1 case of accidental tooth loss during pediatric intubation successfully removed

The incidence of oral injury in patients with tracheotomy in general anesthesia was 5%, of which the most dental damage was found, with an incidence rate of 0.2% to 12%In August 2017, the Chinese Academy of Medical Sciences eight plastic hospitals admitted a case of children in the trachea intubation success, the end of the operation by the roving nurse found that the child's tooth is missing, and finally successfully removed from the mouth, the child's vital signs were stable and no abnormality1Information and methods1.1 general informationmale 7-year-old weight 20 kg elective surgeryIn general anaesthetic the underside face black mole removed, the expander removed1.2 treatment and nursingwhen receiving the patient informed the anesthesiologist and operating room nurse child without loose teeth, the establishment of venous pathways after the anesthesiologist gave midazolam 1 mg, propofol 100 mg, aicosone 20 mg, intravenous induction after the successful use of trachea catheter No5, intubation depth of 16 cm, catheter airbag injection of appropriate airThe trachea intubation did not occur smoothly in exceptional circumstancesAt the end of the operation, the roving nurse found that the child's right upper cut was missing and immediately notified the anesthesiologistconsider the use of the child's trachea intubation with air bags, accidentally shed teeth should also be in the child's mouth, once the tooth misstep into the trachea will endanger the child's life, so immediately call the second line of anesthesia and other nurses, at the same time prepare the trachea fiber mirror and the child's visual laryngoscope, holding the tube clamp sand and surgicalvascularpliers and adjust the attractorAfter the second line of anesthesia arrives, the patient's details are reported one by one, including the patient's age, whether the trachea is equipped with airbags, etc the second-line anaesthetic doctor began trying to find the missing tooth in the child's mouth, but never found it Then use the child's visual laryngoscope to find, because the preoperative fixed trachea intubation of the floss hinders the operation so cut open the dental floss of the fixed trachea intubation, (the hospital head facial surgery will choose 7 silk wire fixed at the pressure of the teeth and then the trachea intubation tied to the tooth line) trachea tube by the roving nurse hand-held fixed, the request for the tube tube can not continue to enter, the purpose is to prevent the tooth into the trachea care tacitly with the tacit cooperation of the child finally found in the child's sound door (will be tired) shed teeth Because the trachea clamp splis and vascular clamps are not very good arc, several attempts were unsuccessful Then some people proposed to try to use the negative pressure attractor, the first negative pressure attractor tube is soft and plastic, the second increase attraction may be successful The pressure of 0.6 kpa of negative pressure attraction is then set, and the radiameter of the attractor tube is adjusted once to successfully remove the tooth that has fallen out 2 Nursing Surgery to ask the child's family if there are active teeth, should also understand the child's tooth replacement time and order, if necessary, to personally check whether there are active teeth If the child's teeth are found to be loose, immediately inform the anesthesiologist to make a good record, accurately indicate which teeth and the degree of loosening, and inform the family Loose serious can consult an oral surgeon, if necessary, should remove loose teeth, to prevent accidental tooth loss, the occurrence of accidental absorption to prevent loose tooth loss leading to accidental inhalation methods; When selecting trachea intubation, choose a trachea duct with an airbag whenever possible, and if there is no such catheter with an airbag, the anesthesiologist may be reminded to stuff the gauze in the back wall of the pharynx in order to prevent accidental suction Operating room nurses and surgical anesthesiologists are a team, the hospital often carry out special circumstances of the tripartite scenario exercise, so that in an emergency situation in a state of emergency, orderly