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The use of normal laryngeal mask
narcotic induction and maintenance: laryngeal mask placement need to have enough depth of anesthesia and maintain phase, to prevent the occurrence of respiratory protective reflex. Whether you need to give the muscle relaxant, should according to the needs of the operation. Maintain anesthesia can be inhaled O2 / N2O/share narcotic analgesics, spinal canal Isoflurane anesthesia, nerve block or local infiltration anesthesia. Anesthesia monitoring: blood pressure, ecg, SpO2 and anesthetic gas concentration.
normal laryngeal mask placement: use the recommended standard placement method of counterpoint good Brain, stimulation of the patients with small and fewer complications. The timing of the LMA pulling: end of anesthesia, patients with spontaneous breathing, respiratory reflex recovery, open your eyes and open, pull out the LMA not give sputum suction before stimulation.
normal laryngeal mask inserted into the correct position after judgment: normal laryngeal mask after insertion, should immediately determine whether ventilation and presence of air leakage effectively. Usually by thoracic movement, chest auscultation, called co2 monitoring and clinical judgment whether there is leakage at the end of the location of the laryngeal mask, if necessary by fiber bronchoscope ( FOB） Check the position of the laryngeal mask. Literature reports: after insert normal laryngeal mask, with FOB check: 83% can see the glottis, 54% saw the epiglottis. Literature reported: normal laryngeal mask in oropharynx leak pressure ( 口咽泄漏压力,OLP) An average of 20 cmh2o. So use normal laryngeal mask in the general anesthesia surgery, should retain spontaneous breathing, avoid long time use of positive pressure ventilation; Especially for patients with pulmonary compliance is poor, should avoid to use positive pressure ventilation.
normal laryngeal mask in the patients with difficult intubation application: nearly 10 years, the LMA in dealing with a difficult airway ( Through the mask ventilation and/or intubation difficulties) The application of caused wide attention. Application mainly in the following two aspects: 1, in the application of unexpected difficult intubation patient: after anesthesia induction, found difficult intubation, especially in the '' neither intubation, and not through the mask ventilation in the case of an emergency, can be chosen first of LMA. LMA after successful insertion, can adopt the following three measures: ( 1) For short body and limbs surgery can directly use the LMA on reservation under spontaneous breathing or IPPV; ( 2) By LMA endotracheal intubation; ( 3) After the patient awake, under surface anesthesia and sedation with FOB guide line endotracheal intubation, in the absence of FOB can blind nasal line endotracheal intubation. 2, in has anticipated difficult intubation in patients with application: first choice under surface anesthesia endotracheal intubation by fiber laryngoscope guide line, in the absence of fiber laryngoscope can blind nasal line endotracheal intubation, but for uncooperative patients can be inserted into the LMA under anesthesia induction, again through the LMA endotracheal intubation.
intubation laryngeal mask ( ILMA） : because of normal laryngeal mask design is not by normal laryngeal mask line designed endotracheal intubation, so by normal laryngeal mask line endotracheal intubation some deficiencies. Design ILMA Brain in 1997, and applied in clinical. ILMA and normal laryngeal mask differences: have regular ILMA ventilation tube bending, shorter length and diameter is larger, can through the larger diameter of the endotracheal tube, it is designed to resolve by laryngeal mask line endotracheal intubation.
: (insert method 1) Insert ILMA, vent hood, gas injection location clinical judgment is right; ( 2) Through ILMA ventilation tube to insert the endotracheal tube, can use the blind method, can also be intubation under FOB help. Literature reports, the use of blind plug method through ILMA line endotracheal intubation overall success rate is 94 - 99%, blind plug the success rate of 50% for the first time, the second success rate was 19%, the third and fourth time success rate is 30%; And with FOB help through ILMA endotracheal intubation success rate was 100%. ILMA is mainly used for: 1, the unexpected difficult intubation patient: same as the above ordinary LMA usage; 2, ILMA used to anticipate to the patients with difficult intubation. To known difficult intubation patients after anesthesia induction via mask ventilation difficult or not through the mask ventilation, but after fully calm and surface anesthesia, insert ILMA, breathe through ILMA unobstructed and confirmed by the FOB check position right after, through ILMA insert the endotracheal tube, and induce.
enhance laryngeal mask or double tube laryngeal mask ( LMA - ProSeal) : normal laryngeal mask because of oropharyngeal leak pressure an average of 20 cmh2o, when used in positive pressure ventilation, ventilation cannot guarantee on one hand, on the other hand is the stomach bilges, reflux and the risk of aspiration. In order to make more effective through the laryngeal mask positive pressure ventilation and safety, avoid the stomach bilges, reflux and aspiration, Brian invented the double tube laryngeal mask, and in 2000 started in clinical application. Double tube laryngeal mask used by clinical, compared with the normal laryngeal mask, its effectiveness and safety has improved significantly, and in many cases the alternative to endotracheal intubation, will gradually replace the normal laryngeal mask.
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