Method of anaesthetic management of surgical interventions in patients with terminal tracheostoma

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, resuscitation and otorhinolaryngology, and can be used if it is necessary to provide the anaesthetic management in the patients with terminal tracheostomy. For this purpose, pre-oxygenation, assisted and forced lung ventilation are conducted before tracheal intubation through a laryngeal mask with an inflated cuff tightly adjoining a tracheostomy opening. Then, an intubation tube is inserted into the tracheostomy, and volumetric induced ventilation is conducted through the above tube.

EFFECT: method provides the prevention of hypoxia in such patients at the stages of intravenous premedication, the induction of anaesthesia and the introduction of muscle relaxants due to the stability of hemodynamics and gas exchange due to the continuous ventilation through a terminal tracheostomy.

1 ex

 

The method of anesthetic management during surgical interventions in patients with end tracheostomy relates to medicine, primarily to anesthesia Handbook for surgical interventions in tracheostomised sick.

In surgery there is a method of General anesthesia with the use of laryngeal mask (V.V. Liventsev (as amended) "a Practical guide anesthesiology", M: LLC "Medical information Agency, 2011, pp.178-179) (similar). It is as follows: after the introduction of anesthesia with laryngeal mask slid down his throat and promote deeper, until it takes its "anatomical" the position of the larynx. While the glottis remains open epiglottis. Ventilation of the lungs begin after inflating the cuff. Laryngeal mask allows artificial lung ventilation (ALV), supports the airway.

The closest in technical essence is a way of anesthesia with endotracheal intubation via tracheostomy and three-dimensional artificial ventilation of the lungs (Olshansky V.O. "Laryngectomy with tracheoesophageal the bypass surgery and prosthetics in laryngeal cancer (clinical, methodological and functional aspects)" / V.O. Olshansky, V.I. Chissov, I.V. Reshetov, V. Dvornichenko, NR. Novoi the ova, M., printing center "real", 2004, p.65) (prototype). Anesthetic management by this method, perform the following way. The patient before surgery after the introduction of anesthesia in the background myorelaxation inkubiruut the trachea through the tracheostomy endotracheal tube through which spend the bulk mechanical ventilation during the operation.

With this method of anesthetic management no respiratory support of the patient on the stages of intravenous sedation, induction of anesthesia and insertion of the muscle until the intubation through the tracheostomy. This is usually accompanied by the development of hypoxia, is associated with the emergence period of apnea due to the use of intravenous anesthetics, analgesics and muscle relaxants with the introduction of the patient to the anesthesia. Episodes of hypoxia on the stages of apoptosis, induction of General anesthesia and intubation of the trachea leads to the development of undesirable hemodynamic reactions (arterial hypertension, tachycardia, arrhythmias and conduction of the heart). Also it is well known negative effect of hypoxia on the functioning of the Central nervous system, depending on its severity may clinically manifest as delayed post anesthesia awakening of the patient with transient cognitive impairment and persistent neurological symptoms what about the deficit.

The objective of the invention is the prevention of hypoxia on the stages of intravenous sedation, induction of anesthesia and insertion of the muscle, making provided a satisfactory and stable performance of gas exchange and hemodynamics during General anesthesia for surgical interventions in patients with end tracheostomy. In addition, in this category of patients with this method of anesthetic management is possible induction of General anesthesia with inhaled anesthetics.

The novelty of the proposed method is to conduct before operation preoxygenation, auxiliary and forced ventilation through the laryngeal mask tightly adjacent to the tracheostomy hole, surgical interventions in patients with end tracheostomy.

Technical solutions that have the signs consistent with the distinguishing characteristics of our proposed method, it is not revealed, which allows to make a conclusion on the conformity of the proposed method the criterion of "inventive step".

The proposed method is as follows. Before the operation the patient are preoxygenation 100% oxygen for 3-10 minutes through a laryngeal mask with an inflated cuff, tightly adjacent to the tracheostomy opening. After promedica the AI and induction of anesthesia via laryngeal mask carry out auxiliary volume ventilator and after the introduction of muscle relaxants is forced hardware volume mechanical ventilation before intubation (photo 1). After reaching total myorelaxation in tracheostomy hole to introduce an endotracheal tube, through which during all operations are performed in hardware IVL.

An example of implementation of the proposed method.

Patient T. 64 years, case history No. 1005. Clinical diagnosis: Cancer of the larynx T4N0M0, III clinical group status after laryngectomy, tracheostomy in 2011. To rehabilitate voice 12.01.12, the patient underwent the operation of forming tracheoesophageal fistula under General anesthesia with myorelaxation and volume ventilation. Before the operation the patient was performed preoxygenation 100% oxygen for 5 minutes through a laryngeal mask with an inflated cuff, tightly adjacent to the tracheostomy opening. After premedication and induction of anesthesia via laryngeal mask was carried out by the auxiliary volume ventilator, and after the introduction of muscle relaxants is forced hardware volume mechanical ventilation before intubation. After reaching total myorelaxation in tracheostomy hole has introduced an endotracheal tube, through which during the whole operation was performed hardware IVL. During anesthesia smooth, without features. Throughout the perioperative period is as marked satisfactory performance of gas exchange and hemodynamics. Later in the fistula has tracheoesophageal valve. The patient was discharged on the second day after surgery. Tracheoesophageal voice sonorous. It legible.

The proposed method of anesthetic management is used during surgical interventions in the hospital for ENT cancer patients with end tracheostomy.

The method of anesthetic management during surgical interventions in patients with end tracheostomy, namely, that during the surgery under General anesthesia spend the bulk of artificial lung ventilation through an endotracheal tube inserted in the end tracheostomy, characterized in that prior to intubation are preoxygenation, auxiliary and forced ventilation through a laryngeal mask with an inflated cuff, tightly adjacent to the tracheostomy opening.



 

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1 tbl, 3 ex

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1 ex

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2 ex

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2 ex

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2 dwg, 2 ex

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7cl, 1 dwg

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