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    Home > Active Ingredient News > Anesthesia Topics > Throat suction cutter guide trachea intubation tube used to support laser throat papilloma excision under the larynx 1 case report

    Throat suction cutter guide trachea intubation tube used to support laser throat papilloma excision under the larynx 1 case report

    • Last Update: 2020-06-21
    • Source: Internet
    • Author: User
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    The child, a woman, aged 1 and 9, weighed 12.5kg and was admitted to hospital on March 27, 2018 due to "more than 20 days of breathing difficulties"More than 20 days ago, children without obvious causes of night snoring, wheezing, symptoms gradually worsened, after the development of minor activities after the appearance of breathing difficulties, with throat wheezing, drinking cough;post-hospital laryngoscope examination: "the larynx can be seen papilloma-like new organisms, two-sided vocal cords in front of 2/3 adhesion, two-sided vocal cord surface is not smooth, sound door open ventilation is poor" (Figure 1); a, b: papilloma-like new organisms; c: sound tape adhesion, sound door open ventilation poorafter entering the room children crying violently, hoarse voice, visible three concave signs, lips still red, lung hearing can be heard and snoringMonitoring of vital signs under oxygen absorption: heart rate (HR) 155 times/min, blood pressure (BP) 86/51mmHg, oxygen saturation (SpO2) 95%, breathing (R) 28 times/minanaesthetic induction: pre-oxygen 5min, heptafluorane pre-charged respiratory circuit, children inhaling 8% heptafluorane, oxygen flow 4L/min, after consciousness disappears to observe the child retains the self-breathing under the mask ventilation can be, chest, abdominal breathing dynamics are good, moisture (VT) up to 7 to 9 ml/kg, respiratory rate 2 5 to 30 times /min, the end of CO2 pressure (PetCO2) maintained at 35 to 40mmHg, SpO2 100%, HR128 times / min, BP78/39mmHg, open ediphyves, and intravenous injection of 0.3mgAfter adjustment inhalation heptafluerane concentration 4 to 6%, after 5min, visual laryngosiexpos exposed under 2% Lidoca in 1 ml throat spray surface anesthesia, after inhalation 4% heptafluorane 10min, direct throat mirror exposure, to throat suction knife guide , place3.5mm with sac trachea duct, depth 13 cm, connected to ventilator, at this time HR143 times/min, BP92/50mmHg, SpO2 98%, PetCO2 43mmHgdetermine the trachea tube position depth is correct, intravenous medamine 0.5mg, fentanyl 20 mg, shun aquor ammonium 1mg, propofol 25mg, methyl strong pine dragon 20mg, machine-controlled breathing, regulated breathing parameters to make VT up to 8 to 10 ml / kg, breathing rate 20 to 25 times / minute, PetCO2 maintenance of about 35mmHg, gas Hg 20mmAnaesthetic maintenance: oxygen flow 0.7L/min, air flow 3L/min, continuous pumping propofol 6 to 8 mg/kg, Riffen 0.1 to 0.2?g/kg minsurgery went smoothly, complete lysing out the throat cavity with multiple papilloma-like new organisms, and removing the new papilloma-like new organisms and adhesion vocal cords at the vocal cordsThe operation lasted 25min, after 15min of the child's self-respiratory recovery: VT110 to 130 ml, respiratory rate of about 20bpm, deoxygenation 10min, circulation stability, PetCO2 35 to 40mm, SpO2 maintained at 96% to 100%, to be fully awake after the removal of trachea catheter, sent to the post-anaesthetic monitoring room (PACU) observation, no special, returned to the wardHe was safely discharged from the hospital the next day after surgerydiscussionthroat papilloma is a common non-immersive benign tumor in the throat, caused by hpvinfection, divided intochildren'sand adult typeUnlike adult throat papillomas, children with small throat cavity, limited operating space, it is difficult to completely remove the lesions, so the disease is prone to recurrence;is well known, tracheotomy is an important surgical emergency to relieve acute upper respiratory obstructionHowever, theclinicalof children with larynx papilloma is not usedThe reason is that tracheostomy activates HPV lurking in the tube mucosa, which is easily planted directly in the damage to the epithelial, increasing the risk of papilloma splevening within the tracheaStudies have shown that the younger the child, the higher the incidence and fatality of complications after tracheostomyTherefore, unless the necessary rescue, in principle, do not cut trachea in children under 8 years of age throat papilloma, in order to reduce the possibility of tumor spread into the trachea, improve the child's prognosisthe particularity of the child in this case: (1) the child has undergone two operations, the preoperative laryngoscope examination indicates that the normal structure of the throat cavity is destroyed, local scarring hyperplhedes, vocal cords partially adhesion, sound door narrow, trachea intubation difficulty increased; Prior to the appearance of the performance of the experimental aggravation of the larynx obstruction, anesthesia induced to establish an effective airway may occur difficult mask ventilation; (3) with tyoma tissue brittle soft, intubation process may occur tumor off blocking the trachea, bronchial tube, causing serious ventilation difficultiesbased on the above factors, for such predictable difficult ienosis, detailed anaesthetic plan and adequate pre-planning treatment is very important, the success of this case is: (1) pre-anaesthetic preparation: intubation equipment: 2.5, 3.0, 3.5, with a set One or tastotic catheter with out of the sac, direct-looking throat mirror, visual laryngoscope, throat suction cutter; Intravenous-induced drugs (proppen, fentanyl, medazole, shunacoam2) ;(2) induction scheme: choose the way of inhalation induced retention of autonomous breathing, do not use analgesics and muscle pine drugs before the successful intubation, to prevent the muscles of the throat Relaxation causes changes in the position almost relationship between the tumor body and the sound door, the tumor blocks the airways, causes difficulty in ventilation of the mask or difficulty of trachea intubation, and reduces the incidence of intubation stimulation by using 2% Lidocara surface anesthesia, reducing the incidence of air holding, throat spasms and other events in children(3) Innovative intubation tool: the use of throat suction cutterinstead of conventional guide wire used to shape and guide trachea intubation, the specific operating steps are: from otolaryngology surgery with throat cutting knife head end cover 3.5mm with a cap of sactracal catheter, child pad shoulder, neck overstretched, laryngos The surgeon determined that the throat is not smooth, the presence of trachea catheter through the difficult possible, gently and quickly cut blocking the sound door part of the tumor, the sound door crack can be increased, and then successfully put the far end of the throat suction cutter into the sound door about 1 cm, and push the trachea intubation slide into the sound door Analysis of the trachea intubation method innovation and advantages as follows: (1) throat suction knife has attracting and cutting two functions, not only can attract oral endocrine, maintain the visibility of the tube when exposed clearly, and can cut part of the tumor in the case of tumor blocking the throat cavity, so as to better expose the sound Door, improve the success rate of intubation; (2) when the neck of a child is stretched, with the help of a laryngoscope, the axis of the throat through the throat close to overlap, the bending of the throat suction knife head can ensure accurate and quick guidance trachea catheter to the sound door and smoothly advance the trachea The conventional pediatric intubation guide wire, due to its soft characteristics, is easy to bend and deform, in the process of pulling out the tube core may lead the trachea tube tube far end to move, damage tissue mucous membrane, touch the tumor body, out of the airway, may reduce the success rate of the first intubation; Compared with the fine plastic suction tube connected to high-frequency jet ventilation method used in pediatric throat papilloma surgery, the airway management method in this case closed the lower respiratory tract and prevented the surgical area from seeping blood, secretions, and tumor into the lower airway, Avoid or reduce the occurrence of lung complications associated with high frequency ventilation, such as CO2 retention, alveolary, pulmonary over-inflating and air pressure injury, and the of airways is more safe and controllable This method requires the close cooperation of an ananesthesio doctor and otolaryngologist, and the outer diameter and length of the throat suction knife need to match the inner diameter and length of the trachea catheter, so it can be applied to children with younger throat papilloma
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