1 case of difficult airway treatment in patients with cytomatoma

Chromium-ophilidoma originated in the epinephrine system chrome-clicoccoma, 90% of which is found in the adrenal myelinThe secretion of endogenous catecholamines (adrenaline, norepinephrine, dopamine) is a fundamental pathophysiological change of chromologoid tumors, which can producehigh blood pressure, high metabolism, high blood sugar and other series ofclinicalsymptoms related to thisSurgical removal of chromosomal celltumor is still the main treatment for the diseaseanaesthetic induction and trauma stimulation during surgery, tumor site extrusion can induce the release of catecholamine, serioushypertensionthe danger, the rapid change in circulatory function performance is the root cause of anesthesia and surgical riskDespite proper preoperative preparation, anesthesia in patients with cytomocytes is still a challenge, and anesthesiologists must take appropriate anaesthetic methods to avoid violent fluctuations in hemodynamics caused by stress reactions, which can have fatal consequences for patients with cytomatomaThe following is reported as follows of 1 case of difficult airway treatment in patients with chromosomal celloblastoma in the anesthesiology department of Jilin University First Hospital in December 20171ClinicalDatapatient male, 66 years old, due to the left adrenal swelling proposed in the whole hemp down the left side laparoscopic adrenal swelling excision Previous history of hypertension for 3 years, up to 169/71mmHg, high blood lipids, no drug allergy history, due to the physical examination found adrenal swelling, combined with other auxiliary examination, confirmed as left adrenal ephymomethlias (main lying norepinephrine) Preoperative examination: Blood pressure 150/79mmHg, heart rate 93 times/min, peripheral oxygen saturation 98% patients self-confessed 8 years ago to carry out heart stent surgery, now regular oral oxatamin, simvastatin The patient is obese, BMI 30kg/m2, giant tongue, jaw distance is less than 6.5 cm, opening degree is less than 3 cm, Mallampati III grade As above, the patient's preoperative assessment clearly has difficult airways, inform the patient that a awake trachea intubation may be taken, and the patient expresses knowledge and consent Patients before entering the room regular fasting 8h, water prohibition 6h the normal monitoring of electrocardiograms after entering the chamber, with the values of arterial blood pressure, pulse, peripheral oxygen saturation and electroencephaly double spectrum index (BIS), while opening the peripheral vein parallel vein sitlier The room temperature is 24.5 degrees C, the relative humidity is 33% Due to the complexity of the patient's condition, hemodynamic strains caused by tracheostomy intubation at the same time relieve preoperative tension and anxiety, so that the patient an hour before surgery oral midazolam 1.5 mg The patient's in-house vital signs were recorded as follows: Blood pressure 145/55mmHg, heart rate of 60 beats per minute, O2 saturation reached 99% for this patient, we finally decided to use a wakeful tracheal intubation The nasal catheter absorbs oxygen and the flow is adjusted to 3L/min Right metomiquine 0.75 sg/kg the speed of continuous infusion 15 minutes, using 2% Lidoca line ring meth puncture First of all, the puncture point of local anesthesia, after the puncture point routine disinfection, the left thumb and middle finger placed on both sides of the cartilage fixed trachea, the left finger to determine the ring armor membrane of the middle line and the upper edge of the ring cartilage Right hand in a pen position holding a 2% Lidoca in 5 ml syringe, the 20th casing needle, the needle tilted 45 degrees angle to the tail through the ring membrane into the trachea 0.5 cm, after the suction test again confirmed that the patient is in the trachea after the patient deep breathing, in the inhalation of the end of the injection of the drug, can lead to the patient cough and the adhesion of the drug, after the operation is quickly pulled out of the injection, with a moment of drying the injectable cloth a trachea intubation is administered until local anesthesia achieves maximum effect and achieves sufficient anaesthetic depth Direct laryngoscope examination, only visible will be tired We immediately use a fiber optician auxiliary tracheal intubation, select 7.0 trachea catheter and use Lidoca inglue lubrication, confirm the success of the trachea intubation, anaesthetic induction, propofol 2mg/kg, fentanyl 3 sg/kg, shun aqualam 1mg/kg to provide good muscle relaxation During the operation, the right metorium continues to pump, 0.7 sg/kg/h During intubation operation, the patient's hemodynamics were stable, the maximum arterial pressure was 165/67mmHg, the subsequent operation proceeded smoothly, no further complications occurred, the helimodynamic stability and no blood vessels active drugs Patients are safely transferred to the ward after surgery When the patient was followed, the patient expressed satisfaction with the whole process and had no unpleasant experience 2 Discussion of elderly men, xylitoma diagnosis clear, and preoperative clearly have difficult airways, the above factors confirm that the patient perire period is a high risk, which is a great challenge for anesthesiologists, the adoption of appropriate narcotic drugs and anaesthetic methods, to reduce the rate of adverse events, reduce the stress response during intubation is essential Obviously, the wakeful tracheal intubation is appropriate for this case clinical work, for the clear difficultair in principle should choose a sober sedative surface anesthesia, wakeful tracheal intubation includes the following links: (1) patient preparation: inform the patient of the process of sober trachea intubation, do a good job of explaining, focus on the matterof the cooperation, such as relaxing the whole body muscles, especially the neck, shoulder, back muscles, to maintain deep and slow breathing (2) sedation: the implementation of the mouth or nasal sobriety trachea intubation, requiring the patient to be fully calmed, which will help the implementation of intubation, but also to basically avoid unpleasant memories after surgery The ideal goal of sedation is to keep the patient quiet, analgesic, reduce nausea and vomitsensitivity and forgetting, while being able to wake up at any time and be highly cooperative mitazole (20-40?g/kg)) is fast, quick, and has the effect of smooth oblivion, while using anaesthetic analgesics can reduce airway reflexes, help prevent coughing and nausea that occur during airway operation, fentanyl (1-2?g/kg) is the most commonly used anaesthetic analgesic Right metorium is a highly selective alpha2 epinephrine receptor agonisant, with a central anti-intersectioneffect effect, can produce an approximate sleep sedative effect, especially for breathing without inhibition, while has a strong anti-salivation and certain analgesic, anti-anxiety effect, may be the most ideal airway treatment drug at present (3) Surface Anesthesiology: Comprehensive and perfect throat trachea surface anesthesia is the most important key to ensure the success of trachea intubation In this case, the patient, the anaesthetic before the preparation is fully prepared, the throat bureau, the external Lidoca syrup lubrication of the trachea catheter, oral midazolam, etc all reduce the stress response of the intubation, to avoid the excessive release of catecholamine and thus lead to violent fluctuations in blood pressure In addition, no matter which type of chrome celltumor, preoperative preparation or treatment will be used epinephrine can suppress drugs, alpha 2 receptor agonists are currently an anaesthetic auxiliary drug, clinically commonly used right metamine, the drug through the agosy synaptic alpha2 receptor, negative feedback to reduce the release of peripheral norepinephrine; The main effect of is sympathetic nerve block The right metalymic selectivity of alpha1 and alpha2 receptors is 1,600:1, and has been widely used in regional, local, general anaesthetic auxiliary drugs From a respiratory point of view, the right metorium has no depressive effect, in this case, the right metamine pump injection continued in anaesthetic induction until the end of surgery, providing a good sedative condition , we can draw, the patients with chromophilioma using right metormia and medamine combined with the line of sobriety tube intubation, can reduce the stress response, avoid violent fluctuations in hemodynamics, for patients with chromosomal tumor, it is a good idea