,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,超声在气道管理中的应用,颈部气道解剖,定位喉上神经,The,thyrohyoid membrane,as a target for,ultrasonography-guided,block of the internal branch of the superior laryngeal nerve,Stopar-Pintaric T,Vlassakov K,Azman J.,J C,lin Anes,th,.2015 N,ov,;27(7):548-52.,In conclusion,we are proposing an anatomical concept for a,new,simpler,consistently reproducible,US-guided iSLN block technique using the,thyrohyoid membrane,to,define the target plane for low-volume local anesthetic injection,.,外侧,舌骨,外侧,舌骨,超声影像,舌骨、喉上神经,外侧,过拱桥，甲舌膜里寻,喉上,定位环甲膜,The conventional method,inspection and palpation,has a low success rate,especially in women(,2435%,).,Elliott DS,Baker PA,Scott MR,et al.Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010;65:889,94,Lamb A,Zhang J,Hung O,et al.Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution.Can J Anaesth 2015;62:495,503,Barbe N,Martin P,Pascal J,et al.,A,nn Fr Anesth Reanim.,2014 Mar;33(3):163-6.,定位环甲膜,Locating the cricothyroid membrane in learning phase:,Value of ultrasonography,?,The CTM was accurately identified by palpation and ultrasound by,46%and 100%,of residents respectively(P 0.05).,Kristensen MS,Teoh WH,Rudolph SS,et al.,Br J Anaesth.2015 Jun;114(6):1003-4.,定位环甲膜,Structured approach to,ultrasound-guided,identification of the,cricothyroid membrane:a randomized comparison with the palpation method in the,morbidly obese,When using the conventional digital palpation method,13 of 35 anaesthetists(37%),were able to locate the cricothyroid membrane successfully,within 2 min,whereas the success rate was,29 of 35(83%),when the structured stepwise ultrasonography method was applied(P=0.0008,McNemars test).,Siddiqui N,Arzola C,Friedman Z,et al.,Anesthesiology.2015 Nov;123(5):1033-41.,定位环甲膜,Ultrasound,Improves Cricothyrotomy Success in,Cadavers with,Poorly Defined Neck Anatomy,Ultrasound guidance significantly decreased the incidence of,injuries to the larynx and trachea,Increased the probability of correct insertion by,5.6 times,in cadavers with difficult and impossible landmark palpation,.,外侧,甲状软骨,声带,声带,环甲膜,外侧,超声影像,甲状软骨、环甲膜,外侧,越尖峰，缺口,伪影,环甲膜,甲状软骨,声带,声带,伪影,超声影像,环状软骨,外侧,气管软骨,甲状腺峡部,外侧,气管软骨,外侧,Ultrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with,laryngeal abscess,Iida T,Suzuki A,Kunisawa T,et al.,J Anesth(2013)27:309310,临床应用,1,清醒插管,Sonographically,Guided Superior Laryngeal Nerve Block During,Awake Fiberoptic Intubation,Sawka A,Tang R,Vaghadia H.,A A Case Rep.2015 Apr 15;4(8):107-10.,Sonographically guided superior laryngeal nerve block may be,useful,in patients where identification of landmarks in the neck is,difficult,as a result of patient anatomy,临床应用,1,清醒插管,临床应用,1,清醒插管,Ultrasound-guided,Cannula Cricothyroidotomy,Suzuki A,Iida T,kunisawa T,et al.,A,nesthesiology,2012 Nov;117(5):1128,Ultrasound-assisted translaryngeal block for awake fibreoptic intubation,De Oliveira GSJr,Fitzgerald P,Kendall M,.,Can J Anesth,.,2011 58:664665,临床应用,1,清醒插管,病态肥胖,BMI 60,临床应用,1,清醒插管,临床应用,1,清醒插管,临床应用,2,判断喉镜显露困难,气管软骨,外侧,食管,甲状腺,W,u J,D,ong J,D,ing Y,et al.,Med Sci Monit,2014;20:2343-2350,Role of anterior neck soft tissue quantifications by ultrasound in,predicting difficult laryngoscopy,Anterior neck soft tissue thicknesses measured by US at,hyoid bone,thyrohyoid membrane,and anterior commissure,levels are independent predictors of difficult laryngoscopy.,Combinations of those screening tests or risk factors with US measurements might,increase the ability to predict difficult laryngoscopy.,临床应用,2,判断喉镜显露困难,气管软骨,外侧,食管,甲状腺,Ultrasonographic measurement of the minimal transverse diameter of the subglottic airway in the transverse plane,typically at the caudal outlet of the cricoid ring,临床应用,3,选择适合气管导管,临床应用,4,判断气管导管位置,气管软骨,外侧,食管,甲状腺,排除食管内插管,证实气管导管在气管内,临床应用,4,判断气管导管位置,THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID,ULTRASONOGRAPHY,TO CONFIRM ENDOTRACHEAL TUBE PLACEMENT IN A CADAVER MODEL,Dynamic assessment resulted in,97%,sensitivity,and,100%,specificity,for detecting esophageal ET placement.,Static assessment resulted in only,51%,sensitivity,and,91%,specificity,.,Ma G,Davis DP,Schmitt J,et al.,J Emerg Med.,2007 May;32(4):405-7.,气管插管过程中环甲膜改变,气管导管气囊充气表现,临床应用,5,判断喉罩位置,Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and,laryngeal mask airway placement,Sonographic upper airway assessment emerges as a,rapid and easily,available method,to predict difficult intubation,to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ.,Wojtczak JA,Cattano D.,Journal of Ultrasonography 2014;14:362366,临床应用,5,判断喉罩位置,蝴蝶征,Unique,喉罩的位置,E,Supreme,喉罩的位置,E,临床应用,6,定位气管切开,Real-time ultrasound-