Chinese name: Anesthesia mode of tracheotomy: indications of local anesthesia or general anesthesia: contraindications such as laryngeal obstruction and lower respiratory secretion retention: anesthesia mode such as tension pneumothorax and hypovolemic shock, preoperative preparation, indications, contraindications, surgical procedures, complications, precautions, postoperative care and anesthesia mode are routine local anesthesia. At present, considering medical safety, general anesthesia (general anesthesia for short) is often chosen, and tracheotomy is performed under general anesthesia after tracheal intubation. Prepare for severe dyspnea before operation, prepare for tracheal intubation, intubate immediately if breathing stops during tracheotomy, or intubate first and then tracheotomy to avoid intraoperative accidents. Indications 1. Laryngeal obstruction: Severe laryngeal obstruction caused by laryngeal inflammation, tumor, trauma and foreign body.
2. Lower respiratory tract secretion retention: various reasons (craniocerebral trauma, chest and abdomen trauma and polio, etc. ) causes lower respiratory tract secretion retention. In order to suck sputum and keep the airway unobstructed, tracheotomy can be considered.
3. Preventive tracheotomy: pharyngeal tumor, abscess with dyspnea; For some major oral, nasopharyngeal, maxillofacial, pharyngeal and laryngeal operations, in order to carry out general anesthesia, prevent blood from flowing into the lower respiratory tract during and after operation, and keep the respiratory tract unobstructed after operation; In order to prevent postoperative bleeding or local tissue swelling from obstructing breathing, tracheotomy can be performed.
4. Removal of foreign bodies from trachea: If the endoscopic forceps removal is unsuccessful, it is estimated that there is a risk of suffocation, or there is no bronchoscope equipment and technology, foreign bodies can be removed through tracheotomy (rarely). Contraindications: 1. Tension pneumothorax (you can go to the computer after intubation and closed drainage).
2. Hypovolemic shock, heart failure, especially right heart failure.
3. Pulmonary bullae, pneumothorax and mediastinal emphysema before drainage.
4. Patients with massive hemoptysis.
5 patients with myocardial infarction (cardiogenic pulmonary edema). Operating steps 1. * * *: Generally, take the supine position, put a small pillow under the shoulders, and look up at the back to make the trachea close to the skin, which is obvious for the operation; The assistant sits on the side of the head to fix the head and keep it in the middle. Routine disinfection, laying sterile towels.
2. Local anesthesia: Lidocaine is used for infiltration anesthesia along the anterior cervical center, from the lower edge of thyroid cartilage to the suprasternal fossa. For comatose, critical or asphyxiated patients, if they are unconscious, anesthesia may not be performed.
3. Incision: A straight incision (transverse incision can be used for general anesthesia patients) is often used to cut the skin and subcutaneous tissue along the anterior cervical midline from the lower edge of thyroid cartilage to the position near the suprasternal fossa.
4. Separation of anterior tracheal tissue: sternohyoid muscle and sternal thyroid muscle were separated along the midline with vascular forceps to expose the isthmus of thyroid gland. If the isthmus is too wide, it can be slightly separated at its lower edge, and the isthmus can be pulled up with a small hook. If necessary, the isthmus can be clamped, cut and sutured to expose the trachea. In the process of separation, the two hooks should be evenly stressed, so that the surgical field of vision is always kept in the midline, and whether the cricoid cartilage and trachea are kept in the central position is often explored with fingers.
5. Tracheotomy: Generally, after the trachea is determined, the front wall of 1 ~ 2 tracheal rings is arcuately cut from bottom to top with a sharp blade to form a tracheal front wall flap (the incision of 4 ~ 5 rings is low tracheotomy). After intubation, it should be fixed under the skin (it is beneficial to insert tracheal intubation after operation), and the tip of the knife should not be inserted too deep to avoid stabbing the posterior wall of trachea and the anterior wall of esophagus.
6. Inserting trachea cannula: Open trachea incision with forceps or tracheotomy dilator, insert trachea cannula with tube core of appropriate size, take out tube core immediately after inserting outer tube, put it into inner tube, suck out secretion, and check whether there is bleeding.
7. Wound treatment: Tie the bandage on the tracheal intubation to the neck, tie it into a fast knot and fix it firmly. Incisions are generally not sutured to avoid subcutaneous emphysema. Finally, place an open gauze between the wound and the cannula. Complications 1. Postoperative bleeding.
2. Pneumothorax and mediastinal emphysema.
3. subcutaneous emphysema.
4. Difficult extubation.
5. Incision infection.
6. The sleeve is taken out.
7. Breathing stops.
8. Tracheoesophageal fistula.
9. Laryngotracheal stenosis.
10. Difficult extubation.
1 1. Rare complications, such as recurrent laryngeal nerve paralysis and air embolism. Precautions 1. Always keep the incision in the center, and the retractor must be lifted evenly and forcefully to ensure that the incision is cut in the center.
2. The endotracheal tube should be provided with an air bag to prevent vomit from being inhaled into the respiratory tract by mistake, which is also beneficial to the management of the respiratory tract.
3. When tracheotomy, the secretions in the trachea should be absorbed immediately; Give oxygen immediately after operation, pay attention to airway humidification or use ultrasonic atomization inhalation regularly.
4. The inner tube must be cleaned and disinfected every day 1 time, and the replacement of the inner tube and sputum aspiration should be strictly sterile.
5. Wear tracheal cuff regularly. Postoperative care 1. Adjust the tightness of the cuff at any time.
2. Observe the breathing closely to make the air circulate smoothly. Don't cover your sleeves with bedding; Wipe the secretions from the cough cannula at any time. Regular intratracheal instillation or atomization. Humidify the cannula opening with a single gauze layer of normal saline.
3. Take out the endotracheal tube and clean it every 12 ~ 24 hours after operation. If the tracheal intubation is noisy or blocked, it should be sucked out at any time or replaced in time, otherwise the intubation blockage will be life-threatening.
4. Pay attention to prevent the casing from coming out.