CN114796787A

CN114796787A - Infant tracheal foreign body taking-out operation anesthesia technology

Info

Publication number: CN114796787A
Application number: CN202110115311.2A
Authority: CN
Inventors: 张俊丽; 白耀武; 钱金洪
Original assignee: Individual
Current assignee: Individual
Priority date: 2021-01-28
Filing date: 2021-01-28
Publication date: 2022-07-29

Abstract

The difficulty of the technique of taking out foreign body from trachea for anesthesia is that an anesthesiologist and an operating doctor share one air passage, so that not only is sufficient oxygen supply for the infant patient guaranteed, but also the stress reaction of the throat and the trachea opposite to the bronchoscope is inhibited to the maximum extent. Foreign body in trachea mostly occurs in infants under 3 years old, the illness state of the infant is critical, and the foreign body is taken out through an operation as the only solution. However, the operative anesthesia has a very high risk, and is easy to cause choking, breath holding, severe cases of oxygen deficiency, and even severe cases of respiratory and cardiac arrest. The anesthesia technology successfully solves the problem that an operator and an anaesthetist share the same airway in an oxygen supply mode of connecting a bronchoscope with an anaesthesia machine. And the sufficient and effective surface anesthesia of the tracheobronchial mucosa relieves the airway spasm and reduces the dosage of the intravenous anesthetic, the autonomous respiration of the sick children is kept on the premise of meeting the operation requirements, and the life safety of the sick children is ensured. The anesthesia technology has been successfully implemented in nearly 3000 children patients in our hospital since 2000, is safe and effective, and should be widely popularized, so that the life safety of more children patients is ensured.

Description

Infant tracheal foreign body taking-out operation anesthesia technology

Technical Field

The infant tracheal foreign body taking operation has extremely high anesthesia risk and has the following three difficulties: (1) the operation and the anesthesia share the same air passage, so that not only is the sufficient oxygen supply of the infant patient ensured, but also the adverse reaction of the throat and the trachea opposite to the bronchoscope is inhibited to the maximum extent, and the difficulty is brought to the respiratory management; (2) the patient is an emergency operation, the condition is fierce, the patient is often complicated with dyspnea and even seriously lacks oxygen; (3) the operation stimulation is large, and the anesthesia depth is difficult to master: the patient struggles, coughs and holds breath during the operation due to over shallow anesthesia, which may cause foreign body displacement or induce severe hypoxemia; if the anesthesia is too deep, the respiratory cycle function is severely inhibited, and even respiratory and heartbeat are suddenly stopped. Our anesthesia technique both ensures the intraoperative oxygen supply for the infant patient and completes the operation at the proper depth of anesthesia.

Background

The foreign body of the trachea is a common emergency of otolaryngology department, and is mostly generated in infants below 3 years old. The infant throat protective launch is not complete, the peanut, melon seed and bean are easy to be sucked by mistake when the infant is eaten in the process of being cheerful, crying and falling, and the infant throat protective launch is the most common reason for the foreign body of the trachea and the bronchus. The most common foreign body entering the trachea and bronchus is manifested as severe cough and reflex laryngospasm, suffocating and bluish purple complexion. Smaller pieces of foreign matter can be generally expelled with coughing, but larger or irregularly shaped pieces of foreign matter are not easily expelled. The method is clinically divided into a complete obstructive type and an incomplete obstructive type according to the size and the character of foreign matters and the retention time in a bronchus and a bronchus: incomplete obstructive type is easy to cause atelectasis, complete obstructive type is easy to cause emphysema, and complete obstructive foreign matter with a long course of disease can cause bronchopneumonia and emphysema to cause serious consequences. The sick children are in critical illness and are taken out under a hard bronchoscope as the only solution. However, the operation stimulation of the foreign body taking-out operation under the hard bronchoscope is strong in the air passage, most of the children patients are infants, the hypoxia tolerance is poor, and the operation cannot be matched, so that the proper anesthesia scheme is particularly important for the smooth implementation of the operation, the treatment effect and the death rate of the children patients.

Disclosure of Invention

Through the summary of years of clinical experience, the anesthesia scheme is continuously optimized, and finally the anesthesia scheme most suitable for the operation is found, so that the scheme not only ensures that the operation is successfully completed, but also ensures the life safety of the infant patient. The content of our invention mainly includes the following aspects:

(1) oxygen supply during operation: a bronchoscope is improved, a sputum suction port of the bronchoscope is plugged by a silica gel cap, an oxygen input end of the bronchoscope is connected with a Y-shaped threaded pipe joint of an anesthesia machine through a cut-out proper tracheal catheter (plastic pipe), and oxygen is sucked into a lung through the threaded pipe, the plastic pipe and the bronchoscope.

(2) Sufficient superficial anesthesia: 1ml of 2% lidocaine was subjected to laryngeal spraying through a laryngeal anesthesia tube; 3ml of 2% lidocaine and 15mg of ephedrine (liquor of lincosane) are connected with an epidural catheter, the epidural catheter is placed through a bronchoscope after the bronchoscope is placed in a glottis, and spraying is carried out when the hand feeling is resistant.

(3) Maintain a certain depth of anesthesia: vein opening, spontaneous breathing preservation: fentanyl 5ug/kg, propofol 2mg/kg slowly pushed statically, dexmedetomidine 1ug/kg for 10 min. 1mg/kg of propofol is added in the period of time to ensure that the sick children are still and are free from choking cough.

(4) After the operation is finished: dexamethasone 5mg/kg and naloxone 0.4mg, and the infant patient is returned to the ward after getting out of the operating room.

Drawings

Figure 1 is a view of a rigid bronchoscope reconstruction.

Detailed Description

After the patient enters a room, opening peripheral veins, connecting an electrocardiogram, blood pressure and pulse oxygen saturation, preparing an aspirator, narcotic drugs and rescue drugs, checking the integrity of anesthesia machine equipment, opening an anesthesia machine oxygen flow meter to 8-10L/min, simultaneously advising an assistant to administer fentanyl 5ug/kg, right American 1ug/kg for pump injection for 10min and propofol 2mg/kg for slow static pushing, keeping the spontaneous respiration of the patient, and additionally adding propofol 1mg/kg in a time interval to ensure that the patient does not move and cough; after the infant falls asleep, a laryngoscope is placed into the exposed throat and the glottis, 1ml of 2% lidocaine is sprayed around the glottis by a laryngeal hemp tube, a hard bronchoscope is placed into the glottis, the laryngoscope is stopped when the glottis reaches the total trachea, a prepared epidural catheter is placed into the trachea through the bronchoscope, the prepared linnet liquid is quickly injected into the trachea by hand feeling resistance in the inspiration period of the infant, so that the linnet liquid is uniformly sprayed on the surfaces of the trachea and the bronchus, and the patient waits for 1min and then slowly enters the bronchoscope for examination. In the operation, the bronchoscope tracheal catheter joint is connected with the Y-shaped threaded pipe joint of the anesthesia machine to ensure oxygen supply for the infant patient, and the specific method comprises the following steps: the bronchoscope is improved by temporarily blocking the inlet end of a sputum suction port by a silica gel cap (an operator can directly suck sputum through an operation port), sleeving a plastic tube with the length of about 3-5 cm outside the oxygen input port, connecting a proper tracheal catheter joint at the other end, immediately connecting a Y-shaped tube joint of an anesthesia machine with the tracheal catheter joint after the bronchoscope is placed into a trachea, opening an oxygen flow meter, and manually controlling a respiratory sac of the anesthesia machine for 30-40 times/min. So that oxygen is inhaled into the lung through the screwed pipe-plastic pipe-bronchoscope. If the bronchoscope is placed into one side of lung for too long operation time and the blood oxygen saturation is less than 80%, an operator withdraws the bronchoscope to the general trachea, an anaesthetizer blocks an operation hole by using the thumb of the left hand (the operation hole is loosened during exhalation), the right hand controls a breathing bag to synchronously assist breathing, and the operation is continued when the blood oxygen saturation rises to more than 95%; after the operation, 5mg of dexamethasone is used for intravenous injection to prevent laryngeal edema, 0.4mg of naloxone is used for intravenous injection to antagonize fentanyl, and after the sick child is awake, the sick child is taken out of an operation room and sent back to a ward.

Claims

1. The invention has the technical characteristics that:

(1) through the transformation of the hard bronchoscope sputum suction port inlet end, the oxygen inlet end of the bronchoscope is connected with the thread pipe of the anesthesia machine through the cut plastic tracheal catheter (plastic pipe), so that the frequency of the patient withdrawing the bronchoscope due to oxygen deficiency is reduced, the operation time is shortened, the ventilation safety of the patient in the operation is ensured, and the problem that an operator and an anesthetic share the same air passage is successfully solved.

(2) The stress reaction of bronchoscope operation can be effectively relieved by local spraying surface anesthesia in the trachea of lidocaine; ephedrine can relax trachea and bronchial smooth muscle, and relieve bronchospasm caused by stimulation of rigid bronchoscope, and the two drugs supplement each other. However, the key problem of how to directly spray local anesthetic on the surfaces of trachea and bronchus is use, an epidural catheter is used to reach the total trachea through a bronchoscope and then is quickly injected when a child patient inhales, and the side hole of the epidural catheter is used to effectively spray the local anesthetic on the surface of the tracheal and bronchus mucosa, so that the problem is successfully solved.

(3) The sufficient and effective surface anesthesia can reduce the use of intravenous anesthetic, can reach the anesthesia depth required by the operation stimulation and less influence the autonomous respiration of the infant, and ensure the smooth completion of the oxygen supply and the operation of the infant in the operation. The anesthesia depth can be controlled more easily by an anesthesiologist, and the problem that the anesthesia depth is difficult to master is solved.

We want to: the anesthesia technology of the infant tracheal foreign body extraction can be protected.