Emergency maxillofacial multi-gap infection sobriety intleption success 1 case.

Jaw facial gap infection is the general designation of soft tissue swelling and pus inflammation in the face, jaw and pharynx area.
There is a potential fascia gap between the layers of tissue in the normal jaw face, and when bacteria invade these gaps, inflammation causes the loose connective tissue to dissolve and liquefy, and the inflammatory product fills it, at which point there is a significant gap.
infection can be confined to a gap, but also through the spread of weak resistance tissue, forming a dispersed multiple gap infection.
severely affected by severe swelling of the entire cheek and neck, often compressing the upper respiratory tract and difficulty breathing, most patients can not back the head.
who may have difficulty breathing or breathing by compressing the respiratory tract, an emergency trachea intive tube or an intive intive tube is given to the trachea.
Such patients have difficulty in intestion of the trachea, so if the general anaesthetic, it is necessary to assess whether the rapid establishment of artificial respiratory tract, coupled with respiratory distress, can not be fully with the anesthesiologist operation for a long time (e.g., fiber mirror clear guide intination), the establishment of artificial respiratory tract is more difficult.
1. Clinical data 1.1 General data patients male, 52 years old, self-complaint about 7 days ago appearedlower and double-sided jaw swelling, pain with limited opening and further aggravation, the patient's past physical fitness, preoperative biochemical examination did not see obvious abnormalities, that night due to sudden breathing difficulties, can not lie flat, emergency planning jaw facial swelling and draination.
After entering the room to assess the patient: the patient body fat (BMI - 27.5), facial swelling, open mouth degree of a cross finger (expected mallampati grade III.-IV.), head back restriction, neck short rough swelling, coupled with the patient can not lie flat, shortness of breath, irritability.
1.2 anesthesia and intination process 22:45 patients after hospitalization routine monitoring: BP128/78mmHg, HR88 times / minute, SpO2 92%; Queer 1mg;23:11 Tells patients to lie flat, cyclocardia puncture drug 2% Lidokain 2mL, anthractic, cough; 23:13 Patient complains of breathing difficulties and needs to sit up and breathe (SpO2 88) %);23:15 After the patient breathes smoothly, 2% Lidokain 2mL plus ephedrine 10mg drop nose; 23:20 selects ID6.0 trachea to be inserted into the mouth through the nose, and the patient sits up again to breathe (SpO2 87%); 23:25 tells the patient to lie down, the patient because of breathing difficulties, lying down, about half a minute and then sit up again, irritable, lying down difficult, in the case of sitting fiber mirror guide to find the sound door, intleter success.
given anaesthetic regularly and the operation went smoothly.
signs were stable in the operation and returned to the ward with a tube after the operation.
the tube after 3 days of successful unplugging.
2. Discussion of multiple gap infections in the jaw can lead to swelling of the tongue and nearby gaps, blocking the vocal doors, compressing the trachea, and even lead to tracheal displacement and throat edema, serious breathing difficulties, endangering the lives of patients, often require emergency surgery.
for this type of patient, conventional direct laryngoscopic tracheal intlenchment becomes very difficult.
the sobriety fiber tracheoscopic tube intestion is considered a more appropriate option when predicting possible difficulty in the air channel.
but the fiber mirror guides the sober tracheal intestor for the patient, needs the patient's cooperation and adequate tracheal surface anesthesia, which is important to improve the success rate of the intring.
The patient has difficulty breathing, irritability, can not cooperate well with the anesthesiologist, which anaesthetist trachea tube has brought great difficulties, coupled with most sedative drugs can cause respiratory inhibition to varying degrees, for the patient we can not use any sedative drugs.
In this case, effective surface anesthesia is particularly important for sober trachea intina under the guidance of a fiber-frame, and the patient's tongue is swollen, it is very difficult to carry out the surface anesthesia of the throat by spraying the drug;
there are reports that atomized inhalation agency drugs seem to solve this problem, can be considered for reference.
, however, the first: liquid bureau drug to vaporize into gaseous bureau drug needs high equipment conditions, our hospital does not yet have this condition, can not carry out this technology.
second, the report also said: the patient's absorption of atomized inhalation of the drug is not accurate enough to play a full anaesthetic throat effect.
at this time should also do a good job of intive failure remedy: ready to open the tracheoly at any time.
In short, a large proportion of patients with oral forehead surgery have difficult airways, such as: difficulty in open mouth, limited movement of the jaw joints, various causes of mouth and throat and respiratory malformations, throat tumor obstruction intestion path, post-surgery scar deformities, respiratory obstruction caused by forehead and facial infections, etc. For such patients, the use of fiber-frame-guided awake intination (preferably through the nasal trachea intestor) has great advantages and importance, it can easily solve the conventional laryngoscope encountered small open mouth, short jaw distance and other difficult gas channel problems, there are a large number of domestic applications of fiber-branch mirror successfully handle difficult gas channel reports.
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