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Click the blue word to follow our esophagotracheal fistula anesthesia management and review the cases mentioned in the previous article before reading this chapter
.
Note: Keep spontaneous breathing before ligation of the fistula.
The purpose of preserving spontaneous breathing: In theory, the negative pressure of the thoracic cavity is more likely to allow air to enter the lungs instead of ventilating through the fistula
.
Xin Zhong et al.
reported a review of the clinical data of 18 cases of neonatal esophageal atresia and tracheoesophageal fistula during perioperative single-lung ventilation, including 11 males and 7 females
.
Age 6 hours~10 days, weight 1380~3100g
.
American Association of Anesthesiologists (ASA) has 13 cases of grade II and 5 cases of grade III
.
16 cases had different degrees of pulmonary infection, 8 cases of premature infants or low birth weight infants (<2500g), and 2 cases of other malformations
.
The method of preserving spontaneous breathing before tracheal intubation and fistula ligation under combined anesthesia with intravenous inhalation did not cause severe respiratory depression and avoided the occurrence of reflux aspiration
.
The previous article has introduced the method of preserving spontaneous breathing in detail
.
The next part emphasizes the details
.
Before the operation, the patient will routinely bring a gastric tube into the room to aspirate the gastric juice, hoping to improve lung compliance
.
Emphasize the importance of preoperative bronchoscopy: 1.
Observe the position and size of the fistula, determine the difficulty of anesthesia and the anesthesia plan
.
2 It may be neglected and missed before the operation, whether there are multiple fistulas, and the missed fistulas are not ligated, which affects the prognosis
.
3.
Whether it is combined with tracheal dysplasia or abnormal bronchial morphology
.
Such as softening of the trachea and softening of the larynx
.
Make better predictions and decisions on the surgical plan and extubation time
.
4.
For older children, if conditions permit, change the position to determine whether the catheter is in the correct position between the fistula and the carina
.
However, the bronchoscopy is too large.
The smallest diameter of the bronchoscopy in our hospital is 2.
8mm, and it cannot pass through the 3.
5 ordinary balloon catheters.
Newborns, especially premature babies, cannot receive both the tracheal tube and the bronchoscopy in the airway at the same time
.
At this time, auscultation is very important
.
In this case, the fistula is 8.
8mm from the carina.
Considering that the fistula is close to the carina, it is difficult for the tracheal tube to get stuck in the fistula and carina.
First consider single-lung ventilation
.
Choose 3.
0 ordinary tracheal tube without balloon, and insert it to the left side of the child by auscultation and changing the position of the child
.
After three failed attempts, the anesthesia method was changed
.
Although this patient failed in one-lung ventilation, there are tips for collecting previous successful cases of single-lung insertion
.
Or friends who have a better plan can also recommend learning
.
Left side insertion technique: preoperative ct assessment, the angular position relationship between the left bronchus and carina, and the diameter of the left main bronchus, help predict the success rate of single lung insertion
.
1.
Thermoforming
.
You can first use a guide wire to shape the left tube of a double-lumen catheter, and then soak it in hot saline for several minutes
.
This kind of maintenance time is limited
.
Seeking quick intubation success
.
2.
Adjust the slope to the left
.
3.
The patient's right side is lying down on the chest
.
In this case, a single lung failed, and the catheter returned to the main airway
.
The retention is all maintained by inhalation, considering that the depth of anesthesia is easy to control
.
As the stimulation of the operation changes, the depth of anesthesia is deepened at this time, the circulation is inhibited, and the appropriate amount of vasoactive drugs is taken
.
Deepening anesthesia can also cause hypoventilation, and it is difficult to maintain spontaneous breathing
.
At this time, ventilation can be properly assisted, and attention should be paid to controlling the gas pressure.
Frequent assisted ventilation can easily lose spontaneous breathing
.
Ligate the fistula as soon as possible
.
After the fistula is ligated, muscle relaxation and positive pressure ventilation can be administered
.
After the operation, the tube was sent to NICU for the next treatment
.
Other concerns are those of general anesthesia for newborns and premature infants: 1.
Premature infants or low birth weight infants are prone to hypoglycemia or hypocalcemia.
Before and during surgery, frequent inspections and corrections should be made
.
2.
Keep your body temperature warm
.
A heated warm mattress, heated and humidified breathing circuit, heated veins and warm rinse water will help prevent heat loss
.
3.
The catheter is fixed, because the body position changes is to check and confirm the correct position
.
4.
preterm newborn child needs a blood transfusion, fluid management and so on
.
Reference book: Gregory's Pediatric Anesthesia Selected Typical Cases of Pediatric Surgery Anesthesia Editor: Zhang Jianmin (Contribution: Wu Yajun Typesetting: Flesh)
.
Note: Keep spontaneous breathing before ligation of the fistula.
The purpose of preserving spontaneous breathing: In theory, the negative pressure of the thoracic cavity is more likely to allow air to enter the lungs instead of ventilating through the fistula
.
Xin Zhong et al.
reported a review of the clinical data of 18 cases of neonatal esophageal atresia and tracheoesophageal fistula during perioperative single-lung ventilation, including 11 males and 7 females
.
Age 6 hours~10 days, weight 1380~3100g
.
American Association of Anesthesiologists (ASA) has 13 cases of grade II and 5 cases of grade III
.
16 cases had different degrees of pulmonary infection, 8 cases of premature infants or low birth weight infants (<2500g), and 2 cases of other malformations
.
The method of preserving spontaneous breathing before tracheal intubation and fistula ligation under combined anesthesia with intravenous inhalation did not cause severe respiratory depression and avoided the occurrence of reflux aspiration
.
The previous article has introduced the method of preserving spontaneous breathing in detail
.
The next part emphasizes the details
.
Before the operation, the patient will routinely bring a gastric tube into the room to aspirate the gastric juice, hoping to improve lung compliance
.
Emphasize the importance of preoperative bronchoscopy: 1.
Observe the position and size of the fistula, determine the difficulty of anesthesia and the anesthesia plan
.
2 It may be neglected and missed before the operation, whether there are multiple fistulas, and the missed fistulas are not ligated, which affects the prognosis
.
3.
Whether it is combined with tracheal dysplasia or abnormal bronchial morphology
.
Such as softening of the trachea and softening of the larynx
.
Make better predictions and decisions on the surgical plan and extubation time
.
4.
For older children, if conditions permit, change the position to determine whether the catheter is in the correct position between the fistula and the carina
.
However, the bronchoscopy is too large.
The smallest diameter of the bronchoscopy in our hospital is 2.
8mm, and it cannot pass through the 3.
5 ordinary balloon catheters.
Newborns, especially premature babies, cannot receive both the tracheal tube and the bronchoscopy in the airway at the same time
.
At this time, auscultation is very important
.
In this case, the fistula is 8.
8mm from the carina.
Considering that the fistula is close to the carina, it is difficult for the tracheal tube to get stuck in the fistula and carina.
First consider single-lung ventilation
.
Choose 3.
0 ordinary tracheal tube without balloon, and insert it to the left side of the child by auscultation and changing the position of the child
.
After three failed attempts, the anesthesia method was changed
.
Although this patient failed in one-lung ventilation, there are tips for collecting previous successful cases of single-lung insertion
.
Or friends who have a better plan can also recommend learning
.
Left side insertion technique: preoperative ct assessment, the angular position relationship between the left bronchus and carina, and the diameter of the left main bronchus, help predict the success rate of single lung insertion
.
1.
Thermoforming
.
You can first use a guide wire to shape the left tube of a double-lumen catheter, and then soak it in hot saline for several minutes
.
This kind of maintenance time is limited
.
Seeking quick intubation success
.
2.
Adjust the slope to the left
.
3.
The patient's right side is lying down on the chest
.
In this case, a single lung failed, and the catheter returned to the main airway
.
The retention is all maintained by inhalation, considering that the depth of anesthesia is easy to control
.
As the stimulation of the operation changes, the depth of anesthesia is deepened at this time, the circulation is inhibited, and the appropriate amount of vasoactive drugs is taken
.
Deepening anesthesia can also cause hypoventilation, and it is difficult to maintain spontaneous breathing
.
At this time, ventilation can be properly assisted, and attention should be paid to controlling the gas pressure.
Frequent assisted ventilation can easily lose spontaneous breathing
.
Ligate the fistula as soon as possible
.
After the fistula is ligated, muscle relaxation and positive pressure ventilation can be administered
.
After the operation, the tube was sent to NICU for the next treatment
.
Other concerns are those of general anesthesia for newborns and premature infants: 1.
Premature infants or low birth weight infants are prone to hypoglycemia or hypocalcemia.
Before and during surgery, frequent inspections and corrections should be made
.
2.
Keep your body temperature warm
.
A heated warm mattress, heated and humidified breathing circuit, heated veins and warm rinse water will help prevent heat loss
.
3.
The catheter is fixed, because the body position changes is to check and confirm the correct position
.
4.
preterm newborn child needs a blood transfusion, fluid management and so on
.
Reference book: Gregory's Pediatric Anesthesia Selected Typical Cases of Pediatric Surgery Anesthesia Editor: Zhang Jianmin (Contribution: Wu Yajun Typesetting: Flesh)
