Experience of the nasal tracheostorine under the guidance of the right Metmy fixed sedative fiber optic mirror in patients with scars in the chest scar contractions after the burn

Patients with severe burns,clinicalare characterized by severe neck scarring, jaw and front chest scar adhesion, patients with difficulty opening mouth, back restrictionsSuch patients have difficulty in mask ventilation, difficulty in the sound door, airway table difficulties and other problems, seriously affecting surgery, threatening the health of patients, the implementation of trachea intubation is a serious challenge for anesthesiologistsShandong University affiliated provincial hospital anesthesiology department recently used the homemade OLYMPUSLF-DP model fiber-styluic intra-intraometer hemp equipment first to implement the trachea intheliometer, and then the use of right metamia sedation, fiber-scoundrel guide to successfully complete the nasal trachea intubation, intubation process patients safe and comfortable1Patient informationpatient, female, 50 years old, height 161 cm, body mass 62kg, due to "the whole body after multiple burns scar contraction malformation" income hospital, proposed in the trachea intubation full hemp down-line scar pine desitation and artificial deridoPatients have a history ofdiabetes, usually regular lying medication, fasting blood sugar control at 9.0mmol /L or soNo other systemic diseases and infectious diseases have been observedspecialist situation: the patient's nasal burn deformity, only see the right side of the nostrils, the nostrils are larger, the nasal cavity is smoothThe body can be seen a wide range of burns after the scar, especially the right upper limb, neck, right lower limb as a heavy, many joint malformation dysfunctionNeck scar contraction is serious, the lower jaw and front chest scar adhesion, the back is limited, the neck scar can be seen to break, the size of about 1 cm x 3 cm local redness and swelling, no obvious oozing2Trachea intubation processpatients into the room, connected with electrocardiogram (ECG), blood pressure (BP), pulse oxygen saturation (SpO2) and other monitoring, pure oxygen 5L/min inhalationIntravenous push length toning 0.02mg/kg, Shufentani 5 sg, and then give the right metatim a fixed load of 1 ?g/kg, 10min pump injection completed, changed to 0.4 sg/ (kg-h) to maintain the pumping, patient quiet fit, can wake up at any time2.1 OLYMPUSLF-DP model fiber optic mirror joint epidural epithelial catheter to implement airway surface anesthesiafirst of all dinka in ephedrine mixture soaked brain cotton, nasal filling for nasal cavity epiphony, 5min after the removal of the brain cottonThen the SURFACE of the OLYMPUSLF-DP fiber optic mirror with a adhesive cloth uniformly fixed a tube of the epidural, fiber optic mirror into the nasal cavity, after the nasal perforation, to find the sound door, through the epidural tube sprayed into 2% Lidocain 1mL, continue to enter the sound door, sub-sprayed into Lidocain a total of 2mLThe patient develops cough, quickly withdraws from the optic oscosis and gives the mask oxygen2.2 fiber optic mirror guide through the nasal trachea intubationto remove the optic tube on the fiber lens, set 5.5 trachea catheter, fiber optic mirror through the nose into, the field of vision to find the sound door, homeopathic into the sound door down to protrusion, the patient has no cough reaction, well toleratedThe assistant is fed into the trachea duct, the fiber optician locates the depth and exits, taking the anaesthetic machineAfter propofol 50mg static push, again to listen to the respiratory tone and observe the exhalation end carbon dioxide pressure (PETCO2) to determine the trachea catheter in the trachea, give the smooth aquex ammonium 20 mg, shufentani 10 mg, heptafluorone inhalation maintenance anesthesia, set moisture volume (VT) 450mL, respiratory frequency (RR) 12 times / min3Discussiondue to the patient's neck scar contraction scar serious, jaw and front chest scar adhesion, back limit, open mouth only half cross finger, the existence of mask ventilation difficulties, sound door exposure difficulties, rapid induced intubation there is a greater risk, in the past blind detection easily caused serious damage to the body, therefore, we chose the right Metmy fixed fiber sedative mirror guide through the nasal trachea tubeFull table hemp is the key to the success of the sobriety intubation, patients with small opening stoue, hemp difficulties through the mouth, and scar contractions, unable to see the anatomical structure, ring film puncture difficultiesWe use homemade fiber optic mirror table hemp equipment can be seen under the full table numbness, patients less pain Table hemp using 2 kinds of prescription drugs, to avoid a single innings of drug overdosing Burn patients after a number of operations, nervous anxiety, pain allergy, low pain threshold, right metatomis is a specific alpha 2 receptor agonists, with good sedative analgesic effect, less impact on the respiratory and circulatory system, not only can eliminate the patient's anxiety and psychological trauma, but also because of its unique "wakeful sedation" effect, can make the patient in the absence of external stimulation in a state of sleep, easy to be commanded language wake-up, with medical staff studies have shown that right-meme-to-cold stress tests have a light, moderate analgesic effect, although it can not raise the pain threshold, but can alleviate the emotional response caused by pain; , we chose the right metorita compound small dose of seffentanil for sedative analgesia, not only to reduce the patient's pain of suffering from the awake trachea intubation, while maintaining the stability of respiratory circulation The fiber-splicing body is fine and soft, and can be bent at will, stimulate the surrounding tissue smaller, the success rate of the intubation is high Studies have shown that the electrothecord of the anaesthetic-induced post-fibre spout is less than the hemodynamic response of patients passing through the mouth, mainly because the fiber optic mirror through the nose into the mouth and pharynx is often directed at the sound door, with a larger angle adjustment, usually at a certain distance can be seen sound door, and from the mouth to the pharynx bending angle is larger, so the way through the mouth than through the nasal tube difficult And sometimes even if the liscoscopy enters the trachea, the trachea duct will be blocked from the tired or into the pear-shaped nest and difficult to push the intake tube smoothly, and will lead to the patient's heart blood vessels reaction enhanced combined with the patient's open mouth is limited, nostril conditions are appropriate, we chose the fiber optic mirror guide through the nasal sobriety intubation, and selected THE OLYMPUSLF-DP model fine fiber optic mirror operation, small trauma, to prevent nosebleeds This surgical patient is characterized by large area scar contractions leading to significant impact and limitation of intubation, we have adopted the appropriate operating methods for patients, successfully carried out trachea intubation In case of such patients should be combined with their own circumstances, all links are not tied to conventional treatment, in order to ensure the safety of patients and the smooth progress of surgery