上海交通大学附属第六人民医院麻醉科赵达强超声在气道管理中的运用2021-5-27上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital颈部气道解剖上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital定位喉上神经Thethyrohyoidmembraneasatargetforultrasonography-guidedblockoftheinternalbranchofthesuperiorlaryngealnerveStopar-PintaricT,VlassakovK,AzmanJ.JClinAnesth.2021Nov;27(7):548-52.Inconclusion,weareproposingananatomicalconceptforanew,simpler,consistentlyreproducibleUS-guidediSLNblocktechniqueusingthethyrohyoidmembranetodefinethetargetplaneforlow-volumelocalanestheticinjection.上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital外外侧舌骨舌骨外外侧舌骨舌骨超声影像超声影像舌骨、喉上神舌骨、喉上神经外外侧过拱拱桥，甲舌膜里，甲舌膜里寻喉上喉上上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital定位环甲膜Theconventionalmethod,inspectionandpalpation,hasalowsuccessrate,especiallyinwomen(2435%).ElliottDS,BakerPA,ScottMR,etal.AccuracyofsurfacelandmarkidentificationforcannulaElliottDS,BakerPA,ScottMR,etal.Accuracyofsurfacelandmarkidentificationforcannulacricothyroidotomy.Anaesthesia2021;65:88994cricothyroidotomy.Anaesthesia2021;65:88994 LambA,ZhangJ,HungO,etal.AccuracyofidentifyingthecricothyroidmembranebyanesthesiaLambA,ZhangJ,HungO,etal.AccuracyofidentifyingthecricothyroidmembranebyanesthesiatraineesandstaffinaCanadianinstitution.CanJAnaesth2021;62:495503traineesandstaffinaCanadianinstitution.CanJAnaesth2021;62:495503上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospitalSiddiquiN,ArzolaC,FriedmanZ,etal.Anesthesiology.2021Nov;123(5):1033-41.定位环甲膜Ultrasound Improves Cricothyrotomy Success inUltrasound Improves Cricothyrotomy Success inCadavers with Poorly Defined Neck AnatomyCadavers with Poorly Defined Neck AnatomyUltrasoundguidancesignificantlydecreasedtheincidenceofinjuriestothelarynxandtracheaIncreasedtheprobabilityofcorrectinsertionby5.6timesincadaverswithdifficultandimpossiblelandmarkpalpation.上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital外外侧甲状软骨甲状软骨声声带声声带环甲膜环甲膜外外侧超声影像超声影像甲状甲状软骨、骨、环甲膜甲膜外外侧越尖峰，缺口越尖峰，缺口伪影影环甲膜甲膜甲状软骨甲状软骨声声带声声带伪影伪影上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital超声影像环状软骨环状软骨外外侧气管软骨气管软骨甲状腺峡部甲状腺峡部外外侧气管软骨气管软骨外外侧上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospitalUltrasound-guidedsuperiorlaryngealnerveblockandtranslaryngealblockforawaketrachealintubationinapatientwithlaryngealabscessIidaT,SuzukiA,KunisawaT,etal.JAnesth(2021)27:309310临床运用床运用1清醒插管清醒插管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospitalSonographically Guided Superior Laryngeal Sonographically Guided Superior Laryngeal Nerve Block During Awake Fiberoptic IntubationNerve Block During Awake Fiberoptic IntubationSawkaA,TangR,VaghadiaH.AACaseRep.2021Apr15;4(8):107-10.Sonographicallyguidedsuperiorlaryngealnerveblockmaybeusefulinpatientswhereidentificationoflandmarksintheneckisdifficultasaresultofpatientanatomy临床运用床运用1清醒插管清醒插管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用1清醒插管清醒插管Ultrasound-guidedCannulaCricothyroidotomySuzukiA,IidaT,kunisawaT,etal.Anesthesiology2021Nov;117(5):1128Ultrasound-assistedtranslaryngealblockforawakefibreopticintubationDeOliveiraGSJr,FitzgeraldP,KendallM.CanJAnesth.202158:664665上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用1清醒插管清醒插管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用1清醒插管清醒插管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用1清醒插管清醒插管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用2判判别喉喉镜显露困露困难气管软骨气管软骨外外侧食管食管甲状腺甲状腺WuJ,DongJ,DingY,etal.MedSciMonit,2021;20:2343-2350RoleofanteriornecksofttissuequantificationsbyultrasoundinpredictingdifficultlaryngoscopyAnteriornecksofttissuethicknessesmeasuredbyUSathyoidbone,thyrohyoidmembrane,andanteriorcommissurelevelsareindependentpredictorsofdifficultlaryngoscopy.CombinationsofthosescreeningtestsorriskfactorswithUSmeasurementsmightincreasetheabilitytopredictdifficultlaryngoscopy.上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用2判判别喉喉镜显露困露困难气管软骨气管软骨外外侧食管食管甲状腺甲状腺上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospitalUltrasonographicmeasurementoftheminimaltransversediameterofthesubglotticairwayinthetransverseplane,typicallyatthecaudaloutletofthecricoidring临床运用床运用3选择适宜气管适宜气管导管管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用4判判别气管气管导管位置管位置气管软骨气管软骨外外侧食管食管甲状腺甲状腺排除食管内插管排除食管内插管证明气管明气管导管在气管内管在气管内上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用4判判别气管气管导管位置管位置THESENSITIVITYANDSPECIFICITYOFTRANSCRICOTHYROIDULTRASONOGRAPHYTOCONFIRMENDOTRACHEALTUBEPLACEMENTINACADAVERMODELDynamicassessmentresultedin97%sensitivityand100%specificityfordetectingesophagealETplacement.Staticassessmentresultedinonly51%sensitivityand91%specificity.MaG,DavisDP,SchmittJ,etal.JEmergMed.2007May;32(4):405-7.上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital气管插管过程中环甲膜改动上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital气管导管气囊充气表现上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用5判判别喉罩位置喉罩位置Laryngo-trachealultrasonographytoconfirmcorrectendotrachealtubeandlaryngealmaskairwayplacementSonographicupperairwayassessmentemergesasarapidandeasilyavailablemethodtopredictdifficultintubation,toassessthelaryngealandhypopharyngealsizeandvisualizethepositionofthelaryngealmaskairwayinsitu.WojtczakJA,CattanoD.JournalofUltrasonography2021;14:362366上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用5判判别喉罩位置喉罩位置蝴蝶征蝴蝶征Unique喉罩的位置ESupreme喉罩的位置E上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用6定位气管切开定位气管切开Real-timeultrasound-guidedpercutaneousdilatationaltracheostomy:afeasibilitystudyPercutaneoustracheostomyperformedunderreal-timeultrasoundguidanceisfeasibleandappearsaccurateandsafe,includinginpatientswithmorbidobesityandcervicalspineprecautions.VenkatakrishnaRajajee,JeffreyJFletcher,LaurynRRochlen,etal.CriticalCare2021,15:R67上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用6定位气管切开定位气管切开Traditionallandmarkversusultrasoundguidedtrachealpunctureduringpercutaneousdilatationaltracheostomyinadultintensivecarepatients:arandomisedcontrolledtrialUltrasoundguidancesignificantlyimprovedtherateoffirst-passpunctureandpunctureaccuracy.Fewerproceduralcomplicationswereobserved;however,thisdidnotreachstatisticalsignificance.Theseresultssupportwidergeneraluseofreal-timeultrasoundguidanceasanadditionaltooltoimprovePDT.MtRudas,IanSeppelt,RobertHerkes,etal.CriticalCare2021,18:514上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用6定位气管切开定位气管切开可可视化化操操作作才才干干有有认识避避开开血血管管上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital临床运用床运用6定位气管切开定位气管切开上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital其他的其他的临床运用床运用1迅速准确建立通气迅速准确建立通气MallinM,CurtisK,DawsonM,etal.AmJEmergMed2021Jan;32(1):61-3.Accuracyofultrasound-guidedmarkingofthecricothyroidmembranebeforesimulatedfailedintubationUltrasoundmarkingoftheCTMofhealthyvolunteersbeforesimulatedintubationaccuratelyidentifiestheCTMafterneckmanipulationexpectedduringafailedintubation.上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital其他的其他的临床运用床运用2改良改良Sellick法法向后方向后方压迫迫环状状软骨骨无效无效向左后方向左后方压迫迫环状状软骨骨有效有效上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital其他的其他的临床运用床运用3耐受插管耐受插管AdvancedDiagnosticBronchoscopyUsingConsciousSedationandtheLaryngealNerveBlock:Tolerability,Thoroughness,andDiagnosticYieldGoyalG,PisaniMA,MurphyTE,etal.Lung(2021)192:905913如何更好耐受如何更好耐受长期气管插管？期气管插管？或或许喉上神喉上神经阻滞是一个阻滞是一个选择上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital1.清醒插管清醒插管超声引超声引导导喉上神喉上神经经阻滞和阻滞和环环甲膜穿刺甲膜穿刺过过拱拱桥桥，甲舌膜里，甲舌膜里寻寻喉上喉上越尖峰，缺口越尖峰，缺口伪伪影影环环甲膜甲膜总结4.判判别别气管气管导导管的位置管的位置环环甲膜甲膜气管插管气管插管进进展展时时更敏感更敏感5.判判别别喉罩位置喉罩位置蝴蝶征蝴蝶征6.定位气管切开定位气管切开准确定位、防止准确定位、防止损伤损伤7.迅速建立迅速建立紧紧急通气急通气超声引超声引导环导环甲膜穿刺甲膜穿刺8.改良改良Sellick法法向左后方向左后方压压迫迫环环状状软软骨骨2.判判别别喉喉镜显镜显露困露困难难颈颈前部前部软组织软组织厚度厚度3.选择选择气管气管导导管型号管型号气管最小内径气管最小内径上海市第六人民医院上海市第六人民医院ShanghaiSixthPeoplesHospital谢谢倾听谢谢倾听