Reinforced-LMAs-for-paediatric-tonsillectomy增强小儿扁桃体切除术昆布多糖硫酸酯课件.ppt
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1、Reinforced LMAs for paediatric tonsillectomy,Lesley AitkenApril 2008,Day-case tonsillectomy in Epsom,98%Day-case discharge rateBenefitscost effectiveLess pressure on inpatient bedsLess psychological trauma for parents and childrenAnaesthesia 2006,61,116-122,Epsom childrens ENT day-case anaesthesia p
2、rotocol,Clear fluids up to 2hrs pre-opEMLA or ametopPropofol inductionIV ondansetronOxygen/air/sevofluranerLMA in children aged 3 or olderSpontaneous ventilationIV dexamethasonePR diclofenacPR paracetamolIM codeineIV crystalloids 10ml/kg,Continued(Post-op),Free fluids and food on demandNursing obser
3、vations for 6hrs post-opPost-op consultant-led ward roundNurse-led discharge 6hrs post-op,Theoretical advantages of LMA,Avoids neuromuscular blockadeMinimises pharyngeal&laryngeal traumaNo endobronchial/oesophageal intubationLess airway soilingAvoids extubation risksDeepAwakeAirway protection until
4、awake,Evidence,Canadian paeds study(1993)English adult&paeds study(1993)Meta-analysis(1996),UK practice,Clarke et al,BJA 99(3):425-8(2007),Ninewells?,Prospective survey of LMA use3 critical stages:1.Insertion2.Opening of BD gag3.recovery,Methods,Simple formAll NW paeds anaesthetists with regular ENT
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- Reinforced LMAs for paediatric tonsillectomy 增强 小儿 扁桃体 切除 昆布 多糖 硫酸 课件
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