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简单、及时、安全?喉罩与小儿气道

SIMPLE, TIMELY, SAFELY? LARYNGEAL MASK AND PEDIATRIC AIRWAY.

作者信息

Karišik Marijana

出版信息

Acta Clin Croat. 2016 Mar;55 Suppl 1:55-61.

Abstract

Laryngeal mask airway (LMA) was a useful, powerful airway management device for routine pediatric airway management, pediatric difficult airway, and in pediatric emergency situations. Over years, various designs, induction and insertion techniques have been described. LMA provides ease of placement and removal as compared with endotracheal intubation, less traumatism for the respiratory tract, better tolerability by patients, improved hemodynamic stability during emergency, less coughing, less sore throat, avoidance of laryngoscopy, and hands free airway. On the other hand, LMA is not suitable to overcome functional airway problems and mechanical airway obstruction in children. Simple airway management in pediatric patients is normally easy in experienced hands, for anesthesiologists working in specialized hospitals with appropriate personnel and equipment that guarantee optimal safety in these patients. On the other hand, pediatric airway management is a great challenge for anesthesiologists working in departments with a small number of pediatric surgical procedures. Careful preoperative evaluation, preparation and training in the recognition of challenges in pediatric airway are essential for the management of the airway in children. LMA plays a special role in the management of difficult pediatric airway; as a supraglottic airway device, it is incorporated into difficult pediatric airway algorithms.

摘要

喉罩气道(LMA)是一种用于小儿气道常规管理、小儿困难气道处理及小儿急诊情况的实用且有效的气道管理设备。多年来,已有多种设计、诱导和插入技术被描述。与气管插管相比,LMA放置和移除容易,对呼吸道创伤小,患者耐受性更好,在紧急情况下血流动力学稳定性更佳,咳嗽少,咽痛轻,无需喉镜检查且可解放双手进行气道管理。另一方面,LMA不适用于解决小儿功能性气道问题和机械性气道梗阻。对于在配备有合适人员和设备以确保患儿最佳安全的专科医院工作的麻醉医生而言,小儿患者的简单气道管理通常易如反掌。另一方面,对于在小儿外科手术量较少的科室工作的麻醉医生来说,小儿气道管理是一项巨大挑战。术前仔细评估、准备以及对小儿气道管理中各种挑战的识别培训对于小儿气道管理至关重要。LMA在小儿困难气道管理中发挥着特殊作用;作为一种声门上气道装置,它被纳入小儿困难气道处理流程。

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