Method for anesthetization

FIELD: medicine, anesthesiology.

SUBSTANCE: it is necessary to perform skin puncture at lower cervical department being2 cm above sterno-clavicular joint where lateral tracheal wall is located restricted with trachea from median side and with general carotid artery - from lateral side. Moreover, before puncturing patient's skin one should pre-shift carotid artery towards lateral side due to pressing the neck in the region between carotid artery and trachea. The present innovation enables to prevent lesions of vascular-nervous bundle and infection of paratracheal fiber.

EFFECT: higher efficiency of anesthetization.

1 cl, 2 ex

 

The invention relates to medicine, namely to anesthesiology, and can be used in the treatment of various diseases in which there is a need to anesthesia.

Known transtracheally way of introducing solutions in the lower part of the neck, which under General anesthesia in the supine position and intubation of the trachea with a long needle 50-55 cm with a limiter on the end (0.5-0.7 cm) was performed puncture right for 4-5 hours or left 7-8 hours and was introduced to the solution in the paratracheal space to the main neurovascular bundle of the medial triangle of the neck. This technique is shown to perform at the end of the manipulation policeware of the tracheobronchial tree during a prolonged attack of asthma [1].

Closest to the claimed method is numbing introduction solution of anaesthetic substances by nadgryzennoe paratracheal puncture in the lateral surface of the trachea, into the space between it and the neurovascular bundle of the neck. When the needle is injected in the midline of the neck 2 cm above the cutting arm of the sternum toward the anterior surface of the trachea. After reaching the anterior surface of the trachea needle pull them back a few (5 mm) and is directed to the side surface to a depth of 10-15 mm at a constant injection jet novocaine [2].

The disadvantages include the fact that mo is a skin puncture is performed in the direction from the projection of the medial edge of the carotid artery and the lateral edges of the trachea. When carrying out the needle from pretracheal space in paratracheal it can seamlessly to the contractor through the interchondral period of the trachea to penetrate into the infected lumen of the trachea. This needle will be placed in the lumen of the trachea and can pierce it again and go to the neurovascular bundle, infecting paratracheal tissue of the lumen and the return stroke and pretracheal fiber and the wall of the puncture of the trachea. When the needle is moved along the side wall of the trachea to the neurovascular bundle from the inner side perpendicular to its elements (common carotid artery, internal jugular vein and the vagus nerve), located in the neurovascular space formed by the spurs of vnutrishnioi fascia must be connected to the common carotid artery, where the injected solution. This manipulation is also blind and dangerous possibility of injury elements of the neurovascular bundle, especially the arteries.

The claimed invention solves the problem of creating a more simple and safe way to pain relief.

The technical result achieved when using the proposed method of pain relief, is a simplification, improved security.

This technical result is achieved by a method of pain relief, including aggrading artykulow puncture by the puncture of the skin, in the region of shoulder-tracheal triangle of the neck, summing up the needle in colorhello space, and the introduction of anaesthetic substances according to the invention the skin puncture is carried out in the lower part of the neck 2 cm above the Sterno-clavicle joint at the location of the lateral wall of the trachea, bounded by the medial side of the trachea, and with the lateral sides of the common carotid artery.

And before skin puncture of the carotid artery pre-move in the lateral direction by pressure on the neck in the area between the carotid artery and trachea.

The method is as follows. Position the patient on his back in the position of maximum extension of the neck. For convenience, the complete method is recommended driver blockade to perform in the position with the right side face to the patient's head, while the left - hand, with the left side of the face to the feet. The index finger of his free hand nemopilema by pulsation of the carotid artery area (sulcus) between the trachea and the carotid artery. The furrow is limited to the medial side of the trachea, and with lateral - common carotid artery. When pressing the artery moves the finger in the lateral side of 1 cm, and the groove becomes wider, and the artery is further separated from the trachea. Needle skalyvaetsya 2 cm above groovecruise joint in the finger, which protects the artery is tons of injuries and monitors the progress of the needle relative to the trachea. The depth of the puncture is 1.5-2 cm, needle tip should be placed at the level of the posterior third of the trachea, where the injected anesthetic solution of novocaine in the amount of 20-40 ml with a concentration of 0.25%.

The difference of the proposed method against known is that paratracheal procaine blockade is carried out in the lower part of the neck 2 cm above the Sterno-clavicle joint at the location of the lateral wall of the trachea, bounded by the medial side of the trachea, and with the lateral sides of the common carotid artery. While the inventive method is safer, less traumatic and eliminates damage to the trachea and the common carotid artery.

The method is illustrated by the following examples.

Example 1. Patient M was in the intensive care unit in a terminal condition with a diagnosis of bronchial asthma, severe asthmatic condition, under hardware artificial respiration, actively breath and active exhalation. Respiratory mixture was supplied through the procaine tube inserted into the trachea. To perform pulmonary blockade was carried out right paratracheal puncture in accordance with the above method. Paratracheal novocaine blockade was performed on the right side because the right vagus nerve, entering the upper mediastinum along the right wall of the trachea, backwards and for bifurcata the trachea goes back in the mediastinum. Anatomical observations on the drugs mediastinum showed that the branches of the right vagus nerve is involved in the formation of not only the right but also the left bronchial plexus. After the patient was performed paratracheal novocaine blockade, there was a decrease spasm of the bronchi, which was marked by the voltage decrease operation of the ventilator. After 30 minutes, the patient appeared attempts to independent breathing. The device was disabled. Recovered calm adequate breathing. The patient was excubitor and consciousness transferred to our clinic.

Example 2. Patient A. Delivered infarction in the Department. The emergency doctor noted complaints against a strong chest pain, accompanied by fear of death, diagnosed with an attack of acute coronary insufficiency (angina).

Spent left paratracheal procaine blockade in accordance with the above method. Paratracheal novocaine blockade was performed with the left hand because the aortic and cardiac nerve plexus is formed largely by the branches of the left vagus nerve, which, entering into the mediastinum lies on the anterior wall of the aortic arch and goes under it in the back of the mediastinum. In the upper mediastinum and he is the main parasimpaticheskih the nerve, forming pre - and retroactive nerve plexus blockade which expands the arteries of the heart. After the patient was performed paratracheal novocaine blockade, the condition has improved, the pain and fear of death decreased.

Sources of information

1. "Topographic-anatomic rationale transpharyngeal and transtracheal needle accesses to the neuro-vascular formations in the neck and mediastinum", PhD thesis, Cheboksary, 1984, p.33.

2. "Nadgradnja novocaine blockade in ischemic heart disease, asthma and concussion of the brain, ed., Medicine, Uzbekistan, 1977, p.42-44.

1. The method of anesthesia, including aggrading paratracheal puncture by the puncture of the skin in the region of shoulder-tracheal triangle of the neck, summing up the needle in colorhello space and injection of anesthetic substance, characterized in that the skin puncture is carried out in the lower part of the neck 2 cm above the Sterno-clavicle joint at the location of the lateral wall of the trachea, bounded by the medial side of the trachea, and with the lateral side of the common carotid artery.

2. The method of anesthesia according to claim 1, characterized in that prior to skin puncture of the carotid artery pre-move in the lateral direction by pressure on the neck in the area between the carotid artery and trachea.



 

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