Izidakamizwa ze-Intubation: Iziguli ezingenawo ukushaya kwenhliziyo kanye ne-apnea noma ukudumala kwezinzwa okukhulu (futhi kufanele) kufakwe ngaphakathi ngaphandle kosizo lwekhemisi. Ezinye iziguli zinikezwa izidakamizwa ezilalisa umzimba nezikhubazayo ukuze kuncishiswe ukungaphatheki kahle futhi kube lula ukuthi kube ne-intubation (inqubo yokulandelanisa ngokushesha okulandelanayo)

Ukwelashwa kwangaphambili ngaphambi kwe-intubation

Ukwelashwa kwangaphambili ngokuvamile kuhlanganisa

• 100% oksijini
• Lidocaine
• Ngezinye izikhathi i-atropine, i-neuromuscular blocker, noma kokubili

Uma kunesikhathi, isiguli kufanele siphefumule i-100% oksijeni ye-3-5 min; ezigulini ezinempilo ngaphambilini lokhu kungase kugcine umoya-mpilo owanelisayo kuze kufike kumaminithi angu-8.

Ukungenisa umoya okungahlanyisi noma i-cannula yamakhala egeleza kakhulu ingasetshenziswa ukusiza ukukhipha umoya-mpilo ngaphambili (1).

Ngisho nasezigulini ze-apnea, ukukhishwa kwe-oxygenation okunjalo kwangaphambili kuboniswe ukuthuthukisa ukugcwala komoyampilo we-arterial nokwandisa isikhathi se-apnea ephephile (2).

Kodwa-ke, isidingo somoya-mpilo kanye nezikhathi zokuphefumula kokuphefumula umoya kuncike kakhulu ekushayeni kwenhliziyo, ukusebenza kwamaphaphu, inani lamangqamuzana abomvu egazi, nezinye izici eziningi zokugayeka kokudla.

I-Laryngoscopy ibangela ukusabela kokucindezela okunozwelo ngokukhuphuka kwezinga lokushaya kwenhliziyo, umfutho wegazi kanye nomfutho we-endocranial okungenzeka.

Ukuze unciphise le mpendulo, lapho isikhathi sivuma, abanye odokotela baphatha i-lidocaine ngesilinganiso se-1.5 mg / kg EV 1 kuya ku-2 min ngaphambi kokudambisa nokukhubazeka.

Izingane kanye nentsha ivame ukuba ne-vagal reaction (ephawulwe i-bradycardia) ekuphenduleni intubation futhi ngesikhathi esifanayo zithola i-0.02 mg/kg EV ye-atropine (ubuncane: 0.1 mg ezinsaneni, 0.5 mg ezinganeni nasentsheni).

Abanye odokotela bahlanganisa umthamo omncane we-neuromuscular blocker, njenge-vecuronium ngesilinganiso se-0.01 mg / kg EV, ezigulini> iminyaka engu-4 ubudala ukuze kuvinjwe i-muscle fasciculations ebangelwa umthamo ogcwele we-succinylcholine.

I-Fasciculations ingabangela ubuhlungu bemisipha ekuvukeni kanye ne-hyperkalemia yesikhashana; nokho, inzuzo yangempela yokwelapha okunjalo ayicacile.

Izidakamizwa: i-sedation kanye ne-analgesia ye-intubation

I-laryngoscopy kanye ne-intubation kubangela ukungakhululeki; ezigulini eziqaphile, ukuphathwa kwe-EV kwesidakamizwa esisebenza isikhathi esifushane esine-sedative noma izakhiwo ezihlangene zokulalisa kanye ne-analgesic kuyimpoqo.

I-Etomidate, i-hypnotic engeyona i-barbiturate, ngethamo lika-0.3 mg/kg ingaba umuthi okhethwayo.

I-Fentanyl ngethamo lika-5 mcg/kg (2 kuya ku-5 mcg/kg ezinganeni; QAPHELA: lo mthamo uphakeme kunomthamo we-analgesic futhi udinga ukuncipha uma usetshenziswa kanye ne-sedative-hypnotic, isb propofol noma i-etomidate) futhi ukukhetha okuhle futhi akubangeli ukucindezeleka kwenhliziyo.

I-Fentanyl iyi-opioid ngakho-ke ine-analgesic kanye nezindawo zokulalisa.

Kodwa-ke, ngemithamo ephezulu ukuqina kodonga lwesifuba kungenzeka.

I-Ketamine, ngemithamo engu-1-2 mg/kg, iyi-anesthetic ehlukanisayo enezakhiwo ze-cardiostimulant.

Ngokuvamile kuphephile kodwa kungabangela ukubona izinto ezingekho noma izinguquko zokuziphatha lapho uvuka.

I-Propofol, i-sedative ne-amnesic, ivame ukusetshenziswa ekungenweni kwemithamo ye-1.5 kuya ku-3 mg/kg EV kodwa ingase ibangele ukucindezeleka kwenhliziyo nemithambo yegazi kanye ne-hypotension elandelayo.

I-Thiopental, i-3-4 mg/kg, kanye ne-methohexital, i-1-2 mg/kg, iyasebenza kodwa ijwayele ukudala umfutho wegazi ophakeme futhi isetshenziswa kancane.

Izidakamizwa ezibangela ukukhubazeka kwe-intubation

Ukuphumula kwemisipha yamathambo nge-EV neuromuscular blocker kusiza kakhulu ukungena.

I-Succinylcholine (1.5 mg/kg EV, 2.0 mg/kg yezingane ezisanda kuzalwa), i-depolarising neuromuscular blocker, inokuqala okusheshayo (imizuzwana engu-30 kuya ku-1 min) kanye nesikhathi esifushane kakhulu sesenzo (3 kuya ku-5 min).

Kufanele kugwenywe ezigulini ezinokusha, ukulimala okuchotshoziwe okungaphezu kwezinsuku eziyi-1-2, Umgogodla ukulimala kwentambo, isifo se-neuromuscular, ukungasebenzi kahle kwezinso, noma ukulimala kwamehlo okungenzeka ukungena.

Izingane ezingaba ngu-1/15 000 (kanye nabantu abadala abambalwa) banezakhi zofuzo ze-hyperthermia eyingozi ngenxa ye-succinylcholine.

I-Succinylcholine kufanele ihlale ilawulwa nge-atropine ezinganeni njengoba ingaholela ku-bradycardia ebalulekile.

Kungenjalo, abavimbeli be-neuromuscular non-depolarising banesikhathi eside sokusebenza (> 30 min) kodwa futhi baqala kancane ukusebenza ngaphandle uma besetshenziswa ngemithamo ephezulu enweba ukukhubazeka.

Izidakamizwa zihlanganisa i-atracurium ngesilinganiso se-0.5 mg / kg, i-mivacurium 0.15 mg / kg, i-rocuronium 1.0 mg / kg kanye ne-vecuronium, i-0.1-0.2 mg / kg, injected over 60 seconds.

Izidakamizwa ze-anesthesia ezisezingeni eliphezulu ku-intubation

I-Intubation yesiguli esiqaphelayo (ngokuvamile ayisetshenziswa ezinganeni) idinga i-anesthesia yekhala kanye ne-pharynx.

I-aerosol etholakala nokudayiswa ye-benzocaine, i-tetracaine, i-butylaminobenzoate (butamben) kanye ne-benzalkonium ivame ukusetshenziswa.

Kungenjalo, u-4% we-lidocaine ungafakwa i-nebulid futhi uhogelwe ngemaski yobuso.

Funda Futhi:

I-Tracheal Intubation: Nini, Kanjani Futhi Kungani Ungayakha I-Airway Yokwenzela Isiguli

I-Endotracheal Intubation Ezigulini Zezingane: Amadivayisi E-Supraglottic Airways

Ukuma kwe-Phaphama Ukuma Okuvikelekile Ukuvimbela Ukushaywa Ukufa Noma Ukufa Ezigulini ZeCovid: Study In The Lancet Respiratory Medicine

I-UK / Igumbi Lezimo Eziphuthumayo, Intubation Yezingane: Inqubo Nengane Esesimweni Esibucayi

Source:

Ama-Manual MSD

Izinkomba zezidakamizwa zokwenza lula i-intubation:

• 1. Higgs A, McGrath BA, Goddard C, et al: Izeluleko 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 kanye ne-apneic oxygenation ngesikhathi sokufakwa kwe-intubation kumuntu ogula kakhulu. I-Intensive Care Med 43(2):226–228, 2017. doi: 10.1007/s00134-016-4426-0