絞り込み

16762

広告

院内トリアージ実施料の範囲を拡大へ (日経BP)

2020年4月8日、中央社会保険医療協議会(中医協)総会が開催され、新型コロナウイルス感染症に伴う医療保険制度の対応が議論された。 厚生労働省保険局医療課は、外...

  1. 「第4の携帯」楽天が船出 コロナで一部店...
  2. ペムブロリズマブのTMB高値既治療固形癌...
  3. 中等症の患者を集めて高次病院の負担軽減目...
  4. 令和2年3月末申請の収容定員の増加に係る...

ニュース一覧

[Anesthesia in spontaneous ventilation for difficult intubation.]

著者 Salvi N , Orliaguet G
Ann Fr Anesth Reanim.2013 Nov 5 ; ():.
この記事をPubMed上で見るPubMedで表示
この記事をGoogle翻訳上で見る Google翻訳で開く

Département d'anesthésie réanimation et samu de Paris, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France. Electronic address: nadege.salvi@nck.aphp.fr.

スターを付ける スターを付ける     (5view , 0users)

Full Text Sources

Medical

Difficult intubation in children is rare and often predicable during anesthesia consultation. This allows to establish a strategy to provide fiberoptic guided tracheal intubation with spontaneous ventilation in function of age and children pathology. A good knowledge of physiologic and anatomic children particularities, of fiberoptic technique and the respect for some principles lead to ensure the security of this procedure. First principle is to use only one anesthetic inhaled or intravenous agent in order to limit an important decrease of ventilation. The anesthetic technique recommended for pediatric fiberoptic guided intubation is inhaled anesthesia with sevoflurane. But it is possible to use an intravenous agent, like propofol, with a continuous infusion (bolus of 0.1 to 0.3mg/kg then 0.1-0.3mg/kg per hour for maintenance) or with target controlled infusion (Schnider model, initial concentration 2.5μg/mL, then increase by 0.5μg/mL steps) particularly in children older than 5 years with an anesthetic depth control. Whatever the agent, the dose must to be titrated to maintain spontaneous ventilation. Second principle is to combine an airway local anesthesia with general anesthesia to limit airway reactivity. First, a nose topical anesthesia is administered with lidocaïne plus naphazoline in children older than 2 years. Then, a laryngeal topical anesthesia is realized with lidocaïne 1% (1-2mL, 2mg/kg) through operating channel of fiberoptic bronchoscope. Finally, third principle is to ensure patient oxygenation with several techniques like use of endoscopic facial mask or nasopharyngeal tube. The use of laryngeal mask is a rescue technique in case of spontaneous ventilation lost. In conclusion, each institution has to establish an algorithm with his own knowledge, constantly feasible and regularly teached.
PMID: 24209989 [PubMed - as supplied by publisher]
印刷用ページを開く Endnote用テキストダウンロード