1 case of anaesthetic control for the removal of bronchial foreign matter by tracheostology

Case male, 68 years old, due to "throat cancer removal after 2 months, cold, fever, headache 4d" was admitted to hospitalThe gas-cut catheter is in place, coughing, sputum, yellow, and the body temperature is up to 39.2 degrees CThere has a history of low blood pressure and a long history of smokingChest hearing: the lower left lung can smell and a small amount of wet soundCT examination show: left lower pulmonary bronchial foreign body (Figure 1) and left lung hypolithal large lobe pneumonia, left small amount of chest fluid; Proposed "hard bronchoscopy at the tracheotomy cut-out surgery"After entering the chamber, electrocardiogram showed blood pressure 88/60mmHg, heart rate 86 times/min, SpO2 95%Conventional oxygen absorption, open peripheral veins, static injection of semimyson 5mg, intravenous pump injection right metamine 0.5 sg / (kg-h); 5min before the start of surgery, give sefyfentany 5 sg; before the operation, intravenous pumps are injected with riffentani 5?g/ (kg.h), propofol 50 ?g/ (kg.h)In surgery, the amount of right metoramidin, rifentani, and propofol was adjusted according to breathing, heart rate, blood pressure, and motor responseDue to the patient's low base blood pressure, continuous pumping dopamine maintains blood pressure to the basic levelThe hard bronchoscopy is attached to the oxygen tube and gives oxygen 5L/minwhen the hard bronchoscopy enters the left bronchial tube, the patient has a motor reaction, exits the hard bronchoscopy to the main trachea, injects 1% dinkain 0.5 ml by rigid lying head alignment to the left bronchial opening, and connects the high-frequency jet vent to perfect the left bronchial gaugeThe hard bronchoscopy gradually penetrates and sprays it again into Dinkain until it enters the lower left lung bronchial tracheaIn the bottom of the left lower bronchial tube found a piece of bone-like foreign objects, with foreign clamps to hold foreign objects, bronchoscopy synchronous exit, take out foreign objects, bone-like foreign object size about 2 cm x 1 cm x 0.3 cm (Figure 2)During the operation to retain autonomous breathing, when SpO2 is less than 90%, by the hard bronchoscopy to give high-frequency injection ventilation, the surgical process is smooth, no due to the decrease of oxygen saturation and suspension of surgical change mechanical ventilationThe operation lasted 110min, during the operation breathed 12 to 20 times / min, heart rate 60 to 80 times / min, blood pressure 85 to 95 / 40 to 60mmHg, SpO 285% to 100%After surgery, he continued to treatment against infection, and was discharged from hospital at 5d after surgery without anaesthetic-related complications discussion hypoxemia, arrhythmia , hypercarbonate, bronchospasm, etc are common complications of bronchosis removal In this case, the patient is old and has a long history of smoking, CT prompts the left lung hypolithalargel large loal pneumonia and a small amount of chest fluid, oxygen reserve function is poor, and anaesthetic ventilation and surgery to share the airway, to ensure the smooth respiratory tract and adequate oxygen supply is the basic condition for the successful completion of surgery placed hard bronchoscopy stimulation through the tracheotomy, muscle relaxation requirements are not high, perfect surface anesthesia and appropriate sedation, analgesic seduction to retain autonomous breathing, can minimize the occurrence of complications By the tracheotomy into Dinkain, the total trachea surface anesthesia effect is good, but the bronchial surface anesthesia is not ideal The hard-attractive head is aimed at the bronchial opening and dinkain is injected with high-frequency injection ventilation to bring Dinkain into the bronchial tube, which can improve the bronchial surface anesthesia and allow the hard bronchoscopy to enter the lower left bronchial tube smoothly In this case, the continuous pump injection right metorite, improve the patient's tolerance, better match the trachea surface anesthesia, and reduce the amount of whole hemp drug, reduce the inhibition of breathing