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1、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应用2016-5-27上海市第六人民医院Shanghai Sixth Peoples Hospital颈部气道解剖上海市第六人民医院Shanghai Sixth Peoples Hospital定位喉上神经The thyrohyoid membrane as a target for ultrasonography-guidedultrasonography-guided block of the internal branch of the superior laryngeal nerveStopar
2、-Pintaric T, Vlassakov K, Azman J. J Clin Anesth.2015 Nov ; 27(7): 548-52.In conclusion, we are proposing an anatomical concept for a new, new, simpler, consistently reproduciblesimpler, consistently reproducible US-guided iSLN block technique using the thyrohyoid membrane to define the target plane
3、 for low- volume local anesthetic injection.上海市第六人民医院Shanghai Sixth Peoples Hospital外侧舌骨外侧舌骨超声影像舌骨、喉上神经外侧过拱桥，甲舌膜里寻喉上上海市第六人民医院Shanghai Sixth Peoples Hospital定位环甲膜The conventional method, inspection and palpation, has a low success rate, especially in women (2435%).Elliott DS, Baker PA, Scott MR, et a
4、l. Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010; 65: 88994Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495503上海市第六人民医院Shanghai Sixth
5、Peoples HospitalBarbe N,Martin P,Pascal J,et al. Ann Fr Anesth Reanim.2014 Mar;33(3):163-6.定位环甲膜Locating the cricothyroid membrane in learning phase: Value of ultrasonography ? The CTM was accurately identified by palpation and ultrasound by 46% and 100% 46% and 100% of residents respectively (P 0.0
6、5). 上海市第六人民医院Shanghai Sixth Peoples HospitalKristensen MS, Teoh WH, Rudolph SS,et al. Br J Anaesth. 2015 Jun;114(6):1003-4. 定位环甲膜Structured approach to ultrasound-guidedultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly ob
7、esemorbidly obeseWhen using the conventional digital palpation method, 13 of 35 anaesthetists (37%) were able to locate the cricothyroid membrane successfully within 2 min, whereas the success rate was 29 of 35 (83%) when the structured stepwise ultrasonography method was applied (P=0.0008, McNemars
8、 test).上海市第六人民医院Shanghai Sixth Peoples HospitalSiddiqui N, Arzola C, Friedman Z, et al. Anesthesiology.2015 Nov;123(5):1033-41. 定位环甲膜Ultrasound Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck AnatomyUltrasound guidance significantly decreased the incidence of injuries
9、 to the larynx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation.上海市第六人民医院Shanghai Sixth Peoples Hospital外侧甲状软骨声带声带环甲膜外侧超声影像甲状软骨、环甲膜外侧越尖峰，缺口伪影环甲膜甲状软骨声带声带伪影上海市第六人民医院Shanghai Sixth Peoples Hospital超声影像环状软骨外侧气管软骨甲状腺峡部外侧气
10、管软骨外侧上海市第六人民医院Shanghai Sixth Peoples HospitalUltrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessIida T,Suzuki A, Kunisawa T,et al.J Anesth (2013) 27:309310临床应用1清醒插管上海市第六人民医院Shanghai Sixth Peoples HospitalSonograp
11、hically Sonographically Guided Superior Laryngeal Nerve Block During Awake Fiberoptic IntubationSawka A, Tang R, Vaghadia H. A A Case Rep.2015 Apr 15; 4(8): 107-10.Sonographically guided superior laryngeal nerve block may be usefuluseful in patients where identification of landmarks in the neck is d
12、ifficultdifficult as a result of patient anatomy临床应用1清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用1清醒插管Ultrasound-guided Cannula CricothyroidotomySuzuki A,Iida T, kunisawa T,et al. Anesthesiology 2012 Nov;117(5):1128Ultrasound-assisted translaryngeal block for awake fibreoptic intubationDe Olivei
13、ra GSJr, Fitzgerald P, Kendall M. Can J Anesth. 2011 58:664665上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用1清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用1清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用1清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺Wu J,Dong J, Ding Y, et al.
14、Med Sci Monit, 2014; 20: 2343-2350Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyAnterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryng
15、oscopy.Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy.上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺上海市第六人民医院Shanghai Sixth Peoples HospitalUltrasonographic measurement of the minimal transvers
16、e diameter of the subglottic airway in the transverse plane, typically at the caudal outlet of the cricoid ring临床应用3选择适合气管导管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用4判断气管导管位置气管软骨外侧食管甲状腺上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用4判断气管导管位置THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL TUBE PLACEMENT IN A CADAVER MODELDynamic assessment resulted in 97% 97% sensit
