,按一下以編輯母片標題樣式,按一下以編輯母片本文樣式,第二階層,第三階層,第四階層,第五階層,*,插管探条之临床应用,陳昭良主任,彰化基督教醫院麻醉科,插管探条之临床应用 陳昭良主任,1,What a bad luck!,What a bad luck!,2,If this is a,Difficult Intubation,situation.,What are our,back-up plans,?,What other,gadgets,do we have?,If this is a Difficult Intubat,3,Non-invasive,Glottis,Invasive,Non-invasive,4,From Below the Glottis(Invasive),Transtracheal Jet Ventilation(TTJV),Retrograde Intubation,Percutaneous dilational tracheal entry,Surgical Airway,From Below the Glottis(Invasi,5,From Above the Glottis,Laryngoscope,Gum Elastic Bougie,Blind Oral/Nasal Intubation,Fiberoptic Bronchoscopy,Intubating LMA(Fastrach,),GlideScope,Lighted Stylet(Trachlight,),Optical Stylet,From Above the Glottis Laryngo,6,Eschmann tracheal tube introducer“Gum Elastic Bougie”,Eschmann tracheal tube introdu,7,History of Gum Elastic Bougie,The Eschmann tracheal tube introducer(,gum elastic bougie,)was marketed in the United Kingdom(UK)in the early,1970,s,.,It differs from previous introducers in its,greater length,(60 cm),angled tip,and the combination of flexibility and malleability.,History of Gum Elastic BougieT,8,Anesthesiology:100(5)2019:1146-50,“GEB“vs Difficult Intubation,Anesthesiology:100(5)2019:11,9,2019,巴黎聖心堂,2019 巴黎聖心堂,10,Lighted Stylet(Lightwand),光棒,Lighted Stylet(Lightwand)光棒,11,History of Lighted Stylet,The first reported use of a,lighted stylet,used to facilitate intubation came in,1957,.,Macintosh,described an 18-inch illuminated tracheal tube introducer,which was designed to,stiffen the tube,and,better illuminate the cords,by supplementing the light of the laryngoscope.,Anaesthesia 1957;12:2235,History of Lighted StyletThe f,12,History of Lighted Stylet,Yamamura,et al.described a,light bulb-tipped wire,that was inserted into the tracheal tube before,blind nasal intubation,in awake patients.The,tube position,was then determined by the medial transillumination of the external throat and neck.,Anesthesiology 1959;20:221,History of Lighted StyletYamam,13,History of Lighted Stylet,In,1977,Foster,used a,transilluminating fiberoptic bundle,to facilitate tracheal intubation in a young child with trismus.,Anaesthesia 1977;32:1038,Ducrow,used a,Flexi-lum,to achieve the same end by first passing a guide into the trachea followed by passage of the tracheal tube over the guide.,Anaesthesia 1978;33:8279,History of Lighted StyletIn 19,14,History of Lighted Stylet,Rayburn,commented that the,Flexi-lum,(flexible surgical light)could be positioned inside the tracheal tube,thereby shortening the intubation sequence and claimed that the technique,nicknamed,“lightwand intubation.”,Anaesthesia 1979;34:6778,History of Lighted StyletRaybu,15,Trachlight,WandETT size,Small2.5#4.0#,Medium4.5#5.5#,Large6.0#,Trachlight,16,Lightwand Intubation,Transillumination of neck tissues,Flexible stylet contains a distal light bulb,Lightwand Intubation Transillu,17,Jaw lifted with non-dominant hand,Jaw lifted with non-dominant h,18,Observing the glow on the neck,Observing the glow on the neck,19,Helpful Maneuvers for Trachlight,Jaw lift(Jaw thrust),Hyperextension of the head and neck,Use of the thumb to lift the tongue,Having an assistant to pull the tongue,Anesthesiology 2019;83:509-514,Helpful Maneuvers for Trachlig,20,Intubation with Trachlight(I),Intubation with Trachlight(I),21,Intubation with Trachlight(II),Intubation with Trachlight(II,22,Advantages of Trachlight,Easy to learn and use,Less traumatic,Suitable for pediatric patients,May use in nasal tracheal intubation,May use in ambient light,Advantages of Trachlight Easy,23,Complications,Instrument disarticulation,Trauma to the upper airway,bleeding,sore throat,hoarseness,dysphagia,Arytenoid cartilage dislocation,ComplicationsInstrument disart,24,Indications,Difficult airway,Unintubatable by direct or fiberoptic laryngoscopy,Neck mobility is limited or contraindicated,Prevention of dental injury,Indications Difficult airway,25,Contraindications,Absolute,Upper airway foreign body,tumor,polyp,retropharyngeal abscess.,Relative,trauma victim with laryngeal injury,known difficult airway,ContraindicationsAbsolute,26,Environment for Trachlight,Ambient light -78.5%,Dimmed -8.7%,Dark -12.2%,Anesthesiology 2019;83:509-514,Environment for Trachlight Amb,27,Effect of Cricoid Pressure on Lightwand Intubation,Time to successful intubation is significantly prolonged,The failure rate for the first attempt is 13%.,Anesthesiology.94(2):259-262,2019,Effect of Cricoid Pressure on,28,Intubation with Trachlight(I),Intubation with Trachlight(I),29,Intubation with Trachlight(II),Intubation with Trachlight(II,30,Intubation with Trachlight(III),Intubation with Trachlight(II,31,Hybrid Techniques,With Direct Laryngoscopy,Light-guided Nasal Intubation,With Laryngeal Mask Airway,With Fiberoptic Scope,Airway Introducer,Light-guided Retrograde Intubation,Hybrid Techniques With Direct,32,Optical Stylet,可視光棒,Optical Stylet可視光棒,33,History of Orotracheal Intubation,The earliest reports of,blind orotracheal intubation,(BOI)in anaesth