3 mg / kg ye-EV kodwa inokubangela ukudakumba kwentliziyo kunye ne-hypotension elandelayo.

I-Thiopental, i-3-4 mg / kg, kunye ne-methohexital, i-1-2 mg / kg, iyasebenza kodwa ivame ukubangela i-hypotension kwaye isetyenziswe ngaphantsi rhoqo.

Amachiza okubangela ukukhubazeka kwi-intubation

Ukuphumla kwemisipha ye-skeletal kunye ne-EV neuromuscular blocker iququzelela kakhulu intubation.

I-Succinylcholine (1.5 mg / kg EV, 2.0 mg / kg yeentsana), i-blocker ye-neuromuscular depolarising, inokuqala ngokukhawuleza (imizuzwana ye-30 ukuya kwi-1 min) kunye nobude obufutshane besenzo (3 ukuya kwi-5 min).

Kufuneka kuphetshwe kwizigulana ezinokutsha, ukwenzakala okutyumzayo okungaphezulu kweentsuku ezi-1-2, Umgudu ukwenzakala kwentambo, isifo se-neuromuscular, ukungasebenzi kakuhle kwezintso, okanye ukulimala kwamehlo okungenokungena.

Phantse i-1/15 000 yabantwana (kunye nabantu abadala abambalwa) bane-genetic predisposition to malignant hyperthermia ngenxa ye-succinylcholine.

I-Succinylcholine kufuneka ihlale ilawulwa nge-atropine kubantwana njengoko ingakhokelela kwi-bradycardia ebalulekileyo.

Kungenjalo, i-non-depolarising neuromuscular blockers inexesha elide lesenzo (> 30 min) kodwa iphinda ibe nesiqalo esicothayo ngaphandle kokuba isetyenziswe kwiidosi eziphezulu eziya kwandisa ixesha elide ukukhubazeka.

Izidakamizwa ziquka i-atracurium kwi-dose ye-0.5 mg / kg, i-mivacurium 0.15 mg / kg, i-rocuronium 1.0 mg / kg kunye ne-vecuronium, i-0.1-0.2 mg / kg, injected over 60 seconds.

Iziyobisi ze-anesthesia ezisemgangathweni kwi-intubation

Intubation yesigulane esinolwazi (ngokuqhelekileyo asisetyenziswanga kubantwana) idinga i-anesthesia yempumlo kunye ne-pharynx.

I-aerosol efumaneka kwintengiso ye-benzocaine, i-tetracaine, i-butylaminobenzoate (i-butamben) kunye ne-benzalkonium isetyenziswa ngokubanzi.

Kungenjalo, i-4% ye-lidocaine inokufakwa nebulis kwaye iphefumle ngemaski yobuso.

Funda kwakhona:

I-Tracheal Intubation: Nini, njani kwaye kutheni uyenza i-Airway yomoya engeyiyo eyomonde

I-Endotracheal Intubation kwizigulana zabantwana: Izixhobo zeSupraglottic Airways

Vuka u-Position Positioning to Thint Intubation or Death in Covid Patients: Study in Lancet Ukuphefumla amayeza

I-UK / Igumbi likaNgxamiseko, Intubation yaBantwana: Inkqubo kunye nomntwana okwiMeko eMandundu

umthombo:

Iincwadana zeMSD

Iireferensi zamachiza ukwenza lula intubation:

• 1. Higgs A, McGrath BA, Goddard C, et al: Izikhokelo zokulawulwa kwe-tracheal intubation kubantu abadala abagula kakhulu. Br J Anaesth 120:323–352, 2018. doi: 10.1016/j.bja.2017.10.021
• 2. I-Mosier JM, i-CD ye-Hypes, i-Sakles JC: Ukuqonda i-preoxygenation kunye ne-apneic oxygenation ngexesha lokungena kwi-intubation egula kakhulu. Ukhathalelo olunzulu lweMed 43 (2): 226–228, 2017. doi: 10.1007/s00134-016-4426-0