Nye teknikker og nytt utstyr for luftveishåndtering

Nye teknikker og nytt utstyr for luftveishåndtering

Anders RudjordSeksjonsoverlege

Akuttmedisinsk avdelingSI-Hamar

Videolaryngoskop

• Godt hjelpemiddel eller nok et redskap som man ikke ser stemmespalten med ?

Vanskelig luftvei

• Vi står utenfor pasienten og kikker inn med direkte laryngoskopi. Hovedproblemet er at man ikke ser under og bak epiglottis

• Videolaryngoskop er et hjelpemiddel for å ”kikke rundt hjørnet”

Preoperativ vurdering

• Gapeevne (Mallapati)• Ansiktsform• Nakkebevegelighet• Kort nakke• Thyromental avstand (> 6 cm, 3 fingre)• Thyrosternal avstand (> 6 cm, 3 fingre)• Bevegelighet kjeve

MALLAPATI

CORMAC-LEHANE

Kjente hjelpemidler

• McCoy laryngoskop• Bougie• FastTrack• CTrack• Light track

AIRTRAQ

McGRAHT

Glidescope

Eur J Anaesthesiol. 2009 Jul;26(7):554-8. Links

Learning curves of the Glidescope, the McGrath and the Airtraq laryngoscopes: a manikin study.

Savoldelli GL, Schiffer E, Abegg C, Baeriswyl V, Clergue F, Waeber JL.

Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland. [email protected]

CONCLUSIONS: In a 'normal airway' model, intubation skills with the new devices appeared to be rapidly mastered. The three indirect laryngoscopes provided a better glottic exposure than the Macintosh. The Airtraq displayed the most favourable learning curve, probably reflecting differences in the techniques of endotracheal tube placement: guiding channel versus steering technique.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Savoldelli%20GL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Schiffer%20E%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Abegg%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Baeriswyl%20V%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Clergue%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Waeber%20JL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus



Pentax AWS

Truview

1: Br J Anaesth. 2009 Jan;102(1):128-34. Links

Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study.

Malik MA, O'Donoghue C, Carney J, Maharaj CH, Harte BH, Laffey JG.Department of Anaesthesia, Galway University Hospitals, Galway, Ireland.

CONCLUSIONS: The Pentax AWS laryngoscope demonstrated more advantages over the Macintosh laryngoscope than either the Truview EVO2 or the Glidescope laryngoscope, when used by experienced anaesthetists in difficult tracheal intubation scenarios.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Malik%20MA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22O'Donoghue%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

C-MAC

GLIDESCOPE

Bonfil rigid stylet

Airway RIFL

Noen ganger er våkenintubasjon det smarteste

Konklusjon

• Alle anestesører bør først og fremst kunne intubere på vanlig måte

• Man kan ordne mye ved å leire bedre• Alle anestesiavdelinger bør ha en klar

alogaritme for håndtering av vanskelig luftvei• Alle anestesører bør ha en klar plan A,B og C • Videolaryngoskop bør være interessant for

alle anestesiavdelinger

TAKK FOR MEG !

Documents

Nye teknikker og nytt utstyr for luftveishåndtering