RU2806513C1 - Anesthetic kit to ensure patient safety under general anesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to an anaesthesia kit for ensuring patient safety under general anaesthesia. The kit comprises a tube with an inflatable cuff at the distal end to obstruct the oesophagus. The kit includes a gastric tube for decompression and evacuation of stomach contents. The kit comprises an upper airway tube, the distal end of which has a 45-degree bend, is equipped with holes for airflow dispersion, and ends in two 8 mm long bevels. The kit includes a catheter to remove fluid from the tracheobronchial tree and a suction catheter to remove sputum and mucus from the oropharynx. The kit comprises an elastic band to seal the mouth outlet with openings for a distal cuffed tube, an airway tube and a suction catheter. The kit is equipped with fixation elements and cotton balls for closing the nostrils.

EFFECT: ability to remove saliva and mucus from the oropharynx and sputum from the tracheobronchial tree, prevent disturbances in blood flow and innervation of the tongue due to the absence of a tightly inflated oropharyngeal cuff, prevent the entry of stomach contents into the oropharynx, prevent complications caused by impaired patency of the lower respiratory tract, simplicity and material accessibility, use in any operating room.

1 cl, 5 dwg, 1 ex

Description

The invention relates to the field of medicine, namely to anesthetic instruments and can be used as an anesthetic set to ensure the safety of a patient under general anesthesia.

Multicomponent general anesthesia (MOA) using general anesthetics, narcotic analgesics, sedatives and muscle relaxants is often accompanied by undesirable side effects. One of the most common and dangerous is hypoventilation or apnea due to depression of the respiratory center, retraction of the tongue, weakness of the respiratory muscles, and aspiration of gastric contents.

One of the generally accepted measures to prevent these complications is the use of an oropharyngeal airway.

A known device for ensuring patient safety under conditions of general anesthesia is the VBMmedizintechnik laryngeal tube (Germany), which has two channels and two cuffs. One channel is used for passing a gastric tube; The cuff installed on it, when inflated, obstructs the esophagus. The other channel is an airway with an oropharyngeal cuff that, when inflated, prevents air from leaking from the oropharynx.

The disadvantage of the laryngeal tube is the inability to remove saliva and mucus from the oropharynx and sputum from the tracheobronchial tree under general anesthesia, as well as the rather high cost of the laryngeal tube.

The technical result of the invention is the ability to remove saliva and mucus from the oropharynx and sputum from the tracheobronchial tree, prevent disturbances in blood flow and innervation of the tongue due to the absence of a tightly inflated oropharyngeal cuff, prevent the entry of stomach contents into the oropharynx, prevent complications caused by impaired patency of the lower respiratory tract, simplicity and material accessibility, use in any operating room.

The specified technical result is achieved in an anesthesia set to ensure the safety of the patient under general anesthesia, characterized in that the set contains a tube with an inflatable cuff at the distal end for obturation of the esophagus; tube-gastric tube for decompression and evacuation of stomach contents; an airway tube to ensure free patency of the upper respiratory tract, the distal end of which has a bend at an angle of 45 degrees, is equipped with holes for dispersing the air flow and ends with two bevels 7-8 mm long, a catheter for removing liquid contents from the tracheobronchial tree, an aspiration catheter for removing sputum and mucus from the oropharynx, elastic band with holes for tubes and fixation elements, soft nose clip.

The essence of the invention is illustrated by the drawings in Fig. 1-5, where:

in fig. 1-3 show all the elements included in the set;

in fig. 4 and 5 - dial diagram in action.

The anesthetic set (Fig. 1) consists of a polyvinyl chloride tube 1 with an inflatable cuff 2 at the distal end for obturation of the esophagus; tube - gastric tube 3 for decompression and evacuation of stomach contents; air duct tube 4 (Fig. 2) which serves to ensure free patency of the upper respiratory tract. The distal end of the airway tube 4 is bent at an angle of 45 degrees over a length of 3.5-4 cm in accordance with the anatomical structure of the hypopharynx. At the distal end of the tube 4, holes 5 are made to dissipate the air flow supplied to the tube 4 and two bevels 6, 7 are made. The lower bevel 6 allows the aspiration catheter 8, which is inserted through the tube 4, to bend downward under the influence of gravity and go into the tracheobronchial tree, bypassing the vocal folds to perform aspiration of the liquid contents of the tracheobronchial tree. The upper bevel 7 is designed to reduce friction between the tube 4 and the root of the tongue, facilitating its insertion.

The set also contains (Fig. 3) a dense elastic tape 9 for sealing the exit from the mouth, equipped with ribbons 10 for fastening around the neck and holes 11, 12, 13 for inserting three tubes, respectively: a tube for obstructing the esophagus - hole 11, a catheter for removing sputum and mucus from the oropharynx - hole 12 and air duct - hole 13.

The set is used as follows.

After standard intravenous premedication on the operating table (fentanyl, phenazepam, atropine in therapeutic doses), the oropharynx is sprayed with a solution of local anesthetic (lidocaine solution - 5% - 1.0-0.5 ml) to prevent unwanted reflex reactions (nausea, vomiting, laryngospasm ) that arise when inserting tubes. The patient then breathes 100% humidified oxygen for 3-5 minutes (preoxygenation). Next, induction anesthesia is carried out, for which various narcotics can be used: solutions of sodium thiopental, diprivan, ketamine, sodium hydroxybutyrate in recommended doses or inhalation of sevoflurane or nitrous-oxygen mixture. The tubes are inserted without muscle relaxants while spontaneous breathing is maintained.

First, tube 1 is inserted into the esophagus along the back wall of the pharynx with cuff 2 deflated (Fig. 5). Tube 1 is inserted below the level of the bulge of the anterior wall of the esophagus, formed by the adjacent posterior plate of the cricoid cartilage. The guideline is the slight resistance felt at this level when inserting tube 1. Cuff 2 is inflated with a certain volume of air to a pressure of no more than 20 mm. Hg, obstructing the esophagus. If a “full stomach” is suspected, a thin gastric tube 3 is inserted through the lumen of tube 1 to empty the stomach and decompress, thereby preventing regurgitation. It is important to emphasize that until the obturator tube 1 is inserted into the esophagus, it is necessary to perform the Sellick maneuver to prevent regurgitation of gastric contents. Then, in parallel with tube 1, an aspiration catheter 8 is inserted into the posterior inferior part of the hypopharynx to evacuate saliva and mucus produced during the operation. The air duct 4 is inserted parallel to tubes 1 and 8 so that its end extends beyond the root of the tongue and is located opposite the entrance to the larynx. This prevents obstruction of the upper respiratory tract due to tongue retraction. Sealing of the exit from the oropharynx is ensured by a rubber elastic band 9 (Fig. 3) with three holes corresponding to the sizes of the inserted tubes 1, 4, 8. The nostrils are closed with damp cotton balls 14 (Fig. 4). 15 - control cylinder; 16 - insertion of catheter 8

The method is confirmed by the following clinical example.

Patient S.K.I., 56 years old, was admitted with complaints of severe pain in the right iliac region of the abdomen, nausea and vomiting, general weakness, and dizziness. Objectively: a woman of average height, increased body weight, forced position (crouched), slight icterus of the sclera, temperature 38.3 degrees, signs of dehydration, abdominal muscle tension on palpation. BP - 145/90, heart rate - 90/min. In the blood: leukocytosis - 12 thousand with a shift of the formula to the left, increased bilirubin, hemoglobin and electrolytes within normal limits, hemotocrit increased to 48 mm. Small amounts of yellow urine. A woman has been smoking for many years and has a “smoker's cough” with mucous sputum. Diagnosis: exacerbation of chronic cholecystitis. Concomitant: stage 1 obesity, chronic bronchitis. An urgent operation is indicated: cholecystectomy.

In the operating room, sensors were attached to monitor the vital functions of the body; 1.2 liters of physiological solution and 400 ml of rheopolyglucin were infused intravenously. IV premedication: seduxen 10 mg, fentanyl 100 mcg, atropine 0.6 mg, diphenhydramine 30 mg. Spraying the pharynx and larynx with lidocaine solution - 2 ml 2%. “Pre-oxygenation” was carried out with 100% oxygen for 5 minutes through the mask of the anesthesia machine. Introductory anesthesia (induction): 1% sodium thiopental solution “before falling asleep” (350 mg) against the background of auxiliary ventilation with oxygen. During induction, until the insertion of the esophageal obturator tube, an assistant performed the Sellick maneuver to prevent regurgitation of gastric contents.

Under conditions of spontaneous breathing, without the use of muscle relaxants, under the control of a laryngoscope, a tube - an esophageal obturator - was inserted into the proximal part of the esophagus, the cuff of the tube for obturating the esophagus was inflated to a pressure of 20 mm Hg. Thus, the digestive and respiratory tracts are separated and aspiration of gastric contents is prevented. A gastric tube may be inserted through this tube to decompress the evacuation of gastric contents.

In parallel with the first tube, a standard catheter was inserted into the hypopharynx to evacuate saliva and mucus, preventing them from flowing into the respiratory tract.

The third tube, the air duct, was inserted into the hypopharynx behind the root of the tongue, its end located opposite the entrance to the larynx. Through the channel of this tube, a standard catheter can be inserted into the tracheobronchial tree to evacuate liquid contents. In order to seal and prevent the release of the respiratory mixture of gases from the oropharynx, an elastic tape made of dense material with three holes for insertion tubes was placed on the mouth and secured with ribbons around the neck. To seal the exit from the nasopharynx, damp cotton balls are inserted into the nostrils.

Multicomponent general anesthesia was performed under mechanical ventilation with sevoflurane with an air-oxygen mixture of gases in combination with fentanyl and muscle relaxants. During anesthesia, liquid contents were evacuated from the tracheobronchial tree and from the oropharynx through installed catheters.

Anesthesia proceeded without complications, blood gases, hemodynamics and acid-base balance were maintained within normal limits. The inflamed gall bladder was removed and the abdominal cavity was drained.

After the end of anesthesia, the patient regained consciousness, adequate spontaneous breathing, muscle tone, and cough reflex were restored. The tubes were removed, and the patient independently coughed up mucous sputum. The postoperative period proceeded without complications, the patient was discharged from the hospital for outpatient treatment.

The inventive anesthetic set to ensure the safety of the patient under general anesthesia provides the ability to remove saliva and mucus from the oropharynx and sputum from the tracheobronchial tree, prevents disturbances in blood flow and innervation of the tongue due to the absence of a tightly inflated oropharyngeal cuff, eliminates the entry of stomach contents into the oropharynx, and prevents complications caused by obstruction of the lower respiratory tract, is economical, simple and accessible in any operating room.

Claims (1)

An anesthetic set for ensuring the safety of the patient under general anesthesia, characterized in that it contains a tube with an inflatable cuff at the distal end for obstructing the esophagus; tube-gastric tube for decompression and evacuation of stomach contents; an airway tube to ensure patency of the upper respiratory tract, the distal end of which has a bend at an angle of 45 degrees, is equipped with holes for dispersing air flow and ends with two bevels 8 mm long, a catheter for removing liquid contents from the tracheobronchial tree, a suction catheter for removing sputum and mucus from the oropharynx, an elastic tape for sealing the exit from the mouth with holes for a tube with an inflatable cuff at the distal end, an airway tube and a suction catheter and fixation elements, cotton balls for closing the nostrils.