definition

Artificial airway: the last stage of the connection between the air path of the anesthesia machine, ventilator, etc. and the patient's anatomical airway to ensure the airway is unobstructed

Patient end: front end of artificial airway←→Anatomy of upper airway of patient

Pneumatic end: rear of artificial airway ←→ machine breathing air path

classification

Artificial airways include: ① face mask, nasal mask; ② airway; ③ endotracheal tube; ④ endobronchial tube.

Masks include: face masks, nasal masks, nasal masks, new masks.

Mask ventilation technology

Patient assessment

The time of fasting water, auxiliary examination, general examination, previous medical history, head and neck activity, mouth and teeth, nasal cavity and throat.

Item preparation

Choose a transparent ventilation mask of the right size, the mask close to the bridge of the nose, cheeks and mouth. You can observe the color of the lips and secretions, check the balloon to ensure that there is no air leakage, and have appropriate oropharyngeal nasopharyngeal airway and negative pressure suction device.

Mask ventilation technique

When ventilating, keep your fingers on the bony markers and do not place them on the soft tissues. The thumb and index finger should be used to tighten the mask firmly. The remaining three fingers will lift the mandible. If necessary, use both hands to lift the mandible.

Precautions and complications of mask ventilation

◆Completely remove airway secretions, blood and foreign bodies;

◆The risk of gas entering the gastrointestinal tract during ventilation;

◆ Mask ventilation is not effective for lower respiratory tract obstruction;

◆Backflow and accidental suction;

◆ Soft tissues around the mouth, pharynx and nose.

Airway

Oropharyngeal airway

Placed through the mouth, suitable for patients with inactive throat reflexes, anesthesia or coma, can relieve the airway obstruction caused by the fall of the tongue.

Length: The length of the oropharyngeal airway is equivalent to the distance from the incisors to the earlobe or mandibular angle. A suitable oropharyngeal tube should meet: the end of the oropharyngeal tube is located in the upper pharynx, separating the base of the tongue from the posterior pharynx wall, so that the hypopharynx reaches The airway of the glottis is unobstructed.

Width: enough width to be able to contact 2-3 teeth of upper and lower jaw is the best.

Reverse insertion

◆Introduce the pharyngeal curvature of the oropharyngeal airway upward into the mouth. When the front end of the oropharyngeal airway is close to the oropharyngeal wall, rotate it 180 degrees to the correct position, and push the thumb down with both hands to the appropriate position.

◆It is forbidden to be conscious, oral and maxillary trauma and pharyngeal occupying lesions pharyngeal foreign body obstruction and shallow anesthesia patients with the risk of broken or lost teeth.

Nasopharyngeal airway

Placed through the nasal cavity, the stimulation is small, the reaction is light, and it is easy to fix. The patient has a side port to prevent it from sliding into the nasal cavity.

◆Check the nasal cavity to determine whether there are nasal polyps or nasal septum deviation;

◆Select length of snuff ventilation channel: distance from earlobe to tip of nose + 1 inch or distance from tip of nose to external auditory canal;

◆Place the curved snuff airway facing the hard palate and push it down the plane of the palatal bone to the hard palate until resistance is encountered in the posterior wall of the nasopharynx.

Ventilation tool

① Laryngeal mask: The laryngeal mask is placed in the laryngo-pharyngeal cavity and the esophagus is closed with a balloon to ventilate the laryngo-pharyngeal cavity.

②Intubation laryngeal mask: solve difficult ventilation and difficult tracheal intubation at the same time, the success rate is high, limited by the patient's mouth opening.

③ Laryngeal tube: The cuff closes the pharyngeal cavity and the opening of the esophagus to implement positive pressure ventilation, which is easy to insert and has less damage.

④Others: New supraglottic tools, which can be bent, pressure-resistant and non-inflatable.

Laryngeal mask indications

◆Patients undergoing general anesthesia for surgery;

◆Emergency airway rescue;

◆ Difficult intubation;

◆Patients with facial or cervical spondylosis;

◆ Difficult intubation during the rapid induction period requires rapid airway control.

Contraindications for laryngeal mask

◆ full stomach;

◆Sick obese obstructive lung disease or abnormal oropharyngeal lesions, tracheal softening, etc.;

◆It is difficult to open the throat through the laryngeal mask.

Endotracheal tube

It is placed in the artificial airway of the patient's trachea through a certain anatomical route, through the mouth and nose.

Endobronchial catheter

Placed on the left and right main bronchus to implement artificial airway for lung isolation and single lung ventilation.

Bronchial catheter

The single-lumen catheter body placed in the bronchus has an elongated cuff body and a short cuff at the front end of the right bronchial catheter. The cuff is divided into two sections, and a port in the middle corresponds to the bronchus opening of the right upper lobe.

Bronchial occlusion catheter

Insert the catheter into the trachea, insert the blocked tube into the left or right bronchus, and inflate the seal to effectively prevent the contents of the diseased lung from invading the healthy lung. When performing single lung ventilation, the ventilation resistance is less than that of the double-lumen tube cuff and then retreat, then it can be restored. Ventilation of both lungs.

Single lung ventilation

Modern minimally invasive thoracic surgery, bronchopulmonary lavage, and lung transplantation all require effective single-lung ventilation to facilitate surgical operations

Double lumen bronchial catheter

It is suitable for the insertion of the left or right bronchus to confirm that the airway of the left or right lung is unobstructed. The dual-lumen bronchial catheter has good isolation and the two lungs can be ventilated separately for easy management.

Simple respirator

Simple respirators are also known as resuscitation balls and balloon balloons. It is suitable for the occasions of cardiopulmonary resuscitation and first aid of artificial respiration, especially for the cases of suffocation, difficulty breathing or the need to increase the oxygen supply. It is easy to use, has fewer complications, and is less painful. It can be ventilated immediately with or without an oxygen source.